Accuracy of smartphone imaging versus clinical examination in the diagnosis of ocular disorders in a rural-based hospital: A descriptive study

Background: In India, there is an unequal distribution of eye health care, and tele-ophthalmology promises to be a potential tool to provide accessible, affordable, and good-quality health care to the population residing in the rural and remote areas of our country. Aims: The aim of the study was to study the accuracy of smartphone imaging versus clinical examination in the diagnosis of ocular disorders at a rural-based hospital. Setting and Design: A hospital-based descriptive study was conducted for 18 months. The study was carried out in the outpatient department (OPD) of ophthalmology at a rural health training center (RHTC), attached to a tertiary care hospital. Materials and Methods: Inclusion-A routine examination was carried out in the ophthalmology OPD at the RHTC. The off-site assessment was done based on the smartphone camera (iPhone Xs Max) images and videos captured on-site, which were remotely shared with two independent blinded observers to make the diagnosis which was compared with the clinical (on-site) diagnosis. Statistical Analysis: The agreement between the expert’s finding and the clinical examination finding was determined using Light’s Kappa coefficient. Accuracy of the photographic method was carried out in terms of sensitivity and specificity, considering clinical findings as the gold standard. Results and Conclusion: The diagnostic accuracy of smartphone imaging was the highest for the diagnosis of cataracts, followed by anterior segment conditions. The clinical diagnosis and smartphone imaging agreement were almost perfect for anterior segment disorders, while it was moderate for glaucoma and other disc pathologies.