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Using an Automated Hirschberg Test App to Evaluate Ocular Alignment
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Quantitative Assessment of Strabismus Using Cloud AI Computing: Validation Study.

Junxian He1,2, Jiawei Zhang3, Zheng Wang4

  • 1Schepens Eye Research Institute of Mass Eye & Ear, Harvard Medical School, Boston, MA, United States.

JMIR Formative Research
|November 4, 2025
PubMed
Summary
This summary is machine-generated.

A new cloud-based AI system, Eyeturn Cloud, accurately measures strabismus angles using smartphone images. This technology offers a convenient and accessible method for vision screening and assessment, potentially aiding in telehealth applications.

Keywords:
AI modelsartificial intelligencecloud computingsmartphonestrabismusweb app

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Area of Science:

  • Ophthalmology
  • Artificial Intelligence
  • Medical Imaging

Background:

  • Strabismus measurement is crucial for vision assessment and screening.
  • Traditional methods often require skilled clinicians or specialized equipment.
  • Photographic methods offer improved accessibility and convenience.

Purpose of the Study:

  • To evaluate Eyeturn Cloud, an AI system for measuring strabismus angles.
  • The system uses smartphone-captured eye images under cover test conditions.

Main Methods:

  • Eyeturn Cloud employs AI to recognize ocular features and segment the iris.
  • Strabismus is calculated using iris boundary fitting and corneal reflection.
  • The system was validated against clinical prism alternate cover test measurements.

Main Results:

  • A strong correlation (R²=0.95) was observed between Eyeturn Cloud and clinical strabismus measurements.
  • Bland-Altman analysis showed 95% limits of agreement from -20.2 to 14.6 prism diopters (PD).
  • Repeatability testing yielded a standard deviation of 1.53 PD.

Conclusions:

  • The cloud-based AI web app reliably computes strabismus angles.
  • Its potential utility in telehealth requires further investigation.