Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
Fundação PIO XII, Barretos, SP, Brazil.
Arq Bras Oftalmol. 2021 Nov-Dec;84(6):531-537. doi: 10.5935/0004-2749.20210080.
To compare the quality of retinal images captured with a smartphone-based, handheld fundus camera with that of retinal images captured with a commercial fundus camera and to analyze their agreement in determining the cup-to-disc ratio for a cohort of ophthalmological patients.
A total of 50 patients from a secondary ophthalmic outpatient service center underwent a bilateral fundus examination under mydriasis with a smartphone-based, handheld fundus camera and with a commercial fundus camera (4 images/patient by each). Two experienced ophthalmologists evaluated all the fundus images and graded them on the Likert 1-5 scale for quality. Multivariate regression analyses was then performed to evaluate the factors associated with the image quality. Two masked ophthalmologists determined the vertical cup-to-disc ratio of each fundus image, and both the intraobserver (between devices) and interobserver agreement between them was calculated.
Ninety-eight images from 49 patients were processed in this study for their quality analysis. Ten images from five patients (four from commercial fundus camera and one from smartphone-based, handheld fundus camera) were not included in the analyses due to their extremely poor quality. The medians [interquartile interval] of the image quality were not significantly different between those from the smartphone-based, handheld fundus camera and from the commercial fundus camera (4 [4-5] versus 4 [3-4] respectively, p=0.06); however, both the images captured with the commercial fundus camera and the presence of media opacity presented a significant negative correlation with the image quality. Both the intraobserver [intraclass correlation coefficient (ICC)=0.82, p<0.001 and 0.83, p<0.001, for examiners 1 and 2, respectively] and interobserver (ICC=0.70, p=0.001 and 0.81; p<0.001, for smartphone-based handheld fundus camera and commercial fundus camera, respectively) agreements were excellent and statistically significant.
Our results thus indicate that the smartphone-based, handheld fundus camera yields an image quality similar to that from a commercial fundus camera, with significant agreement in the cup-to-disc ratios between them. In addition to the good outcomes recorded, the smartphone-based, handheld fundus camera offers the advantages of portability and low-cost to serve as an alternative for fundus documentation for future telemedicine approaches in medical interventions.
比较基于智能手机的手持式眼底相机拍摄的视网膜图像的质量与商业眼底相机拍摄的视网膜图像的质量，并分析它们在确定一组眼科患者的杯盘比方面的一致性。
共有 50 名来自二级眼科门诊服务中心的患者在散瞳下接受了基于智能手机的手持式眼底相机和商业眼底相机（每位患者拍摄 4 张图像）的双侧眼底检查。两位经验丰富的眼科医生评估了所有眼底图像，并根据质量对其进行了 1-5 级 Likert 评分。然后进行多变量回归分析，以评估与图像质量相关的因素。两位盲法眼科医生确定了每张眼底图像的垂直杯盘比，计算了他们之间的观察者内（设备间）和观察者间一致性。
本研究共处理了 49 名患者的 98 张图像，以进行质量分析。由于图像质量极差，有 5 名患者的 10 张图像（商业眼底相机 4 张，基于智能手机的手持式眼底相机 1 张）未纳入分析。基于智能手机的手持式眼底相机和商业眼底相机拍摄的图像质量中位数[四分位间距]无显著差异（分别为 4 [4-5]与 4 [3-4]，p=0.06）；然而，商业眼底相机拍摄的图像和存在的介质不透明度与图像质量呈显著负相关。观察者内[组内相关系数（ICC）=0.82，p<0.001 和 0.83，p<0.001，分别为两位检查者 1 和 2]和观察者间（ICC=0.70，p=0.001 和 0.81；p<0.001，分别为基于智能手机的手持式眼底相机和商业眼底相机）一致性均很好且具有统计学意义。
因此，我们的结果表明，基于智能手机的手持式眼底相机产生的图像质量与商业眼底相机相似，它们之间的杯盘比具有显著的一致性。除了记录的良好结果外，基于智能手机的手持式眼底相机还具有便携性和低成本的优势，可以作为未来远程医疗方法中眼底记录的替代方法。
