Vol. 47 No. 2 Original Research PDF

Diagnostic Accuracies of a Smartphone-Based Fundus Photography and Tablet-Based Visual Field Testing

Patricia Anne S. Tecson MD, MBA, Victor Jose L. Caparas MD, MPh,
Rainier Victor A. Covar, MD, MMed

Eye and Vision Institute, The Medical City, Pasig City

Corresponding Author: Patricia Anne S. Tecson
Clinic Address: 4th floor, Eye and Vision Institute, The Medical City, Ortigas Avenue, Pasig City, Metro Manila, Philippines
Contact Number: (02) 8988-1000 / 8988-7000 local 7877
Email Address: piatecsonmd@gmail.com

Disclosure: The authors have no financial interests or relationships to disclose.


Objective: We determined the diagnostic accuracies of the mydriatic, monoscopic, iPhone 6s+ optic nerve photographs with a 20D lens and the Melbourne Rapid Fields (MRF) visual fields iPad application.

Methods: This was a prospective, cross-sectional, single-center study involving 47 non-glaucomatous and 49 glaucomatous eyes. Each eye underwent 2 visual field tests: MRF iPad application and the Humphrey Field Analyzer (HRF). Mydriatic photographs of the fundus were taken with two devices: an iPhone 6s+ combined with a 20 D lens and the Visucam 500 fundus camera. All printouts were evaluated by 2 independent, masked glaucoma specialists. Diagnostic accuracies between the modalities were computed. Agreements between different parameters of both devices were analyzed using Cohen’s kappa test.

Results: Smartphone-based (iPhone 6s+) fundus photos had an overall sensitivity of 100%, specificity of 89.36%, positive predictive value (PPV) of 89.36% and negative predictive value (NPV) of 100%, with all kappa values between graders of each parameter above 0.61. Tablet-based Melbourne Rapid Fields test had a sensitivity of 81.82%, specificity of 86.54%, PPV of 83.72% and NPV of 84.91%, showing good agreement with the HRF with a kappa value of 0.68 ± 0.07.

Conclusion: Smartphone-based fundus photography and tablet-based visual field tests are comparable to the standard fundus photos and visual field tests in evaluating the optic nerve and visual field. These portable devices are reliable and appropriate tools for diagnosing glaucoma and can be used for documentation and testing in remote areas and in a wider range of settings.

Keywords: teleglaucoma, Melbourne rapid fields, remote diagnosis, iphone fundus photo