Purpose
Corneal and anterior segment diseases cause the majority of urgent visits to eye-care professionals. We evaluated the diagnostic accuracy of detecting corneal diseases using external photographs from two portable cameras for telemedicine purposes.
Methods
A prospective study of adults with a clinical diagnosis of corneal pathology including corneal abrasions, ulcers, scars, and pterygia. A corneal specialist provided the gold-standard diagnosis by slit-lamp examination. Images of both eyes were obtained using iTouch 5S and Nidek VersaCam cameras in multiple gazes and interpreted by 3 cornea specialists for presence of pathology. Accuracy to detect disease was compared to gold standard diagnosis, stratified by camera and grader. Reliability was evaluated with weighted kappa statistics. Graders assessed image quality on a Likert scale from 1 (poor) to 9 (optimal).
Results
198 eyes (110 subjects) were photographed. By gold standard diagnosis, 59 eyes (30%) had corneal scars, 34 (17%) had ulcers, 13 (7%) had abrasions, 10 (5%) had pterygia, and 82 (41%) were normal. Sensitivity to detect AS pathology ranged from 54–71% for iTouch and 66–75% for Nidek, across graders; specificity ranged from 82–96% for iTouch and 91–98% for Nidek. Inter-grader reliability was moderate to strong (kappa ranges: 0.54–0.71 for iTouch; 0.75–0.76 for Nidek. Quality ratings were variable between graders.
Conclusions
External photographs taken by standard, non-enhanced portable cameras and interpreted remotely by ophthalmologist graders yielded sensitivity values that are not yet suitable for telemedicine applications. Additional work is needed to improve the ability to detect AS pathology remotely.