Prospective evaluation of medical student accuracy conducting direct ophthalmoscopy with an unmodified iPhone X

• Published in: International ophthalmology 2022-12, Vol.42 (12), p.3933-3940
• Main Authors: Ahmed, Yusuf, Pereira, Austin, Rai, Amrit S., Leung, Victoria C., Ahmed, Aadam, Rai, Amandeep S.
• Format: Article
• Language: English
• Subjects: Comparative analysis; Evaluation; Medical students; Medicine; Medicine & Public Health; Ophthalmology; Optic nerve; Original Paper; Retina; Smartphones; Students; Telemedicine
• ISSN: 1573-2630; 0165-5701; 1573-2630
• DOI: 10.1007/s10792-022-02377-4

Purpose To evaluate fundus examination accuracy of medical students when using an unmodified iPhone X or a direct ophthalmoscope in comparison to a staff ophthalmologist’s retinal examination. Methods In this prospective comparative analysis, patients underwent dilated fundus examination by novice medical trainees using either an unmodified iPhone X or standard direct ophthalmoscope. The primary outcome was the mean difference and degree of agreement in cup-to-disc ratio between student examination and the staff ophthalmologist’s cup-to-disc observation. Results A total of 18 medical students conducted 230 retinal examinations, 117 with the iPhone X and 113 with the direct ophthalmoscope. A greater proportion of students were unable to report cup-to-disc ratio using the iPhone X (81.2%) vs direct ophthalmoscope (30.1%). Student examination of cup-to-disc ratio led to a systematic bias (95% limits of agreement) of + 0.16 (−0.22 to + 0.54) and + 0.10 (−0.36 to + 0.56) with the iPhone X and direct ophthalmoscope, respectively. iPhone X and direct ophthalmoscope student observation concordance for optic disc colour (88.7 and 82.4%, respectively) and contour (68.3 and 74.2%, respectively) demonstrated low agreement with staff ophthalmologist findings. Student iPhone X observations demonstrated lower agreement with staff findings compared to direct ophthalmoscope observations for spontaneous venous pulsations (Cohen’s Kappa = −0.044 vs 0.099). Conclusion Amongst medical trainees, optic disc visualization using an unmodified iPhone X was inferior to the direct ophthalmoscope. When able to visualize the optic nerve head, there was no significant difference in reported cup-to-disc ratio between modalities. However, both modalities demonstrated poor reliability in comparison to staff ophthalmologist findings.