Training time and quality of smartphone-based anterior segment screening in rural India

Figures & data

Figure 1 The EyeGo adapter.

Notes: (A) The EyeGo adapter for anterior segment imaging: a smartphone adapter consisting of an external LED light source and a macrolens. (B) A health fair screening volunteer capturing images of the anterior segment for a high school student by using the EyeGo adapter prototype. (C) A photograph taken by the EyeGo adapter of a normal eye.
Abbreviation: LED, light-emitting diode.

Table 1 Baseline characteristics of EyeGo users (n=7) and their relationship with image quality

Characteristic	n (%)	Odds ratioa (95% confidence interval)
Ageb – median (interquartile range)	20 (20, 36)	0.915c (0.77 to 1.09)
Highest level of training/education
Undergraduate student	2 of 7 (28.6)
Undergraduate degree	1 of 7 (14.3)
Lab technician	1 of 7 (14.3)
Multipurpose health worker (female)	2 of 7 (28.6)
Land surveyor	1 of 7 (14.3)
“How comfortable do you feel using a smartphone?”d
Very comfortable	4 of 7 (57.1)	1.25 (1.13 to 1.39)
Somewhat comfortable	1 of 7 (14.3)
Neutral	1 of 7 (14.3)
Somewhat uncomfortable	1 of 7 (14.3)
Very uncomfortable	0 of 7 (0.0)
“How comfortable do you typically feel while assessing problems with the eye?”d
Very comfortable	2 of 7 (28.6)	1.17 (1.07 to 1.29)
Somewhat comfortable	1 of 7 (14.3)
Neutral	3 of 7 (42.9)
Somewhat uncomfortable	1 of 7 (14.3)
Very uncomfortable	0 of 7 (0.0)

Notes:

a Estimated by using a binary regression model with image quality <4 or ≥4 as the outcome variable and age, comfort using a smartphone, and comfort in assessing problems with the eye as predictors;

b median age was used, as the distribution was non-normal when tested by using the Shapiro–Wilk test statistic;

c calculated by 10-year intervals in age;

d EyeGo users were asked these two questions prior to screening.

Figure 2 Photographs of the ocular surface taken by using the EyeGo adapter for anterior segment imaging. Reflections present due to suboptimal lighting conditions.

Notes: (A) Normal. (B) Arcus resulting from the deposition of lipids in the peripheral cornea. (C) Oculodermal melanocytosis associated with glaucoma. (D) Conjunctival injection.

Table 2 Baseline characteristics of subjects screened by Healthy Scholars

Baseline characteristics	n (%)
Agea – median (interquartile range)	12.5 (11.5, 13.7)
Presenting ocular complaints
Watering	9 of 751 (1.2)
Blurred vision	6 of 751 (0.8)
Ocular pain	5 of 751 (0.7)
Photophobia	2 of 751 (0.3)
Floaters	2 of 751 (0.3)
Total	17 of 751 (2.3)
Anterior segment findings on examination
Decreased visual acuity	90 of 751 (12.0)
Stye	1 of 751 (0.1)
Strabismus	1 of 751 (0.1)
Ptosis	1 of 751 (0.1)
Blepharitis	1 of 751 (0.1)
Periorbital wound	1 of 751 (0.1)
Oculodermal melanocytosis	1 of 751 (0.1)
Arcus	1 of 751 (0.1)
Conjunctival injection	1 of 751 (0.1)
Total	98 of 751 (13.0)

Notes:

a Median age was used, as the distribution was non-normal when tested by using the Shapiro–Wilk test statistic; n=751.

Table 3 Changes in time taken per eye and change in the quality of photographs taken with experience

User	First 100 eyes		Last 100 eyes		Difference		P-valueb
	Median timea (s)	Median quality	Median time (s)	Median quality	Time (s)	Quality	Time (s)	Quality
1	25.0	3.0	17.5	4.0	−7.5	1.0	0.01	<0.001
2	18.0	4.0	20.0	5.0	2.0	1.0	0.15	<0.001
3	20.0	5.0	18.0	5.0	−2.0	0.0	0.13	0.20
4	22.0	5.0	24.0	5.0	2.0	0.0	0.15	0.67
5	12.0	5.0	10.0	5.0	−2.0	0.0	0.01	0.70
6	25.0	4.0	15.5	5.0	−9.5	1.0	<0.001	<0.01
7	22.0	4.0	16.0	5.0	−6.0	1.0	0.01	0.11

Notes:

a Median time and quality were used, as distributions were non-normal when tested by using the Shapiro–Wilk test statistic;

b Statistical significance was measured by using the Wilcoxon rank sum test.