Nonmydriatic Fundoscopic Imaging Using the Pan Optic iExaminer System in the Pediatric Emergency Department

Day, L.; Wang, Serena X.; Huang, Craig J.

doi:10.1111/acem.13128

Cited by 22 publications

(22 citation statements)

References 19 publications

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“…The D-Eye is not the only adapter allowing for SBFP. Both the PEEK vision 12 and the Welch Allyn iExaminer 16 are two possible alternatives, with only the latter allowing for undilated SBFP. As no comparison between the different adapters has been done so far further studies are needed to evaluate and compare the available smartphone adapters.…”

Section: Discussionmentioning

confidence: 99%

“…As the vertical cup-to-disc ratio (vCDR) has proved to be a simple, relatively robust index of glaucomatous loss of the neuroretinal rim 13 , 14 , ONH evaluation using SBFP may be applicable in glaucoma screening. If the camera’s light beam and the illumination source are adequately coaxial, SBFP can even be performed without pupil dilation, which further simplifies its application 15 , 16 .…”

Section: Introductionmentioning

confidence: 99%

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Undilated versus dilated monoscopic smartphone-based fundus photography for optic nerve head evaluation

Wintergerst¹,

Brinkmann²,

Holz³

et al. 2018

Sci Rep

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Smartphone-based fundus photography (SBFP) allows for a cheap and mobile fundus examination with the potential to revolutionize eye care especially in low income settings. The purpose of this study was to assess the impact of pupil dilation on image quality in optic nerve head (ONH) imaging and vertical cup-to-disc ratio (vCDR) evaluation with SBFP. Eyes with glaucoma or suspected to have glaucoma were imaged with conventional digital fundus photography (CFP) and SBFP undilated and following dilation, all monoscopically. SBFP was possible in 74% of eyes without dilation and in 98% following dilation. Better image quality on SBFP was achieved with dilation and complete visualization of the optic disc rim was possible in 46% of images without dilation and on 94% of images with dilation. VCDR measurements on images obtained following dilation highly correlated with measurements on CFP (coefficient of correlation r = 0.91, p < 0.001), whereas vCDR on images obtained without dilation correlated less well with CFP (r = 0.70, p < 0.001). SBFP for ONH evaluation is promising, however dilation appears mandatory to achieve results comparable to optic disc evaluation on CFP. ONH imaging with smartphones without dilation might bear the risk of underestimating the CDR and hence overlooking patients at risk for glaucoma.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Undilated versus dilated monoscopic smartphone-based fundus photography for optic nerve head evaluation

Wintergerst¹,

Brinkmann²,

Holz³

et al. 2018

Sci Rep

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“…Previous studies (Table 2) demonstrated the usefulness of the PanOptic ophthalmoscope, while the present study provided an alternative solution to use the device with the add-on translator and chinrest. The PanOptic ophthalmoscope was used qualitatively for patients' fundus imaging in the emergency room [23] and optic disc assessment [24], for diabetic retinopathy screening [7,9] and medical students ophthalmoscopy skills assessment [8]. There are some studies using the PanOptic device, quantitatively analyzing the vessel diameter in the retina [20] and anterior lens capsule vascularity only [22].…”

Section: Discussionmentioning

confidence: 99%

Characterization of the retinal vasculature in fundus photos using the PanOptic iExaminer system

Wei

Xiao

et al. 2020

Eye and Vis

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Background The goal was to characterize retinal vasculature by quantitative analysis of arteriole-to-venule (A/V) ratio and vessel density in fundus photos taken with the PanOptic iExaminer System. Methods The PanOptic ophthalmoscope equipped with a smartphone was used to acquire fundus photos centered on the optic nerve head. Two fundus photos of a total of 19 eyes from 10 subjects were imaged. Retinal vessels were analyzed to obtain the A/V ratio. In addition, the vessel tree was extracted using deep learning U-NET, and vessel density was processed by the percentage of pixels within vessels over the entire image. Results All images were successfully processed for the A/V ratio and vessel density. There was no significant difference of averaged A/V ratio between the first (0.77 ± 0.09) and second (0.77 ± 0.10) measurements (P = 0.53). There was no significant difference of averaged vessel density (%) between the first (6.11 ± 1.39) and second (6.12 ± 1.40) measurements (P = 0.85). Conclusions Quantitative analysis of the retinal vasculature was feasible in fundus photos taken using the PanOptic ophthalmoscope. The device appears to provide sufficient image quality for analyzing A/V ratio and vessel density with the benefit of portability, easy data transferring, and low cost of the device, which could be used for pre-clinical screening of systemic, cerebral and ocular diseases.

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“…48,49 Numerous other studies have now validated the use of cameras in clinical settings other than adult EDs. [50][51][52][53][54] The feasibility and reliability of nonmydriatic fundus photography in children as young as 22 months was demonstrated in a pediatric ophthalmology clinic. 50 A subsequent study validated the use of a tabletop nonmydriatic camera in children ages 5-12 years in a pediatric ED.…”

Section: Future Applicationsmentioning

confidence: 99%

Ophthalmoscopy in the 21st century

2018

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Although the usefulness of viewing the ocular fundus is well-recognized, ophthalmoscopy is infrequently and poorly performed by most nonophthalmologist physicians, including neurologists. Barriers to the practice of ophthalmoscopy by nonophthalmologists include not only the technical difficulty related to direct ophthalmoscopy, but also lack of adequate training and discouragement by preceptors. Recent studies have shown that digital retinal fundus photographs with electronic transmission and remote interpretation of images by an ophthalmologist are an efficient and reliable way to allow examination of the ocular fundus in patients with systemic disorders such as diabetes mellitus. Ocular fundus photographs obtained without pharmacologic dilation of the pupil using nonmydriatic fundus cameras could be of great value in emergency departments (EDs) and neurologic settings. The Fundus Photography vs Ophthalmoscopy Trial Outcomes in the Emergency Department (FOTO-ED) study showed that ED providers consistently failed to correctly identify relevant ocular funduscopic findings using the direct ophthalmoscope, and that nonmydriatic fundus photography was an effective alternate way of providing access to the ocular fundus in the ED. Extrapolating these results to headache clinics, outpatient neurology clinics, and adult and pediatric primary care settings seems self-evident. As technology advances, nonmydriatic ocular fundus imaging systems will be of higher quality and more portable and affordable, thereby circumventing the need to master the use of the ophthalmoscope. Visualizing the ocular fundus is more important than the method used. Ocular fundus photography facilitates nonophthalmologists' performance of this essential part of the physical examination, thus helping to reestablish the value of doing so.

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Nonmydriatic Fundoscopic Imaging Using the Pan Optic iExaminer System in the Pediatric Emergency Department

Abstract: Fundoscopic images were consistently obtained using the Pan Optic iExaminer system in the pediatric ED particularly in children 2-18 years of age. CA images were obtained in children less than 2 years old, but less consistently.

Cited by 22 publications

References 19 publications

Undilated versus dilated monoscopic smartphone-based fundus photography for optic nerve head evaluation

Undilated versus dilated monoscopic smartphone-based fundus photography for optic nerve head evaluation

Characterization of the retinal vasculature in fundus photos using the PanOptic iExaminer system

Ophthalmoscopy in the 21st century

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