Smartphone Based Pupillometry: An Empirical Evaluation of Accuracy and Safety

Calandra, Davide; Martino, Sergio Di; Riccio, Daniel; Visconti, Antonio

doi:10.1007/978-3-319-68548-9_40

Cited by 7 publications

(6 citation statements)

References 17 publications

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“…Several groups have described the use of the unmodified rear-facing camera and visible light spectrum from light emitting diode (LED) flashlight of smartphones for pupillography and pupillometry (Table 3). [4][5][6][7][8][9][10][11][12] Some have described momentary illumination of the pupils with flashlights to capture pupillary images during different stages of PLR, while others captured pupillography videos during continuous LED flashlight illumination of the pupils. 4,8-10 Shin et al 4 introduced a smartphone application that acquires five sequential images using the rear-facing camera and flashlight to illuminate the pupil during PLR.…”

Section: Discussionmentioning

confidence: 99%

“…9 McKay et al compared the commercially available Brightlamp iPhone application (BL; Brightlamp Inc., Indianapolis, IN, USA) with a portable infrared pupillometer and demonstrated poor reproducibility of the application. 10 Calandra et al 12 reported that the Sober-Eye application (SOBER-EYE Inc., Menlo Park -CA, USA), 12 designed to self-assess pupillary reaction to a smartphone light flash as a measure of level of impairment from drugs or alcohol, is highly correlated with manual measurements. 9 Typically, non-infrared methods of pupillography (i.e., those reliant on visible light) are limited in evaluation of the dim/dilating states of the pupil, particularly in patients with dark irides, and this characteristic limits the clinical application of these devices.…”

mentioning

confidence: 99%

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Pilot Study of Smartphone Infrared Pupillography and Pupillometry

Solyman

Abushanab

Carey

et al. 2022

OPTH

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To describe and validate a novel portable smartphone-based infrared pupillographer. Materials and Methods: A prototype infrared smartphone pupillographer device was custom designed for this project. Infrared video and photo pupillography were attempted on 12 patients with different clinical pupillary examination findings. Captured pupillography media files were assessed by three masked investigators, and the agreement between their qualitative clinical evaluation was tested against the evaluation of the neuro-ophthalmologist who performed the real-time examination and pupillography. Quantitative measurements of the pupillary diameter were performed by three investigators using a custom designed smartphone application on three different smartphones and on a personal computer. Measurements obtained by the three investigators using the smartphone and the desktop computer were compared. Results: Infrared video pupillography of high quality was successfully captured for light and near pupillary reflexes, and infrared still photographs were obtained in light and dark conditions in 23 eyes of the 12 patients. Examination findings included relative afferent pupillary defect (n = 5), normal pupillary examination (n = 4), anisocoria (n = 2), and relative afferent pupillary reflex by reverse (n = 1). There was 100% agreement in the qualitative pupillary evaluation of the masked investigators compared with real time clinical examination. Quantitative measurements of pupillary size obtained on the smartphone and desktop computer showed excellent agreement among the three investigators with intraclass correlation (ICC) coefficient ranging from 0.982-0.986 (P<0.001) and 0.995 (P<0.001) for the smartphone and the desktop computer groups, respectively. Level of agreement ranged between −0.27 and 0.32. Mean pupil diameter errors were 0.03 ± 0.15 mm between groups (P = 0.248). Conclusion:This pilot study demonstrates the feasibility of smartphone-based infrared pupillography for high quality photo and video documentation of pupillary examination at the bedside and in the clinic with accurate and reproducible measurements of the pupillary size in light and dark conditions.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Pilot Study of Smartphone Infrared Pupillography and Pupillometry

Solyman

Abushanab

Carey

et al. 2022

OPTH

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“…The potential phototoxic effect of smartphone retinal photography has been studied on a limited number of phones in a few prior reports [ 13 , 15 - 17 ]. With the ongoing advancements in smartphone cameras and their associated brighter LED flashlights, studying of the safety of newer generations of smartphones and previously untested smartphone versions are indicated [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…There have been some concerns regarding the safety of the smartphone´s flashlight on the neurosensory retina and RPE [ 13 , 15 ]. A few older versions of smartphones´ flashlights had been tested for their safety for indirect retinal photography in a few prior reports, most recently in 2018 [ 13 , 15 - 17 ]. With the ongoing advancements in smartphone cameras and their associated brighter LED flashlights, studying the safety of newer generations of smartphones and previously untested smartphone versions are indicated [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Investigating the light emitting diode (LED) flashlight characteristics of a sample of smartphones for its safety in indirect retinal photography

Solyman¹,

Hamdy²,

Abdelkawi³

et al. 2022

Pan Afr Med J

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Introduction the off-label use of smartphones for indirect retinal photography and videography made it a popular ophthalmic clinical practice for its ubiquity and simplicity which enhanced telemedical care. Smartphone indirect retinal photography involves focusing the bright flashlight from the light emitting diode (LED) source on the rear side of the phone on the patient´s retina. Phototoxic hazards of the bright light on the already compromised patients´ retina raise concerns that require safety studies. The aim of this work is to study the characteristics of LED flashlights of a sample of smartphone types currently in use by ophthalmologists in Egypt to evaluate for potential photobiological implications when used in conjunction with + 20-diopter indirect ophthalmoscopy condensing lens for indirect photography of the retina. Methods the spectral profile, weighted irradiance, and thermal exposure rates produced by a variety of smartphones´ LED flashlights currently used by ophthalmology specialists and trainees at the Comprehensive Outpatient Clinic of the Research Institute of Ophthalmology, Giza, Egypt, were tested in this study when collimated by a +20-diopter indirect ophthalmoscopy lens in a setup similar to actual indirect smartphone retinal photography. Results the spectrum of the LED flashlights of all tested smartphones fell entirely in the optically safe visible spectrum between 400-750 nm with no significant infrared or ultraviolet components. Two regions of main spectral distribution were noticed in all tested smartphones with a peak at 450 nm and the other ranging between 520 to 585 nm. Weighted irradiance was within the safe limits for ocular examination and ranged from 0.58 to 2.30 mW/cm 2 (safe limit is up to 706 mW/cm 2 ) without a measurable thermal effect. Conclusion the LED flashlight of the tested smartphones appeared to be within safe limits when used for indirect smartphone retinal photography. However, the high composition of the short wavelength blue light spectrum may be a concern particularly with prolonged and repeated examinations.

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“…6 Previous studies have demonstrated that the use of a smartphone's flashlight does not harm the human eye, and its potential hazard is far below the constraints of international safety standards. 7 Recently, in a controlled study, an iPhone-based pupillometer established a statistically significant correlation with the infrared pupillometry method. 8 The aim of this study is the introduction and standardization of a pupil examination method using an android mobile pupillography app ("Doctor kit") developed in the Faculty of medicine of the Autonomous University of San Luis Potosi, in cooperation with Discomp Mobile inc. (Ing.…”

Section: Introductionmentioning

confidence: 99%

Estimation and interrater reliability of pupillography by digital mobile app: Digital movil pupillography app validity

Hernández-Sierra

Tellez-Quijada

Gómez

et al. 2020

European Journal of Ophthalmology

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Objective: The examination of pupillary light reflexes is widely employed to evaluate the autonomic system’s balance, ocular, and neurological conditions, typically evaluated by qualitative observation. To describe and evaluate the inter-rater reliability and agreement of pupillometric values obtained with a novel semi-automatic mobile pupillography app. Methods: Two examiners and two graders perform the measurements with an android app which corrects the device-face distance, measure the maximum contraction of the pupil, and calculates its slope, in a hospital room setting with three levels of environmental light intensity: <100, 101 to 200, and 201 to 300 lux, at 200, 400, 600, 900, 1200, and 1500 milliseconds. Results: Sixty healthy individuals, aged 18 to 45, were included; 85% had brown eyes. The reliability of the pupil/iris ratio had Ri = 70% to 88%, and bland Altman graphics show a uniform agreement. The pupillography curves show a similar slope at different light intensities, during the contraction phase. Conclusion: There were very good repeatability and inter-rater reproducibility of the measurements at average levels of illumination in examination rooms, even in dark-eyed people. This app provides a highly promising approach to pupillary measurements in clinical practice.

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Smartphone Based Pupillometry: An Empirical Evaluation of Accuracy and Safety

Cited by 7 publications

References 17 publications

Pilot Study of Smartphone Infrared Pupillography and Pupillometry

Pilot Study of Smartphone Infrared Pupillography and Pupillometry

Investigating the light emitting diode (LED) flashlight characteristics of a sample of smartphones for its safety in indirect retinal photography

Estimation and interrater reliability of pupillography by digital mobile app: Digital movil pupillography app validity

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