Dr. Amit Mohan, M11516, Dr. Navjot Kaur, Dr. Vinod Kumar Sharma
Abstract
Background: Teleophthalmology has potential in facilitating everyone access to expert advice.
Aim : This study was designed to assess whether images of different eye ailments viewed on Smartphone (SP) and tablets are of comparable quality as viewed on computer screen.
Methods: This was a prospective study comparing the quality of images on SP, tablets and computer screens. 30 images were analyzed 10 of extraocular, 10 of anterior segment (from 3 vision canters) and 10 of retinal diseases (fundus images of Queen Elizabeth foundation project). 10 ophthalmologists have participated & were instructed to rate the overall quality of each image on a 7 point Likert scale. Results: SP were rated very good. (88.33%, mean score-5.9). All consultant (n=10) were comfortable with SP and using it for teleconsultation at least 3 times in a month. Vision technician got minimum delay in getting advice when sending the images on mobile application.
Conclusion: Smartphone can be used for teleconsultation.
Full text
Introduction
Teleophthalmology has potential in facilitating everyone access to expert advice. However, to ensure effectiveness, the turnaround time has to be kept to a minimum. This may require experts to view the images received on their handheld smart-phone or tablet to avoid potential delays occurred to access a computer screen when required.[1]
Increasing Smartphoneutilization and rapidly growing internet access world-wide make mobile health more widely available, including in resource-poor settings.
By speeding up and facilitating access to expert advice, it contributes to effective treatment, reduced referral rates and ultimately reduced costs for both healthcare systems and patients.[2,3]
The evidence is promising regarding the usability of handheld devices (Smartphones and tablets) for expert teleconsultation.
This study is concerned with ophthalmological conditions presented to optometrist at vision centers who are not accessible to specialized ophthalmic consultation directly in resource-poor settings, specifically extra ocular diseases, anterior segment pathology and images of diabetic retinopathy, and assesses whether images viewed on handheld devices by expert ophthalmologist as being comparable in quality as when viewed on a standard computer screen.
Material and methods
This was a prospective study comparing the quality of images on Smartphones, tablets and computer screens. 30 images were analyzed 10 of extra ocular diseases, 10 of anterior segment pathology (received from our 3 vision centers located in remote areas of south west Rajasthan) and 10 of retinal diseases (fundus images received from community hospitals in district Pali and adopted in Queen Elizabeth foundation project for diabetic retinopathy screening). 10 ophthalmologists have participated & were instructed to rate the overall quality of each image on a 7 point Likert scale. (Terrible-1, poor-2, average-3, fair-4, good-5, very good-6, excellent-7)
Three different display devices of types commonly used by ophthalmologist to view images were selected: a laptop computer screen (model HP pavilion dv4 windows 7) used as the reference, a tablet (model Samsung Galaxy Tab 3) and a smartphone (model Apple iPhone 5S)
Clinical images of extraocular diseses are captured with camera, anterior segment diseases by slit lamp camera and retinal images by fundus camera.
All the images are sent for expert opinion to 10 ophthalmologists both to their whatsapp instant messaging app and also to their registered email address. A questionnaire was used to rate the image quality and utility of Smartphone as teleconsultation. Each individual participant viewed the 30 images on each of the three devices and was asked to rate the overall quality of each image on a 7-point Likert scale (1=terrible to 7=excellent). Beforehand, the participants were instructed to focus on the quality of the images as such rather than on the ability to diagnose any particular condition.
Once participants had rated all the images on each device, questions were asked concerning image quality and regarding how frequently the participant used the specific type of device to look at images for professional and teleconsultation purposes, the use of the device’s zoom feature during the survey and whether they would feel comfortable using the device for image-based remote consultation.
Concerning quality, the participants were asked to rank order the importance of five image features: focus, resolution, contrast, colour and composition.
Results
Table-1 presents the demographic data of the entire participating ophthalmologist.
| Variable | Ophthalmologist (n) |
| Gender | |
| Male | 6 (60%) |
| Female | 4 (40%) |
| Age Mean (min- max) | 37.5 (26-64) |
Mean age was 37.5 years ranging from 26 years to 64 years. 60% participants were male and 40% were female. The device that was used most often for professional purpose was the Smartphone. All 10 participants used Smartphone at least once a week for professional purposes. The computer was also used by all participants for personal and professional purposes. However only 2 ophthalmologists were using tablets. A total of 9 participants reported using their Smartphone for image based teleconsultation at least 2-3 times a month compared to 2 participants for computers and 1 for tablet.
Table -2 presents the results of quality of images (average of likert scale on a 7 point scale 1=terrible to 7=excellent) for the Smartphone, tablets and computers for all images aggregated for 3 different type of images ( extraocular diseases, anterior segment diseases and fundus photographs.
| Image category | Smartphones | Tablets | Computers |
| Extraocular | 6.1 | 5.2 | 5.1 |
| Fundus | 5.8 | 5.2 | 5.0 |
| Anterior segment | 5.8 | 5.0 | 4.9 |
| Overall | 5.9 | 5.13 | 5.0 |
Overall smartphones have significantly higher ratings than the tablets and computers. Smartphones have higher likert scale score for all three types of images. The images were rated good or very good in 100% times in smartphones. Fundus images and extrocular images were rated higher than anterior segment images.
Participants used the zoom function more often with the smartphones (n=10) than with tablets (n=4) and computers (n=4). Almost all participants answered that they would be comfortable while giving image based consultation using the smartphones (n=10), tablets (n=7) and computers (n=6).
When vision technicians were asked about their comfort and delay in reply regarding clinical advice, all the optometrist (n=5) were comfortable when sending the images on smartphones using instant messaging apps like whatsapp and got the reply within half an hour after consultation but got delay when sending the computer applications.
Discussion
This study support that handheld devices are good solution for image based teleconsultation in ophthalmic practice. Teleophthalmology is inclusion of technology by which people in remote and underserved areas can get to specialized expert health care.[4] Telemedicine has special significance in India because its vast geographical spread and predominant rural population where eye care facility is neither available nor accessible.[5] Teleophthalmology could be useful in primary eye care where distance to an ophthalmologist can be significant obstacle to diagnosis and treatment.[6] The use of mobile health in ophthalmology has allowed greater efficiency and communications between ophthalmologist and vision techinician. As more health care providers are using smartphones in the clinical setting, ensuring mobile tools are reliable, accurate and consistent for teleconsultation. The practice is valuable for pictures taken for ophthalmology.[7] Earlier study addressed the use of tablets and smartphones in the field of radiology and emergency and found that tablets and smartphones were rated equal or better than computer screen.[8,9] Our study broadens the current knowledge on the potential for use of handheld devices in ophthalmic consultation.
Conclusion
Hand held devices specially Smartphone could be substitute for computer for image based teleconsultation in ophthalmology practice and will save the time without delay in expert advice to no accessible people.
References
- World Health Organization. mHealth: new horizons for health through mobile technologies. WHO global observatory for ehealth, Geneva, 2011.
- Al-Hadithy N, Ghosh S. Smartphones and the plastic surgeon. J Plast Reconstr Aesthetic Surg 2013;66:e155–61.
- Betjeman TJ, Soghoian SE, Foran MP. mHealth in Sub-Saharan Africa. Int J Telemed Appl 2013;2013:482324
- K. Sharma and M. Rajput, “Telemedicine: socio-ethical considerations in the Indian milieu,” The Medico-legal journal, vol. 77, no. 2, pp. 61–65, 2009.
- S. Bedi, “Telemedicine standards: need and Indian initiatives,” Telemedicine and E-Health, vol. 15, no. 6, pp. 597–599, 2009
- Blomdahl, N. Marén, and R. Lof, “Tele-ophthalmology for the treatment in primary care of disorders in the anterior part of the eye,” Journal of Telemedicine and Telecare, vol. 7, pp. 25–26, 2001.
- Maamari RN, Keenan JD, Fletcher DA, et al. A mobile phone-based retinal camera for portable wide field imaging. Br J Ophthalmol 2014;98:438–41.
- Constance Boissin, Lisa Blom, Lee Wallis, Lucie Laflamme Image-based teleconsultation using smartphones or tablets: qualitative assessment of medical experts Emerg Med J 2017;34:95–99.
- Toomey RJ, Rainford LA, Leong DL, et al. Is the iPad suitable for image display at American Board of Radiology examinations? Am J Roentgenol 2014;203:1028–33.
Leave a Comment