Laptops are routinely used for expert teleconsultation purposes. Compared to conventional laptops, smartphones are more handy, have better wireless internet connectivity, and have different image viewing capabilities. This pilot study compares the diagnostic ability and reliability of smartphones compared to the established use of laptops in teleophthalmology (the delivery of eye care through digital medical equipment and telecommunications technology).
To assess the reliability and accuracy of smartphones in diagnosing transmitted fundus images in comparison with a laptop.
Smartphones are technically feasible alternatives to laptops in telemedicine in areas where internet connectivity is unreliable.
Commentary and Implication to mHealth:
This study has implications for making practicing telemedicine in remote locations more convenient. Because the smartphone showed high sensitivity (98%) for diagnosing ocular conditions, it would be useful as a screening tool when laptops are not available. Since there was not a substantial difference in an incorrect diagnosis between the smartphone and laptop, there is a promising future for use of smartphone technology in teleophthalmology. With the data from this pilot study, and the high sensitivities reached, we could further extrapolate these findings and implement these technologies at home for underserved healthcare areas, providing these communities with access to a specialist.
This study shows how ophthalmology lends itself well to telemedicine; this technology can be used in areas with limited access to screening for common ophthalmologic diseases, as well as serve as a remote teaching tool. Another big implication from this study is that despite the poor resolution of the camera used (480 x 800 pixels), the correct diagnosis can still be obtained remotely. The iPhone 5 has a resolution of 1136 x 640 pixels and can provide even better photos for diagnostic purposes.
- 114 randomly selected patients that presented to the fundus photography clinic of a tertiary care center in India participated in the study (total of 228 eyes evaluated)
- Examining ophthalmologist recorded the actual diagnosis in the EMR
- A Topcon NW200 3.1 megapixel camera was used to take a single photograph of each subject’s eyes (centered midway between the center of the macular and the disc)
- Image was stored on computer using Imagenet software in a JPEG format
- The fundus images and the EMR were downloaded onto a smartphone (HTC Sensation) and a laptop (Sony notebook with a diagonal screen size of 15.6’, and a display resolution of 1024 x 768 pixels)
- Data was compressed to zip folders on the HTC sensation and transmitted via 3G network to a LG Optimus G2X phone (android version 2.3.4 ,4’multi touch display screen with resolution of 480×800 pixels and a 50% brightness contrast ratio of 982) with another ophthalmologist at a distant centre
- Ophthalmologists reviewed the brief history and images on the smartphone and laptop and recorded it as the smartphone and laptop diagnosis
- Diagnosis was labeled as correct or incorrect in concordance with the face to face examination
The paper did not address any issues with data connection or speed. Patients had an array of pathologies including: diabetic retinopathies, macular diseases, retinal vasculopathies, optic nerve head conditions, etc. The correct diagnosis was reached using both smartphone and laptop in 211 (92.5%) eyes and incorrectly diagnosed in 8 (0.03%) eyes. The diagnosis was diagnosed correctly on smartphone but incorrectly on laptop in 6 (0.02%) eyes. The diagnosis was diagnosed correctly on laptop and incorrectly on smartphone in 3 (0.01%) eyes. The sensitivity of the smartphone was 98% (95% CI:95-99%) while specificity was 57% (95% CI:25-81%), and p < 0.05.
Article Name: Are smartphones comparable to laptops for image diagnosis in teleophthalmology?
Authors: John S, Arun V, Katti N, Appukuttan B, Pearlson IC, Badrinath SS.
Journal Published: Stud Health Technol Inform.
Date Published: 2013
Citation: Stud Health Technol Inform. 2013;192:1065.ih reviewed