Author Block: Rachel Curtis, Mark Xu, Daisy Liu, Jason Kwok, Isabella Irrcher, Wilma Hopman, Stephanie Baxter

Author Disclosure Block: R. Curtis: None. M. Xu: Funded grants or clinical trials; PSI Foundation Grant (Resident Research Grant applied to this project). D. Liu: None. J. Kwok: None. I. Irrcher: None. W. Hopman: None. S. Baxter: Funded grants or clinical trials; PSI Foundation Grant (Resident research grant applied to this project).

Abstract Body:

Purpose: To compare the performance and ease-of-use in optic disc assessment using a smartphone direct ophthalmoscope attachment (D-EYE) and the gold standard conventional direct ophthalmoscope in first year medical students.

Study Design: Prospective, randomized, crossover educational trial.

Methods: Participants were first year medical students naïve to ophthalmoscopy, and were exposed to a standardized training session using both devices on the same day as the study. Optic discs of standardized patients and patient volunteers were examined in a randomized, crossover design using a smartphone attachment ophthalmoscope (D-EYE) and a conventional direct ophthalmoscope (DO). Optic disc identification using an online fundus matching program, ease-of-use (EOU) ratings of the devices, self-reported confidence level in their exam with the devices, and the student’s estimation of vertical cup-to-disc ratio (VCDR) were used to compare ophthalmoscopes.

Results: Forty-four medical students voluntarily participated in the study. Students using the DO required more attempts to match the patient’s fundus to the correct photograph when compared to the D-EYE device (3.57 vs. 2.69, p=0.010, t-test), and more time to correctly select the proper fundus photograph (197.00 vs. 168.02 seconds, p=0.043, t-test). Multivariable linear regression controlling for eye, dilation and repeated student measurements showed that students needed on average one more attempt to correctly match the fundus using the DO compared to the D-EYE device (B=0.879, p=0.009), and that the DO took on average 30 seconds longer (29.222, p=0.041). Participants reported being able to see the right and left optic discs of the patient using the D-EYE, 75.8% and 87.1% of the time, respectively, compared to 61.3% and 59.7% when using the DO (p=0.082 right eye, p=0.001 left eye, Chi-square test). Overall reported EOU when examining the right eye (5.94 vs. 5.13, p=0.005, t-test), left eye (5.95 vs. 5.15, p=0.002, t-test), overall device EOU (6.40 vs. 4.79, p<0.001, t-test) and overall confidence in exam (5.65 vs. 4.49, p=0.003, t-test) was greater when using the D-EYE compared to the DO. There were no statistically significant differences in accuracy of VCDR estimations between the D-EYE and the DO.

Conclusions: Smartphone ophthalmoscopy creates additional learning opportunities in medical education given its greater ease-of-use and increased success in visualizing the optic disc. Given that smartphone compatible technologies are becoming progressively more relevant in the clinical setting, medical training programs should consider ensuring that trainees are exposed to these new and advancing technologies to prepare them for the changing realities of medical practice.