Abstract
Background/objectives
In recent years, eye casualty clinics have seen significant increases in patient numbers with reduced capacity. COVID-19 has exacerbated this issue and demonstrated the potential of telemedicine as a solution. Our study evaluated the potential benefit of a smartphone-based lens attachment to improve the referral pathway for anterior segment related complaints in eye casualty.
Subjects/methods
Fifty-four consecutive patients with anterior segment complaints were recruited. A questionnaire was completed with each patient to simulate the history from the point of referral. White light and cobalt blue photos were captured using a smartphone lens. The clinician reviewing the patient was asked to document the actual diagnosis and the appropriate time-frame within which they felt the patient could safely have been seen within; both with and without the option of management advice at the time of triage. The subsequent images and questionnaires were reviewed by a single consultant Ophthalmologist who was independent to the data collection process. The assessor was asked to make a diagnosis and management plan based upon the questionnaire (‘History’), and the questionnaire with the photo (‘History with Image’), as well as rate their clinical confidence on a 1–5 scale.
Results
Diagnostic accuracy was significantly higher in “History with Image” (98.2%), when compared to “History” only (48.2%). “History with Image” prevented significantly more appointments when compared to “History” alone, at similar levels to retrospective clinic review. Preventable appointments were increased if clinical advice was possible. Timeframe of appointments between ‘History with Image’ and ‘Clinic’ appointments was similar. Clinical’Confidence was significantly higher at 4.5 with ‘History with Image’ when compared to 2.37 with ‘History Only’.
Conclusion
A low-cost smartphone lens attachment, alongside a standardised clinical questionnaire, can improve the referral pathway to the hospital eye service by reducing unnecessary appointments, while improving clinical confidence and diagnostic accuracy during triage. Further work to evaluate referral pathways, including the development of systems that allow for secure image transmission are needed to understand the feasibility for the widespread adoption of this technology.
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Data availability
The data that support the findings of this study are available on request from the corresponding author [SM]. The data is not publicly available due to it containing information that could compromise research participant privacy/consent.
References
Siempis T. Urgent eye care in the UK increased demand and challenges for the future. Med Hypothesis Disco Innov Ophthalmol. 2014;3:103–10.
Bhopal RS, Parkin DW, Gillie RF, Han KH. Pattern of ophthalmological accidents and emergencies presenting to hospitals. J Epidemiol Community Health. 1993;47:382–7.
Ludwig CA, Newsom MR, Jais A, Myung DJ, Murthy SI, Chang RT. Training time and quality of smartphone-based anterior segment screening in rural India. Clin Ophthalmol. 2017;14:1301–7.
Lai KY, Pathipati MP, Blumenkranz MS. Assessment of eye disease and visual impairment in the nursing home population using mobile health technology. Ophthalmic Surg Lasers Imaging Retin. 2020;51:262–70.
Mohan A, Kaur N, Sharma V, Sen P, Jain E, Gajraj M. Ophthalmologists on smartphones: image-based teleconsultation. Br Ir Orthopt J. 2019;15:3–7.
Wasfi EI, Sharma R, Powditch E, Abd-Elsayed AA. Pattern of eye casualty clinic cases. Int Arch Med. 2008;1:13.
Deaner JD, Amarasekera DC, Ozzello DJ. Accuracy of referral and phone-triage diagnoses in an eye emergency department [published online ahead of print, 2020 Jul 27]. Ophthalmology. 2020;20:30728–4.
Kumar S, Yogesan K, Constable I. Telemedical diagnosis of anterior segment eye diseases: validation of digital slit-lamp still images. Eye. 2009;23:652–60.
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SM, OR, PM, JC, JB and JL planned the study design, completed the data collection, analysis and interpretation. SM, OR, JC, AK, AC, PM, JB and JK co-authored the article and approved the final version of the manuscript.
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Mamtora, S., Riley, O., Chervenkoff, J. et al. A smartphone lens attachment improves the quality of referrals to eye casualty. Eye 37, 1885–1889 (2023). https://doi.org/10.1038/s41433-022-02233-w
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DOI: https://doi.org/10.1038/s41433-022-02233-w
