Background:The current medical scenario is closely linked to recent progress in telecommunications, photodocumentation, and artificial intelligence (AI). Smartphone eye examination may represent a promising tool in the technological spectrum, with special interest for primary health care services. Obtaining fundus imaging with this technique has improved and democratized the teaching of fundoscopy, but in particular, it contributes greatly to screening diseases with high rates of blindness. Eye examination using smartphones essentially represents a cheap and safe method, thus contributing to public policies on population screening. This review aims to provide an update on the use of this resource and its future prospects, especially as a screening and ophthalmic diagnostic tool. Methods:In this review, we surveyed major published advances in retinal and anterior segment analysis using AI. We performed an electronic search on the Medical Literature Analysis and Retrieval System Online (MEDLINE), EMBASE, and Cochrane Library for published literature without a deadline. We included studies that compared the diagnostic accuracy of smartphone ophthalmoscopy for detecting prevalent diseases with an accurate or commonly employed reference standard. Results:There are few databases with complete metadata, providing demographic data, and few databases with sufficient images involving current or new therapies. It should be taken into consideration that these are databases containing images captured using different systems and formats, with information often being excluded without essential detailing of the reasons for exclusion, which further distances them from real-life conditions. The safety, portability, low cost, and reproducibility of smartphone eye images are discussed in several studies, with encouraging results. Conclusions:The high level of agreement between conventional and a smartphone method shows a powerful arsenal for screening and early diagnosis of the main causes of blindness, such as cataract, glaucoma, diabetic retinopathy, and age-related macular degeneration. In addition to streamlining the medical workflow and bringing benefits for public health policies, smartphone eye examination can make safe and quality assessment available to the population. 

Smartphone Eye Examination: Artificial Intelligence and Telemedicine.

Worsening vision at age 4–5 in England post‐COVID: Evidence from a large database of vision screening data

BACKGROUND
While it is treatable, uncorrected refractive error is the number one cause of visual impairment worldwide. This eye condition alone, or together with ocular misalignment, can also cause amblyopia, which is also treatable if detected early but still occurs in about 4% of the population. Mass vision screening is the first and most critical step to address these issues, but due to limited resources, vision screening in many rural areas remains a major challenge.


OBJECTIVE
We aimed to pilot-test the feasibility of using smartphone apps to enhance vision screening in areas where access to eye care is limited.


METHODS
A vision screening program was piggybacked on a charity summer camp program in a rural county in Sichuan, China. A total of 73 fourth and fifth graders were tested for visual acuity using a standard eye chart and were then tested for refractive error and heterophoria using 2 smartphone apps (a refraction app and a strabismus app, respectively) by nonprofessional personnel.


RESULTS
A total of 5 of 73 (6.8%, 95% CI 2.3%-15.3%) students were found to have visual acuity worse than 20/20 (logarithm of minimal angle of resolution [logMAR] 0) in at least one eye. Among the 5 students, 3 primarily had refractive error according to the refraction app. The other 2 students had manifest strabismus (one with 72-prism diopter [PD] esotropia and one with 33-PD exotropia) according to the strabismus app. Students without manifest strabismus were also measured for phoria using the strabismus app in cover/uncover mode. The median phoria was 0.0-PD (IQR 2.9-PD esophoria to 2.2-PD exophoria).


CONCLUSIONS
The results from this vision screening study are consistent with findings from other population-based vision screening studies in which conventional tools were used by ophthalmic professionals. The smartphone apps are promising and have the potential to be used in mass vision screenings for identifying risk factors for amblyopia and for myopia control. The smartphone apps may have significant implications for the future of low-cost vision care, particularly in resource-constrained and geographically remote areas.

Using Smartphones to Enhance Vision Screening in Rural Areas: Pilot Study.

<sec> <title>BACKGROUND</title> While it is treatable, uncorrected refractive error is the number one cause of visual impairment worldwide. This eye condition alone, or together with ocular misalignment, can also cause amblyopia, which is also treatable if detected early but still occurs in about 4% of the population. Mass vision screening is the first and most critical step to address these issues, but due to limited resources, vision screening in many rural areas remains a major challenge. </sec> <sec> <title>OBJECTIVE</title> We aimed to pilot-test the feasibility of using smartphone apps to enhance vision screening in areas where access to eye care is limited. </sec> <sec> <title>METHODS</title> A vision screening program was piggybacked on a charity summer camp program in a rural county in Sichuan, China. A total of 73 fourth and fifth graders were tested for visual acuity using a standard eye chart and were then tested for refractive error and heterophoria using 2 smartphone apps (a refraction app and a strabismus app, respectively) by nonprofessional personnel. </sec> <sec> <title>RESULTS</title> A total of 5 of 73 (6.8%, 95% CI 2.3%-15.3%) students were found to have visual acuity worse than 20/20 (logarithm of minimal angle of resolution [logMAR] 0) in at least one eye. Among the 5 students, 3 primarily had refractive error according to the refraction app. The other 2 students had manifest strabismus (one with 72–prism diopter [PD] esotropia and one with 33-PD exotropia) according to the strabismus app. Students without manifest strabismus were also measured for phoria using the strabismus app in cover/uncover mode. The median phoria was 0.0-PD (IQR 2.9-PD esophoria to 2.2-PD exophoria). </sec> <sec> <title>CONCLUSIONS</title> The results from this vision screening study are consistent with findings from other population-based vision screening studies in which conventional tools were used by ophthalmic professionals. The smartphone apps are promising and have the potential to be used in mass vision screenings for identifying risk factors for amblyopia and for myopia control. The smartphone apps may have significant implications for the future of low-cost vision care, particularly in resource-constrained and geographically remote areas. </sec> 

Using Smartphones to Enhance Vision Screening in Rural Areas: Pilot Study (Preprint)

Introduction To validate a novel smartphone-based approach for subjective refraction, specifically for myopia screening, offering a cost-effective and accessible tool for at-home vision assessment. Methods A total of 230 healthy volunteers, encompassing 460 eyes, aged between 7 and 40 years (mean ± SD: 21.04 ± 7.76), and exhibiting refractive error (RE) ranging from −6.25 to +0.50 diopter (D), were deemed eligible subjects in this research. Subjective refraction assessments were conducted on all subjects, involving both the conventional phoropter examination by experienced optometrists which served as the clinical gold-standard, and the smartphone-based methodology. During smartphone measurement, the screen was gradually moved toward the eye until achieving clear differentiation of the ‘E’ optotypes and the astigmatic dial. The eye-to-smartphone screen distances (ESD) were calculated based on the image of iris diameter (ID) acquired by the front-facing camera of the smartphone. Applying the definitions of the far point and the rule of thirty, this allowed for the computation of sphere (S), cylinder (C), and astigmatism axis ( α ) values. The concordance between the two methods was assessed by establishing the Limits of Agreement (LOAs), which were calculated as the mean difference ± 1.96 times the standard deviation of the differences. Results The smartphone-based screening technique showed that it closely matched the gold-standard subjective refraction used in clinical practice. The LOAs for S, C, and spherical equivalent refraction (SER) were 0.11 ± 0.89 D, −0.03 ± 0.82 D, and 0.10 ± 0.89 D, respectively. The average deviation in measuring the α was 4.72°, with 64.35% of deviations falling within the ±15° range. Additionally, the technique demonstrated impressive areas under the receiver operating characteristic curve (AUC) of 0.973 for the range of −3.00 D &amp;lt; SER ≤ 0.00 D and 0.986 for the range of −6.00 D &amp;lt; SER ≤ −3.00 D. Discussion The innovative vision screening through smartphones can expand access to measuring RE, especially in home. The study confirms the validity of an innovative vision-screening approach for myopia. Its effectiveness and accessibility make it a valuable tool for opportunistic or large-scale myopia screening programs. 

pdf/innovative-myopic-screening-platform-based-on-smartphones-4r9e6zteudz0.pdf

Innovative myopic screening platform based on smartphones

Purpose The purpose of this study was to evaluate the potential feasibility of using a smartphone app in myopia screening. Methods The app estimates myopic refractive error by measuring the far point distance for reading three 20/20 Tumbling E letters. In total, 113 myopic subjects with astigmatism no greater than −1.75 diopters (D) were enrolled from 5 sites. The mean age was 22 ± 8.5 years. The app measurement was compared with noncycloplegic subjective refraction measurement or autorefractor if subjective refraction was not available. In addition, 22 subjects were tested with the app for repeatability. Results For 201 eyes included, the range of spherical equivalent refraction error was 0 to −10.2 D. The app measurement and clinical measurement was highly correlated (Pearson R = 0.91, P < 0.001). There was a small bias (0.17 D) in the app measurement overall, and it was significantly different across the 5 sites due to different age of subjects enrolled at those sites (P = 0.001) – young adults in their 20s were underestimated the most by 0.49 D, whereas children were overestimated by 0.29 D. The mean absolute deviation of the app measurement was 0.65 D. The repeatability of multiple testing in terms of 95% limit of agreement was ±0.61 D. Conclusions Overall, the app measurement is consistent with clinical measurement performed by vision care professionals. The repeatability is comparable with that of some autorefractors. Age-associated human factors may influence the app measurement. Translational Relevance The app could be potentially used as a mass screening tool for myopia.

Preliminary Evaluation of a Smartphone App for Refractive Error Measurement

Intraocular lens (IOL) opacification after cataract surgery has been widely reported, but opacification during pars-plana vitrectomy (PPV) has not been reported. In our case, a 59-year-old male patient underwent PPV. During the surgery, IOL was found to be cloudy, and the area accounted for half of IOL. The surgical field was not affected. At the end of surgery, the degree of opacification decreased significantly. On the first day after surgery, IOL was completely transparent. IOL opacification may be caused by condensation and does not affect retina observation during PPV. It is not necessary to remove and replace the IOL immediately.

Intraocular lens opacification during pars-plana vitrectomy: A case report

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Preliminary Evaluation of a Smartphone App for Refractive Error Measurement

Intraocular lens opacification during pars-plana vitrectomy: A case report