In reply We appreciate Chakrabarti and Perera's interest in our work,1 and we thank them for their thoughtful comments about our study and its relation to developments in the application of mobile devices to ophthalmology and other fields of medicine. We should clarify that the relatively high proportion of poor-quality images in our analysis was not due to any particular limitation of the camera or our imaging protocol. Rather, the distribution of image quality was reflective of all images obtained during the study, allowing us to have a sample representative of the full spectrum of photographic quality. From a clinical perspective, images of some diagnostic quality were obtained in 97% of patients and a high-quality image (grade 4 or 5) of at least 1 eye was obtained in 83% of patients, despite the challenges of obtaining high-quality nonmydriatic photographs in the emergency department setting.2-4 As we acknowledged, our findings would be enhanced by a study specifically addressing diagnostic agreement. We also concur that with the rapid advances in smartphone technology and the growing body of related research, it is unlikely to be long before smartphones are ready for more widespread clinical use, even for subtle findings. Indeed, since our article was accepted, Kumar et al5 assessed the diagnostic capability of the iPhone 4 for features of diabetic retinopathy and found high agreement between the iPhone and desktop workstations. We are excited that further research regarding nonmydriatic photography and mobile devices will continue to enhance ophthalmologic care and help to restore the important role of the examination of the ocular fundus in the general physical examination. Back to top Article Information Correspondence: Dr Newman, Department of Ophthalmology, Emory University, 1365-B Clifton Rd NE, Atlanta, GA 30322 (email@example.com). Conflict of Interest Disclosures: None reported. Funding/Support: This study was supported in part by a departmental grant (Department of Ophthalmology) from Research to Prevent Blindness Inc and core grant P30-EY06360 (Department of Ophthalmology). Dr Bruce is supported by grant K23-EY019341 from the National Eye Institute. Dr Newman is a recipient of the Lew R. Wasserman Merit Award from Research to Prevent Blindness. References 1. Lamirel C, Bruce BB, Wright DW, Newman NJ, Biousse V. Nonmydriatic digital ocular fundus photography on the iPhone 3G: the FOTO-ED study. Arch Ophthalmol. 2012;130(7):939-94022776940PubMedGoogle ScholarCrossref 2. Bruce BB, Lamirel C, Wright DW, et al. Nonmydriatic ocular fundus photography in the emergency department. N Engl J Med. 2011;364(4):387-38921268749PubMedGoogle ScholarCrossref 3. Bruce BB, Lamirel C, Biousse V, et al. Feasibility of nonmydriatic ocular fundus photography in the emergency department: phase I of the FOTO-ED study. Acad Emerg Med. 2011;18(9):928-93321906202PubMedGoogle ScholarCrossref 4. Lamirel C, Bruce BB, Wright DW, Delaney KP, Newman NJ, Biousse V. Quality of nonmydriatic digital fundus photography obtained by nurse practitioners in the emergency department: the FOTO-ED study. Ophthalmology. 2012;119(3):617-62422218140PubMedGoogle ScholarCrossref 5. Kumar S, Wang EH, Pokabla MJ, Noecker RJ. Teleophthalmology assessment of diabetic retinopathy fundus images: smartphone vs standard office computer workstation. Telemed J E Health. 2012;18(2):158-16222304438PubMedGoogle ScholarCrossref
JAMA Ophthalmology – American Medical Association
Published: Mar 1, 2013
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