Abstract
Objective The aim of the study is to compare performance and ease-of-use (EOU) of optic disk
assessment using a smartphone direct ophthalmoscope attachment (D-EYE) to the gold
standard direct ophthalmoscope (DO).
Design The type of study involved is prospective, randomized, crossover, and educational
trial.
Participants The participants involved were first year medical students inexperienced in ophthalmoscopy.
Methods Optic disks of standardized and volunteer patients were examined using the D-EYE
and a conventional DO. Optic disk identification, EOU ratings of the devices, self-reported
confidence level in their examination with the devices, and estimation of vertical
cup-to-disk ratio (VCDR) were compared. Analyses included Chi-square tests, independent
samples t-tests, correlations, and multivariable linear regression.
Results Forty-four medical students voluntarily participated in the study. Students using
the DO required more attempts (3.57 vs. 2.69, p = 0.010) and time (197.00 vs. 168.02 seconds, p = 0.043) to match the patient's fundus to the correct photograph. Overall EOU between
the devices (6.40 vs. 4.79, p < 0.001) and overall confidence in examination (5.65 vs. 4.49, p = 0.003) were greater when using the D-EYE. There were no statistically significant
differences in accuracy of VCDR estimations between the two ophthalmoscopes.
Conclusion Smartphone ophthalmoscopy could offer additional learning opportunities in medical
education and may be considered in clinical practice by non-specialist physicians
given its greater EOU and increased success in visualizing the optic disk.
Keywords
direct ophthalmoscopy - D-EYE - smartphone ophthalmoscope - medical education - undergraduate
medicine
