Ocular fundus smartphone device trumps tradition retinal fundoscopy in ED setting
D-Eye, a new small smartphone device, appears to be useful in an emergency department setting (ED) for the fundoscopic examination, detecting a significant number of abnormal ocular fundus, a recent study has found. Furthermore, the reliability of relevant ocular fundus abnormalities seems to be superior to traditional retinal fundoscopy.
Researchers identified 52 consecutive patients (mean age 69 years; 50 percent women) presenting to a hospital ED with an acute increase in blood pressure (systolic >180 and/or diastolic >100 mm Hg). To examine the presence of grade III and IV Keith Wegener retinopathy, a medical student (observer 1) used both a traditional ophthalmoscope and D-Eye in all patients admitted to the ED to obtain mydriatic ocular fundus examination.
Two independent expert (ophthalmologist; observer 2) and inexpert (medical student; observer 1) observers analysed all ocular fundus images and videos recorded with the D-Eye system. Researchers used a quantitative score of hemorrhages, exudates or papillary oedema (0 absent, 1 early, 2 moderate, 3 severe and 4 very severe). They also used the Cohen K coefficient to assess the interobserver concordance index.
The mean duration of ocular fundus examination for traditional ophthalmoscopy was 130±39 and for smartphone D-Eye 74±31. The traditional ophthalmoscopy detected no relevant abnormalities, performed by observer 1, whereas the use of the D-Eye device detected a significant number of abnormal ocular fundus findings in 17 and 19 patients by observer 1 and observer 2, respectively.
The K coefficient value showed good concordance (range, 0.66 to 0.77) for the assessment of haemorrhages and exudates, and optimal concordance (range, 0.89 to 0.90) for the evaluation of presence and severity of papilledema.
“The ocular fundus examination is infrequently and poorly performed in the ED clinical settings, placing patients at risk for missed diagnosis of hypertensive emergencies,” researchers noted.