Smartphone Compatible versus Conventional Ophthalmoscope: A Randomized Crossover Educational Trial

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.