1
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Vilela MAP, Arrigo A, Parodi MB, da Silva Mengue C. Smartphone Eye Examination: Artificial Intelligence and Telemedicine. Telemed J E Health 2024; 30:341-353. [PMID: 37585566 DOI: 10.1089/tmj.2023.0041] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Background: The current medical scenario is closely linked to recent progress in telecommunications, photodocumentation, and artificial intelligence (AI). Smartphone eye examination may represent a promising tool in the technological spectrum, with special interest for primary health care services. Obtaining fundus imaging with this technique has improved and democratized the teaching of fundoscopy, but in particular, it contributes greatly to screening diseases with high rates of blindness. Eye examination using smartphones essentially represents a cheap and safe method, thus contributing to public policies on population screening. This review aims to provide an update on the use of this resource and its future prospects, especially as a screening and ophthalmic diagnostic tool. Methods: In this review, we surveyed major published advances in retinal and anterior segment analysis using AI. We performed an electronic search on the Medical Literature Analysis and Retrieval System Online (MEDLINE), EMBASE, and Cochrane Library for published literature without a deadline. We included studies that compared the diagnostic accuracy of smartphone ophthalmoscopy for detecting prevalent diseases with an accurate or commonly employed reference standard. Results: There are few databases with complete metadata, providing demographic data, and few databases with sufficient images involving current or new therapies. It should be taken into consideration that these are databases containing images captured using different systems and formats, with information often being excluded without essential detailing of the reasons for exclusion, which further distances them from real-life conditions. The safety, portability, low cost, and reproducibility of smartphone eye images are discussed in several studies, with encouraging results. Conclusions: The high level of agreement between conventional and a smartphone method shows a powerful arsenal for screening and early diagnosis of the main causes of blindness, such as cataract, glaucoma, diabetic retinopathy, and age-related macular degeneration. In addition to streamlining the medical workflow and bringing benefits for public health policies, smartphone eye examination can make safe and quality assessment available to the population.
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Affiliation(s)
| | - Alessandro Arrigo
- Department of Ophthalmology, Scientific Institute San Raffaele, Milan, Italy
- University Vita-Salute, Milan, Italy
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology, Scientific Institute San Raffaele, Milan, Italy
- University Vita-Salute, Milan, Italy
| | - Carolina da Silva Mengue
- Post-Graduation Ophthalmological School, Ivo Corrêa-Meyer/Cardiology Institute, Porto Alegre, Brazil
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2
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Wang H, Liao X, Zhang M, Pang CP, Chen H. Smartphone ophthalmoscope as a tool in teaching direct ophthalmoscopy: a crossover randomized controlled trial. MEDICAL EDUCATION ONLINE 2023; 28:2176201. [PMID: 36762913 PMCID: PMC9930769 DOI: 10.1080/10872981.2023.2176201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
To evaluate the effectiveness of smartphone ophthalmoscope (SO) in teaching ophthalmoscopy, compared with direct ophthalmoscope (DO). In this cross-over study, 45 final-year medical students attending sessions at a single institution were randomly allocated to two groups (A and B). Both groups attended two training sessions. In the first session, Group A students were taught ophthalmoscopy using DO and Group B students using SO. In the second session, the training sessions were crossed over. A series of eye models with 10 letters placed on the inner surface were designed to assess the students' skill on ophthalmoscopy. Students performed ophthalmoscopy on the eye models, recorded their findings, and completed a questionnaire of feedback on DO and SO. The main outcome measure was the score of ophthalmoscopy, assessed by the student correctly recording each letter (score 1 for each letter). For Group A, the mean score of ophthalmoscopy on the eye model using DO and SO was 3.9±2.4 and 8.2±2.2, respectively. For Group B, the mean score of ophthalmoscopy on the eye model using SO and DO 8.7±1.8 and 5.7±3.5 . Students scored significantly higher in ophthalmoscopy when using SO than DO (P<0.001). They expressed better visualization of the fundus using SO than DO (4.49±0.65 vs 4.13±0.81, P=0.004). Students' performance of ophthalmoscopy was better when SO was used compared with DO. The use of SO as an adjunctive tool is recommended to improve the effectiveness of teaching ophthalmoscopy.
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Affiliation(s)
- Hongxi Wang
- ophthalmology, Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Xulong Liao
- ophthalmology, Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Mingzhi Zhang
- ophthalmology, Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Chi Pui Pang
- ophthalmology, Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
- Department of Ophthalmology & Visual Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - Haoyu Chen
- ophthalmology, Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
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3
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Kherani IZ, Kritzinger J, Micieli JA, Wong JCY. Evaluating smartphone fundoscopy as a pedagogical tool in medical education: a narrative review. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023:S0008-4182(23)00305-8. [PMID: 37865120 DOI: 10.1016/j.jcjo.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 03/05/2023] [Accepted: 07/31/2023] [Indexed: 10/23/2023]
Abstract
Direct ophthalmoscopy continues to be the "gold standard" method for retinal and optic nerve evaluation despite known challenges for learners to acquire this clinical skill and minimal opportunities for patient-facing practice. Here we review current literature regarding smartphone fundoscopy (SF) as an alternative learning tool that remains underutilized in Canadian medical schools. SF has significant advantages over direct ophthalmoscopy, such as enhanced learner visualization of ocular structure and pathologies, greater learner usability in comparison, and improved fundus assessment during more difficult ocular examinations such as with pediatric patients. Furthermore, SF provides opportunities for instructor exchange and feedback, group learning, increased learner confidence, and most important, an improved patient experience. Yet challenges remain with SF, including patient confidentiality during data capture and sharing and meaningful integration into an already limited and saturated curriculum. Our review finds SF to be a pedagogic tool with the potential to reinvigorate fundoscopy learning to improve competency in this important clinical skill.
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Affiliation(s)
| | | | - Jonathan A Micieli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Kensington Vision and Research Center, Toronto, Ont
| | - Jovi C Y Wong
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont..
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4
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Park J, Rho MJ. Factors Influencing the Acceptance of Distributed Research Networks in Korea: Data Accessibility and Data Security Risk. Healthc Inform Res 2023; 29:334-342. [PMID: 37964455 PMCID: PMC10651399 DOI: 10.4258/hir.2023.29.4.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES Distributed research networks (DRNs) facilitate multicenter research by enabling the use of multicenter data; therefore, they are increasingly utilized in healthcare fields. Despite the numerous advantages of DRNs, it is crucial to understand researchers' acceptance of these networks to ensure their effective application in multicenter research. In this study, we sought to identify the factors influencing the adoption of DRNs among researchers in Korea. METHODS We used snowball sampling to collect data from 149 researchers between July 7 and August 28, 2020. Five factors were used to formulate the hypotheses and research model: data accessibility, usefulness, ease of use, data security risk, and intention to use DRNs. We applied a structural equation model to identify relationships within the research model. RESULTS Data accessibility and data security were critical to the acceptance and use of DRNs. The usefulness of DRNs partially mediated the relationship between data accessibility and the intention to use DRNs. Interestingly, ease of use did not influence the intention to use DRNs, but it was affected by data accessibility. Furthermore, ease of use impacted the perceived usefulness of DRNs. CONCLUSIONS This study highlighted major factors that can promote the broader adoption and utilization of DRNs. Consequently, these findings can contribute to the expansion of active multicenter research using DRNs in the field of healthcare research.
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Affiliation(s)
- Jihwan Park
- College of Liberal Arts, Dankook University, Cheonan,
Korea
| | - Mi Jung Rho
- College of Health Science, Dankook University, Cheonan,
Korea
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5
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Optimising fundoscopy practices across the medical spectrum: A focus group study. PLoS One 2023; 18:e0280937. [PMID: 36706098 PMCID: PMC9882965 DOI: 10.1371/journal.pone.0280937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/11/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Fundoscopy can be of great clinical value, yet remains underutilised. Educational attempts to improve fundoscopy utilisation have had limited success. We aimed to explore the barriers and facilitators underlying the uptake of clinical direct ophthalmoscopy across a spectrum of medical specialties and training levels. METHODS Ten focus groups were conducted with medical students (n = 42), emergency department doctors (n = 24), basic physician trainees (n = 7), hospital physicians (n = 6) and general practitioners (n = 7). Independent thematic analysis of transcripts was conducted by three investigators. A consensus thematic framework was developed, and transcripts were reanalysed using this framework. RESULTS Thematic analysis identified seven main themes: (1) technical barriers to performing fundoscopy examinations; (2) clinical culture and expectations regarding fundoscopy; (3) the influence of fundoscopy on clinical management; (4) motivation to perform the examination; (5) novel technology including smartphone fundoscopy, and the value of a digital fundus image; (6) training requirements, and; (7) use of limited resources. CONCLUSION Our results build a more nuanced picture of the factors which determine fundoscopy utilisation. As current barriers limit practice by clinicians and medical students, expertise and confidence performing and interpreting fundoscopy are lost. This shifts the balance of perceived clinical utility to futility in changing patient management, and reinforces a cycle of reducing fundoscopy utilisation. We identified important cultural barriers such as accepted incompetence, and misperceptions of senior discouragement. Emerging technologies reduce the technical barriers to fundoscopy. Therefore education should: focus on detecting pathology from digital images; clarify the role of fundoscopy in patient management, and; be targeted at key career progression points.
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Biousse V, Danesh-Meyer HV, Saindane AM, Lamirel C, Newman NJ. Imaging of the optic nerve: technological advances and future prospects. Lancet Neurol 2022; 21:1135-1150. [DOI: 10.1016/s1474-4422(22)00173-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 01/02/2023]
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7
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Hartley MJ, Bartley GB. Ophthalmology and Direct Ophthalmoscopy in Contemporary Medical Education. Am J Ophthalmol 2022; 238:xv-xvi. [PMID: 35192792 DOI: 10.1016/j.ajo.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/01/2022]
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8
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He G, Dunn HP, Ahmad KE, Watson E, Henderson A, Tynan D, Leaney J, White AJ, Hewitt AW, Fraser CL. Fundoscopy Use in Neurology Departments and the Utility of Smartphone photography (
FUNDUS
): A prospective prevalence and crossover diagnostic accuracy study amongst neurology inpatients. Eur J Neurol 2022; 29:2463-2472. [PMID: 35531644 PMCID: PMC9541490 DOI: 10.1111/ene.15390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/13/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022]
Abstract
Background and purpose Although fundoscopy is a crucial part of the neurological examination, it is challenging, under‐utilized and unreliably performed. The aim was to determine the prevalence of fundus pathology amongst neurology inpatients and the diagnostic accuracy of current fundoscopy practice compared with systematic screening with smartphone fundoscopy (SF) and portable non‐mydriatic fundus photography (NMFP). Methods This was a prospective cross‐sectional surveillance and diagnostic accuracy study on adult patients admitted under neurology in an Australian hospital. Inpatients were randomized to initial NMFP (RetinaVue 100, Welch Allyn) or SF (D‐EYE) followed by a crossover to the alternative modality. Images were graded by neurology doctors, using telemedicine consensus neuro‐ophthalmology NMFP grading as the reference standard. Feasibility parameters included ease, comfort and speed. Results Of 79 enrolled patients, 14.1% had neurologically relevant pathology (seven, disc pallor; one, hypertensive retinopathy; three, disc swelling). The neurology team performed direct ophthalmoscopy in 6.6% of cases and missed all abnormalities. SF had a sensitivity of 30%–40% compared with NMFP (45.5%); however, it had a lower rate of screening failure (1% vs. 13%, p < 0.001), a shorter examination time (1.10 vs. 2.25 min, p < 0.001) and a slightly higher patient comfort rating (9.2 vs. 8/10, p < 0.001). Conclusion Our study demonstrates a clinically significant prevalence of fundus pathology amongst neurology inpatients which was missed by current fundoscopy practices. Portable NMFP screening appears more accurate than SF, whilst both are diagnostically superior to routine fundoscopic practice, feasible and well tolerated by patients.
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Affiliation(s)
- George He
- The University of Melbourne Melbourne (Vic) Australia
| | - Hamish P. Dunn
- The University of Sydney (Faculty of Medicine & Health), Sydney, (NSW) Australia
- Westmead Hospital, (Department of Ophthalmology), Sydney, (NSW) Australia
- The University of New South Wales (Rural Clinical School) Port Macquarie (NSW) Australia
| | - Kate E. Ahmad
- Royal North Shore Hospital, (Department of Neurology), Sydney, (NSW) Australia
| | - Eloise Watson
- Royal North Shore Hospital, (Department of Neurology), Sydney, (NSW) Australia
| | - Andrew Henderson
- Westmead Hospital, (Department of Neurology), Sydney, (NSW) Australia
| | - Dominique Tynan
- The University of Sydney (Faculty of Medicine & Health), Sydney, (NSW) Australia
- Royal Victorian Eye & Ear Hospital, (Vic) Australia
| | - John Leaney
- The University of Sydney (Faculty of Medicine & Health), Sydney, (NSW) Australia
- Westmead Hospital, (Department of Ophthalmology), Sydney, (NSW) Australia
| | - Andrew J. White
- The University of Sydney (Faculty of Medicine & Health), Sydney, (NSW) Australia
- Westmead Hospital, (Department of Ophthalmology), Sydney, (NSW) Australia
- Centre for Vision Research Westmead Institute for Medical Research Sydney
| | - Alex W. Hewitt
- The University of Melbourne Melbourne (Vic) Australia
- Centre for Eye Research Melbourne (Vic) Australia
| | - Clare L. Fraser
- The University of Sydney (Faculty of Medicine & Health), Sydney, (NSW) Australia
- Save Sight Institute Sydney, The University of Sydney, (NSW) Australia
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9
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Dunn HP, Marks S, Teo KZ, Dunn SM, Healey PR, White AJ. Applications of electronic devices based on smartphones in ophthalmic diagnosis and treatment activities: Response. Clin Exp Ophthalmol 2022; 50:351-352. [DOI: 10.1111/ceo.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hamish P. Dunn
- Northern Clinical School, Royal North Shore Hospital University of Sydney St Leonards New South Wales Australia
- Department of Ophthalmology, Westmead Hospital University of Sydney Westmead New South Wales Australia
- Rural Clinical School University of New South Wales Kensington New South Wales Australia
- Department of Ophthalmology Port Macquarie Base Hospital Port Macquarie New South Wales Australia
| | - Samuel Marks
- Northern Clinical School, Royal North Shore Hospital University of Sydney St Leonards New South Wales Australia
- Westmead Millennium Institute for Medical Research Westmead New South Wales Australia
| | - Kai Z. Teo
- Northern Clinical School, Royal North Shore Hospital University of Sydney St Leonards New South Wales Australia
| | - Stewart M. Dunn
- Northern Clinical School, Royal North Shore Hospital University of Sydney St Leonards New South Wales Australia
- Pam McLean Centre University of Sydney St Leonards New South Wales Australia
| | - Paul R. Healey
- Northern Clinical School, Royal North Shore Hospital University of Sydney St Leonards New South Wales Australia
- Department of Ophthalmology, Westmead Hospital University of Sydney Westmead New South Wales Australia
- Westmead Millennium Institute for Medical Research Westmead New South Wales Australia
| | - Andrew J. White
- Northern Clinical School, Royal North Shore Hospital University of Sydney St Leonards New South Wales Australia
- Department of Ophthalmology, Westmead Hospital University of Sydney Westmead New South Wales Australia
- Westmead Millennium Institute for Medical Research Westmead New South Wales Australia
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10
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Khachatryan T, Mozaffar T, Mnatsakanyan L. Utility of video-fundoscopy and prospects of portable stereo-photography of the ocular fundus in neurological patients. BMC Neurol 2022; 22:61. [PMID: 35183131 PMCID: PMC8857737 DOI: 10.1186/s12883-022-02578-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background Proper evaluation of ocular fundi is an integral part of neurological examination. Unfortunately, neurology residents are increasingly uncomfortable performing fundoscopy and interpreting findings because of diminishing skills and lack of experience. This became more prominent during the COVID-19 pandemic as fundoscopy requires proximity to the patient. With the recent dramatic improvement of smartphone cameras, fundus photography using the PanOptic Ophthalmoscope (Welch Allyn, Skaneateles Falls, NY) with a smartphone adapter offered an alternative to direct fundoscopic examination. We present the first experience with our own design of a universal smartphone adapter. Methods This is a single-center case series, consecutive for a single user and certain presenting neurological symptoms, which is aimed to evaluate the feasibility and practicality of a new, universal PanOptic smartphone adapter. Presenting symptoms included headache, ocular symptoms, seizure, or encephalopathy. We used 3D modeling and printing techniques to create the adapter. We also developed a methodology of capturing stereoscopic images of the optic disc using a single smartphone camera, but the method was not systematically evaluated in this paper. Results Here we present our initial experience of fundus video/photography in patients, who presented with encephalopathy, headache, seizure, vision loss, and other ocular symptoms. Fundoscopic abnormalities were discovered in 11 out of 100 patients. Some were incidental findings and were unrelated to the presentation. In one case, fundoscopy played a critical role in establishing the correct diagnosis. Conclusions Our custom-designed smartphone adapter allowed obtaining high-quality video and photo recordings using PanOptic Ophthalmoscope. The acquisition of high-quality photos enables a high-yield diagnostic tool and allows revisiting the image in the patient’s chart. Improvement of smartphone cameras opens vast horizons for stereo-fundoscopy and 3D reconstruction of the ocular fundus without using sophisticated and costly equipment. Microscopic eye movements allow taking snapshots of two side-by-side photos for 3D reconstruction and stereoscopic image viewing, which is the next level of optic disc assessment.
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11
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Ayub G, Souza RB, de Albuquerque AM, de Vasconcellos JPC. Comparison of conventional and wide field direct ophthalmoscopy on medical students' self-confidence for fundus examination: a 1-year follow-up. BMC MEDICAL EDUCATION 2021; 21:507. [PMID: 34565378 PMCID: PMC8474948 DOI: 10.1186/s12909-021-02942-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/15/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND Fundus examination is an easy, quick and effective way to diagnose sight- and life-threatening diseases. However, medical students and physicians report lack of proficiency and self-confidence in perform fundoscopy. The aim of this study was to compare students' self-confidence in fundus examination, using two different direct ophthalmoscopes, 1 month and 1 year after practical training. METHODS In this prospective cohort, medical students (MS) of the same class were divided in small groups for PanOptic (PO) or conventional (CO) direct ophthalmoscope training. The intervention group encompassed MS of the 4th -year (class of 2019), and the control group encompassed MS of year behind (class of 2020). A questionnaire to measure self-confidence in fundoscopy technique assessing optic nerve, cup-to-disc ratio and macula was translated and validated to Portuguese, and applied 1-month and 1-year after practical training. RESULTS One-hundred and sixty-seven MS were enrolled (35 PO group, 38 CO group, and 94 control group). PO group had a significantly higher overall self-confidence comparing either control or CO groups, respectively (3.57 ± 0.65 vs. 2.97 ± 1.03 vs. 2.46 ± 0.87, p < 0.01) as well as in evaluate cup-to-disc ratio (3.09 ± 0.75 vs. 2.32 ± 0.87 vs. 1.46 ± 0.81, p < 0.01), optic disc margins (3.26 ± 0.85 vs. 2.71 ± 0.96 vs. 2.01 ± 0.97, p < 0.01) and macula (3.43 ± 1.12 vs. 2.89 ± 1.08 vs. 2.02 ± 0.89, p < 0.01) 1-month after practical training. One-year after intervention, CO group showed a significantly higher score compared to PO group in overall self-confidence (3.31 ± 0.69 vs. 3.18 ± 0.73, p = 0.03) and in optic disc margins assessing (3.16 ± 0.85 vs. 2.95 ± 0.78, p = 0.03), but not significant in the evaluation of cup-to-disc ratio (2.78 ± 0.97 vs. 2.68 ± 0.94, p = 0.08), and macula (3.34 ± 0.79 vs. 3.27 ± 0.98, p = 0.07). CONCLUSIONS Students were more confident in use PO as an instrument to perform direct ophthalmoscopy immediately after practical training, but confidence level of CO was higher compared to PO one year after practical training. These findings would help medical schools decide which ophthalmoscope to choose to teach fundus examination.
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Affiliation(s)
- Gabriel Ayub
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, 251 Vital Brazil St, SP, 13083-888, Campinas, Brazil.
| | - Rafael Boava Souza
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, 251 Vital Brazil St, SP, 13083-888, Campinas, Brazil
| | - Andrelisa Marina de Albuquerque
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, 251 Vital Brazil St, SP, 13083-888, Campinas, Brazil
| | - José Paulo Cabral de Vasconcellos
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, 251 Vital Brazil St, SP, 13083-888, Campinas, Brazil
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12
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Dunn HP, Marks S, Teo KZ, Dunn SM, Healey PR, White AJ. eFOCUS 2: A randomised crossover trial of smartphone fundoscopy and direct ophthalmoscopy aiming to improve optic disc interpretation by medical students with e-learning support. Clin Exp Ophthalmol 2021; 49:704-713. [PMID: 34291862 DOI: 10.1111/ceo.13977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/04/2021] [Accepted: 07/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ophthalmoscopy and its interpretation are complex. We aimed to compare the diagnostic accuracy of smartphone fundoscopy with traditional direct ophthalmoscopy for optic disc interpretation, with e-learning support. METHODS We conducted a randomised, crossover study of 102 medical students. Students were offered e-learning for optic disc interpretation. A fundoscopy objective structured clinical examination was conducted after an introductory lecture and 10-min practical training session on smartphone fundoscopy and traditional ophthalmoscopy. Participants examined patients and simulator slides with a randomised crossover between smartphone [D-eye (Padova, Italy) or iExaminer (Welch Allyn, Macquarie Park, Australia)] and traditional ophthalmoscopy (Welch Allyn). Optic discs were graded independently by three masked ophthalmologists. The primary outcome was the ability to interpret an optic disc as normal or abnormal. Secondary outcomes included other optic disc aspects; student preferences; and e-learning performance. RESULTS Students' agreement with the gold standard for an abnormal or normal disc was significantly greater using a smartphone (74.4%) than with direct ophthalmoscopy (68.1%, p = 0.032). More students preferred smartphone (74%) over direct ophthalmoscopy (26%, p < 0.001). E-learning led to an improvement in optic disc interpretation scores (mean improvement = 4.5%, 95% CI = 3.7-5.2, p < 0.001). CONCLUSIONS Medical students are more accurate at recognising an abnormal optic disc using smartphone fundoscopy than traditional direct ophthalmoscopy, and have a strong preference for smartphone fundoscopy. E-learning may improve the interpretation of optic disc abnormalities. Smartphone fundoscopy may mitigate some technical challenges of fundoscopy and reinvigorate use of this valuable clinical examination.
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Affiliation(s)
- Hamish P Dunn
- Northern Clinical School, Royal North Shore Hospital, University of Sydney, St Leonards, New South Wales, Australia.,Westmead Hospital, Department of Ophthalmology, University of Sydney, Westmead, New South Wales, Australia.,Rural Clinical School, University of New South Wales, Kensington, Australia.,Department of Ophthalmology, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Samuel Marks
- Northern Clinical School, Royal North Shore Hospital, University of Sydney, St Leonards, New South Wales, Australia.,Westmead Millennium Institute for Medical Research, Westmead, Australia
| | - Kai Z Teo
- Northern Clinical School, Royal North Shore Hospital, University of Sydney, St Leonards, New South Wales, Australia
| | - Stewart M Dunn
- Northern Clinical School, Royal North Shore Hospital, University of Sydney, St Leonards, New South Wales, Australia.,Pam McLean Centre, University of Sydney, St Leonards, New South Wales, Australia
| | - Paul R Healey
- Northern Clinical School, Royal North Shore Hospital, University of Sydney, St Leonards, New South Wales, Australia.,Westmead Hospital, Department of Ophthalmology, University of Sydney, Westmead, New South Wales, Australia.,Westmead Millennium Institute for Medical Research, Westmead, Australia
| | - Andrew J White
- Northern Clinical School, Royal North Shore Hospital, University of Sydney, St Leonards, New South Wales, Australia.,Westmead Hospital, Department of Ophthalmology, University of Sydney, Westmead, New South Wales, Australia.,Westmead Millennium Institute for Medical Research, Westmead, Australia
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