Singh Aqeeda, Cheyne Kirsten, Wilson Graham, Sime Mary Jane, Hong Sheng Chiong
Student, Dunedin School of Medicine, University of Otago, Dunedin.
Research Assistant, Ophthalmology Department, University of Otago, Dunedin.
N Z Med J. 2020 Apr 3;133(1512):31-38.
There is consensus among general practitioners regarding the difficulty of direct ophthalmoscopy. Hence, there is increasing interest in smartphone-based ophthalmoscopes; the New Zealand-made oDocs Nun ophthalmoscope is one such device, released in November 2018. This study aims to subjectively assess the quality of the images captured with it in order to determine the feasibility of its use in a primary care setting.
Twenty-eight general practitioners (GPs) from different practices throughout New Zealand agreed to participate in this prospective observational study and were sent an oDocs Nun ophthalmoscope. Using the device, clinicians took retinal photographs of patients who presented with visual complaints and uploaded one image per eye onto a database. Three hundred and fifty-seven photographs were collated and rated by four professionals (two ophthalmologists and two optometrists) on the basis of image quality and the anatomical features visible.
On a Likert scale from 1 (poor quality) to 4 (very good quality), the median and mode values for each professional's rating of all photographs were both 2. On average, 94.5% of the photographs were deemed to have visible optic discs and 50.0% to have visible maculae adequate for detecting an abnormality. Pairwise comparison showed 93.7% agreement among the four professionals for optic disc visibility, and 74.2% agreement for macula visibility.
The oDocs Nun is a promising tool which GPs could use to circumvent the challenges associated with direct ophthalmoscopy. With appropriate training to ensure proficiency, it may have a valuable role in telemedicine and tele-referral.
全科医生对于直接检眼镜检查的难度已达成共识。因此，基于智能手机的检眼镜越来越受到关注；新西兰制造的oDocs Nun检眼镜就是这样一种设备，于2018年11月发布。本研究旨在主观评估用其拍摄的图像质量，以确定其在初级保健环境中使用的可行性。
来自新西兰各地不同诊所的28名全科医生同意参与这项前瞻性观察性研究，并收到了一台oDocs Nun检眼镜。临床医生使用该设备为有视觉主诉的患者拍摄视网膜照片，并将每只眼睛的一张图像上传到数据库。整理了357张照片，由四名专业人员（两名眼科医生和两名验光师）根据图像质量和可见的解剖特征进行评分。
在从1（质量差）到4（质量非常好）的李克特量表上，每位专业人员对所有照片评分的中位数和众数均为2。平均而言，94.5%的照片被认为可见视盘，50.0%的照片被认为可见黄斑，足以检测异常。两两比较显示，四名专业人员对视盘可见性的一致性为93.7%，对黄斑可见性的一致性为74.2%。
oDocs Nun是一种有前景的工具，全科医生可利用它来规避与直接检眼镜检查相关的挑战。通过适当培训以确保熟练掌握，它可能在远程医疗和远程转诊中发挥重要作用。
