Arquivos Brasileiros de Oftalmologia

The objectives of this study were to compare the quality of retinal images taken with a smartphone-based hand-held fundus camera (SHFC) with those from a commercial fundus camera (CFC), and to analyze their agreement in determining the cup-to-disc ratio in a cohort of ophthalmological patients.

Fifty patients from a secondary ophthalmic outpatient service underwent a bilateral fundus examination under mydriasis using the SHFC and CFC (four images per patient). A multivariate regression analysis was performed to evaluate 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 presented sufficient quality and were used in this study. The medians [interquartile interval] of image quality were not significantly different between the SHFC and CFC 4 [4-5] versus 4 [3-4] respectively, p=0.06); however imagens taken with the CFC, as well as the presence of media opacity presented a significant negative correlation with image quality. Both the intraobserver and interobserver agreements were excellent and statistically significant (p<0,01).

Our results indicate that the SHFC presents image quality similar to CFC, with significant agreement in the analysis of the cup-to-disc ratios. Besides the good results observed, the SHFC may be considered as a portable, low cost alternative for fundus documentation in further telemedicine settings.