Use of a smartphone-based, non-mydriatic fundus camera for patients with red flag ophthalmic presentations in a rural general practice

Scott Davidson; Waldir Rodrigues de Souza Jr; Kyle Eggleton

doi:10.1071/HC24040

RESEARCH ARTICLE (Open Access)

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Use of a smartphone-based, non-mydriatic fundus camera for patients with red flag ophthalmic presentations in a rural general practice

Scott Davidson

¹ ^* , Waldir Rodrigues de Souza Jr ² ³ , Kyle Eggleton

⁴

+ Author Affiliations

- Author Affiliations

¹ Dargaville Medical Centre, Dargaville, Northland, New Zealand.

² Dunedin Hospital, Te Whatu Ora Southern, New Zealand.

³ Ophthalmology Section, Department of Medicine, University of Otago, New Zealand.

⁴ Rural Health Unit, Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.

^* Correspondence to: scottd@dargavilledocs.co.nz

Handling Editor: Felicity Goodyear-Smith

Journal of Primary Health Care https://doi.org/10.1071/HC24040

Submitted: 9 March 2024 Accepted: 7 May 2024 Published: 21 May 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Introduction

Fundus examination by direct ophthalmoscopy is widely used in general practice; however, it offers limited field of view, requires close approximation to the patient, has a steep learning curve and is a difficult skill to master and maintain. Non-mydriatic fundus photography (NMFP) offers an alternative with a wider field of view, ability for image analysis and transmission, and is able to be conducted by allied healthcare staff.

Aim

This study aimed to compare the use of direct ophthalmoscopy with smart-phone NMFP in a large rural general practice. It also aimed to analyse the number of adequate views and positive findings achieved with each instrument and the impact of NMFP on ophthalmology referral decisions.

Methods

Patients aged ≥16 years presenting to Dargaville Medical Centre (Dargaville, New Zealand) with visual disturbance, headache, hypertensive urgency (systolic blood pressure (BP) >200 mmHg or diastolic BP >120 mmHg), transient ischemic attack (TIA) or stroke were enrolled prospectively into an observational study of visualisation, diagnosis and management impact for a 1-year period (n = 152, 304 eyes). Direct ophthalmoscopy findings and management plans were documented by the attending general practitioner (GP), and then again following assessment of the NMFP.

Results

NMFP significantly improved visualisation of the fundal structures with an increase in adequate views achieved of both the optic disc and the retina. Inter-rater agreement between the referring GP and ophthalmologist was good.

Discussion

The use of NMFP in general practice might result in greater accuracy in diagnosing retina and optic disc disease. Routine transmission of NMFP images to specialist eye clinics as part of the referral might improve management and result in health system efficiencies.

Keywords: direct ophthalmoscope, fundoscopy, fundus photo, ophthalmology, optic nerve, retina, rural, general practice.

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