Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
JAMA Ophthalmol. 2023 Oct 1;141(10):974-981. doi: 10.1001/jamaophthalmol.2023.4044.
The current clinical criterion standard for measuring abnormal eyeball protrusion is still the historic Hertel exophthalmometer, which is prone to reading errors. Therefore, a smartphone application has been developed to measure exophthalmos.
To evaluate a relatively simple noninvasive measurement method for exophthalmos using a smartphone.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study compared smartphone exophthalmometry with the existing reference standard, the Hertel exophthalmometer, or a professional high-resolution 3-dimensional scanner. Participants were patients with exophthalmos due to Graves orbitopathy and other intraorbital conditions and healthy volunteers who were recruited between June 2019 and January 2022 from the Department of Ophthalmology, University Hospital Zurich.
All participants were examined twice by 3 different operators using 3 different methods (smartphone, high-resolution scanner, or Hertel exophthalmometer) at an interval of a minimum of 2 weeks or after exophthalmos-changing treatment.
Accuracy and precision, test-retest reliability, and interoperator reliability of eyeball protrusion measurements obtained with the smartphone compared to the Hertel exophthalmometer and the high-resolution face scanner.
Of 39 participants, 23 patients (median [IQR] age, 54 [44-59] years; 15 [65%] female and 8 [35%] male) showed a mean difference in eyeball protrusion of 3.3 mm and 16 healthy volunteers (median [IQR] age, 32 [30-37] years; 11 [69%] female and 5 [31%] male) of 0.8 mm without any significant difference between the 3 methods. Accuracy and precision agreement between exophthalmos measures with the smartphone and the Hertel exophthalmometer showed an intraclass correlation coefficient (ICC) of 0.89 (95% CI, 0.80-0.94) and 0.93 (95% CI, 0.83-0.97) for the high-resolution scanner. Interoperator agreement was highest for the high-resolution scanner (ICC, 0.99 [95% CI, 0.98-0.99]), followed by the smartphone (ICC, 0.95 [95% CI, 0.92-0.97]) and the Hertel exophthalmometer (ICC, 0.91 [95% CI, 0.85-0.95]). Test retest reliability was similarly high for the smartphone (ICC, 0.93 [95% CI, 0.82-0.95]), the Hertel exophthalmometer (ICC, 0.92 [95% CI, 0.83-0.96]), and the high-resolution scanner (ICC, 0.95 [95% CI, 0.89-0.97]).
The findings of this study demonstrate relatively high accuracy and precision, interoperator reliability, and test-retest reliability for smartphone exophthalmometry. These data support the use of a smartphone in place of a Hertel exophthalmometer for measuring exophthalmos in the future.
目前用于测量眼球突出度的临床标准仍是历史悠久的 Hertel 突眼计，但该仪器容易出现读数错误。因此，开发了一种智能手机应用程序来测量突眼度。
评估一种相对简单的使用智能手机的非侵入性突眼测量方法。
设计、设置和参与者：本横断面研究比较了智能手机突眼计与现有的参考标准（Hertel 突眼计或专业的高分辨率 3 维扫描仪）。参与者为因格雷夫斯眼病和其他眶内疾病导致突眼的患者以及 2019 年 6 月至 2022 年 1 月期间从苏黎世大学医院眼科招募的健康志愿者。
所有参与者由 3 名不同的操作人员使用 3 种不同的方法（智能手机、高分辨率扫描仪或 Hertel 突眼计）在至少 2 周或突眼改变治疗后进行两次检查。
与 Hertel 突眼计和高分辨率面部扫描仪相比，智能手机眼球突出度测量的准确性和精密度、重测信度和操作者间信度。
在 39 名参与者中，23 名患者（中位数[IQR]年龄，54 [44-59] 岁；15 [65%]为女性和 8 [35%]为男性）的眼球突出度平均差异为 3.3mm，16 名健康志愿者（中位数[IQR]年龄，32 [30-37] 岁；11 [69%]为女性和 5 [31%]为男性）的差异为 0.8mm，3 种方法之间无显著差异。智能手机和 Hertel 突眼计的突眼测量之间的准确性和精密度一致性显示，内类相关系数（ICC）分别为 0.89（95%CI，0.80-0.94）和 0.93（95%CI，0.83-0.97），高分辨率扫描仪的 ICC 为 0.99（95%CI，0.98-0.99）。操作者间一致性以高分辨率扫描仪最高（ICC，0.99[95%CI，0.98-0.99]），其次是智能手机（ICC，0.95[95%CI，0.92-0.97]）和 Hertel 突眼计（ICC，0.91[95%CI，0.85-0.95]）。智能手机（ICC，0.93[95%CI，0.82-0.95]）、Hertel 突眼计（ICC，0.92[95%CI，0.83-0.96]）和高分辨率扫描仪（ICC，0.95[95%CI，0.89-0.97]）的重测信度也相似较高。
本研究结果表明，智能手机突眼计具有较高的准确性和精密度、操作者间可靠性和重测信度。这些数据支持将来使用智能手机替代 Hertel 突眼计来测量突眼度。
