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March 2013

Nonmydriatic Digital Ocular Fundus Photography With iPhone 3G

Author Affiliations

Author Affiliations: Department of Ophthalmology, Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria (Dr Chakrabarti), and Department of Neurosurgery, Austin Health, Melbourne (Dr Perera), Australia.

JAMA Ophthalmol. 2013;131(3):405-406. doi:10.1001/jamaophthalmol.2013.826

We read with great interest the article by Lamirel et al1 in the July issue regarding the utility of the iPhone 3G (320 × 480 resolution; Apple Inc) for reviewing nonmydriatic color fundus photographs. The study raises important considerations for the use of mobile technology in settings where access to sophisticated photographic equipment is limited.

A large proportion of the nonmydriatic camera images were inadequate for clinical use. The authors specified that of the 100 selected images, 50 were inadequate to exclude emergent pathology. This is a limitation of the quality of nonmydriatic photographs obtained in the first place using the Kowa α-D camera and not the iPhone per se. Nevertheless, the authors were able to show that there was excellent interreviewer and intraviewer agreement of image quality between the desktop computer and the iPhone display. This in itself is a validation of their rating scale and an initial indicator of agreement between iPhone displays and desktop screens. However, the inference from this study is that retinal images can be assessed in a telemedicine network with comparable accuracy on an iPhone screen, thereby facilitating rapid identification of emergent pathology. Certainly, the promising results would have been enhanced by obtaining higher-quality images to be transferred and read on the iPhone in the first place. It would be interesting to see a future study from this group comparing diagnoses made when using high-quality images.