Comparing smartphone camera adapters in imaging post-operative cataract patients

J Telemed Telecare. 2017 Jan;23(1):36-43. doi: 10.1177/1357633X15625400. Epub 2016 Jul 9.


Introduction The goal of this study is to compare image quality and clinical confidence for managing post-operative cataract patients based on anterior segment smartphone images obtained in real-world settings using four types of adapters: (a) macro lens (ML), (b) ML with augmented light-emitting diode (LED) illumination (ML-LED), (c) no adapter (NA) and (d) slit lamp (SL) adapter. Methods Anterior segment images were obtained from 190 eyes after cataract surgery using an eight-megapixel iPhone 6 smartphone camera with four adapters: ML, ML-LED, NA, and SL. Smartphone images were subjectively rated by ophthalmologists as acceptable or not acceptable for: (a) image quality for evaluating the anterior segment structures and (b) reader confidence in clinically managing post-operative patients based on smartphone images. Results NA, ML-LED, and SL had the highest scores for image quality with 100%, 93.7%, and 86.3% judged as acceptable, respectively. NA, SL, and ML-LED were also rated highest in clinical confidence with 100%, 98%, and 93.2% having acceptable levels, respectively. ML was judged lowest in both image quality (61.1% acceptable) and clinical confidence (37.4% acceptable). Discussion This study represents the first effort to compare different smartphone camera adapters' ability to image the anterior segment of the eye in a real-world setting. Our study shows that ML-LED, NA, and SL adapters were acceptable for visualizing anterior segment structures to physician readers in 86-100% of cases. When coupled with visual acuity, intro-ocular pressure and history, these images can result in acceptable clinical confidence in 93-100% of cases.

Keywords: Smart phone camera; cataract surgery; smart phone adapters; telemedicine.

MeSH terms

  • Aged
  • Anterior Eye Segment / diagnostic imaging
  • Cataract / diagnostic imaging*
  • Clinical Competence
  • Diagnostic Techniques, Ophthalmological / instrumentation*
  • Diagnostic Techniques, Ophthalmological / standards
  • Female
  • Humans
  • Image Processing, Computer-Assisted / standards*
  • Male
  • Middle Aged
  • Photography / instrumentation
  • Photography / methods*
  • Photography / standards
  • Postoperative Period
  • Self Efficacy
  • Smartphone*