Evidence map›Paper›PMID 26606110›Full record

ArticleJAMA ophthalmology2016

Clinical Validation of a Smartphone-Based Adapter for Optic Disc Imaging in Kenya.

Andrew Bastawrous, Mario Ettore Giardini, Nigel M Bolster, Tunde Peto, Nisha Shah, Iain A T Livingstone, Helen A Weiss, Sen Hu, Hillary Rono, Hannah Kuper and 1 more

Open access · bronzeAbstract readValidation Study
PubMed Full text at PMC Publisher
In one paragraph

Article in JAMA ophthalmology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 61 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
61citing papers in PubMed, 2 pooled it
9.2field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

61 citing papers in PubMed, 2 syntheses or guidelines pooled it, 169 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
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  10. The emerging role of digital health in the management of asthma.Therapeutic advances in chronic disease · 2023
    Review
  11. A Systematic Review of Digital Ophthalmoscopes in Medicine.Clinical ophthalmology (Auckland, N.Z.) · 2023
    Review
  12. Review
  13. Article
  14. Article
  15. Article
  16. Review
  17. Article
  18. [Smartphone-based fundus photography from the perspective of medical product regulation and IT security].Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft · 2022
    Review
  19. [Smartphone-based fundus imaging: applications and adapters].Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft · 2022
    Review
  20. Article

1 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 7 institutions in 1 country.

Andrew BastawrousInternational Centre for Eye Health, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Mario Ettore GiardiniDepartment of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom.
Nigel M BolsterDepartment of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom.
Tunde PetoNational Institute for Health Research, Biomedical Research Centre, University College London Institute of Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom.
Nisha ShahNational Institute for Health Research, Biomedical Research Centre, University College London Institute of Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom.
Iain A T LivingstoneGlasgow Centre for Ophthalmic Research, National Health Service Greater Glasgow and Clyde, Gartnavel General Hospital, Glasgow, United Kingdom.
Helen A WeissInternational Centre for Eye Health, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom5Medical Research Council Tropical Epidemiology Group, Faculty of Epid.
Sen HuDivision of Optometry and Visual Science, School of Health Science, City University London, London, United Kingdom.
Hillary RonoInternational Centre for Eye Health, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom7Kitale and Zonal Eye Surgery, Kitale Hospital, North Rift, Kenya Nort.
Hannah KuperInternational Centre for Eye Health, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom8International Centre for Evidence in Disability, London School of Hyg.
Matthew BurtonInternational Centre for Eye Health, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom3National Institute for Health Research, Biomedical Research Centre, U.
London School of Hygiene & Tropical Medicine · GBUniversity College London · GBUniversity of Strathclyde · GBCity, University of London · GBMedical Research Council · GBNational Health Service · GBNational Institute for Health Research · GB

Funding

Medical Research Council G1001934Medical Research Council MR/K012126/1Wellcome Trust 098481Wellcome Trust 098481/Z/12/Z
6 · The paper itself

Abstract

importanceVisualization and interpretation of the optic nerve and retina are essential parts of most physical examinations.

objectiveTo design and validate a smartphone-based retinal adapter enabling image capture and remote grading of the retina. DESIGN, SETTING, AND

participantsThis validation study compared the grading of optic nerves from smartphone images with those of a digital retinal camera. Both image sets were independently graded at Moorfields Eye Hospital Reading Centre. Nested within the 6-year follow-up (January 7, 2013, to March 12, 2014) of the Nakuru Eye Disease Cohort in Kenya, 1460 adults (2920 eyes) 55 years and older were recruited consecutively from the study. A subset of 100 optic disc images from both methods were further used to validate a grading app for the optic nerves. Data analysis was performed April 7 to April 12, 2015. MAIN OUTCOMES AND MEASURES: Vertical cup-disc ratio for each test was compared in terms of agreement (Bland-Altman and weighted κ) and test-retest variability.

resultsA total of 2152 optic nerve images were available from both methods (also 371 from the reference camera but not the smartphone, 170 from the smartphone but not the reference camera, and 227 from neither the reference camera nor the smartphone). Bland-Altman analysis revealed a mean difference of 0.02 (95% CI, -0.21 to 0.17) and a weighted κ coefficient of 0.69 (excellent agreement). The grades of an experienced retinal photographer were compared with those of a lay photographer (no health care experience before the study), and no observable difference in image acquisition quality was found. CONCLUSIONS AND RELEVANCE: Nonclinical photographers using the low-cost smartphone adapter were able to acquire optic nerve images at a standard that enabled independent remote grading of the images comparable to those acquired using a desktop retinal camera operated by an ophthalmic assistant. The potential for task shifting and the detection of avoidable causes of blindness in the most at-risk communities makes this an attractive public health intervention.

Indexed as

AgedAged, 80 and overDiagnostic Techniques, OphthalmologicalFemaleHumansKenyaMaleMiddle AgedMydriaticsObserver VariationOptic DiskOptic Nerve DiseasesPhotographyPupilReference ValuesReproducibility of ResultsMydriatics

Identifiers

PMID26606110
PMCPMC5321504
OpenAlexW2180164968

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.