Digital Anterior Segment Photography in Clinical Practice: Mixed Methods Study

In the digital era, smartphone technology has significantly advanced ocular imaging, allowing for high-resolution anterior segment photography (ASP) to enhance referrals, decision-making, and disease monitoring within clinical workflows.

This exploratory quality-improvement project aims to examine clinician experiences with 4 smartphone-based and slit-lamp-based ASP workflows used in eye casualty and corneal services.

A mixed methods project was conducted at a tertiary eye hospital in England (United Kingdom) between October 21, 2024, and December 6, 2024. The full imaging setups of 4 ASP workflows were evaluated within an established clinical setting: the Magnifier app (a smartphone-based app; Apple Inc), QuikVue smartphone adapter (a smartphone-based camera lens attachment; VisuScience Meditech Co Ltd), NexYZ Slit-Lamp Adapter (a slit-lamp-based attachment; Celestron LLC), and Zeiss Slit Lamp Imaging Solution (ZSLIS; an integrated slit-lamp camera system; Carl Zeiss AG). Ophthalmology residents and corneal fellows completed nonvalidated usability surveys and participated in one-on-one interviews examining the role of ASP workflows in clinical practice. Survey data were analyzed using descriptive statistics. Interviews were transcribed and subjected to reflexive thematic analysis.

Among 25 survey respondents (17 residents and 8 fellows) and 12 interviewees, clinician-rated assessments of usability, cost-effectiveness, and clinical utility favored the Magnifier workflow, which received the highest ratings across these domains (19/25, 76%; 23/25, 92%; and 18/25, 72% strongly agreed, respectively). Five themes emerged from qualitative analysis: obstacles to clinical implementation, accessibility, quality and workflow, digital ethics, and innovation.

No single ASP workflow proved superior in usability ratings and interview themes regarding clinical application. However, the use of the Magnifier workflow appeared to offer the most favorable balance of usability, cost-effectiveness, and clinical utility in clinician-rated assessments, though this reflects the full imaging workflow rather than the app alone. These findings are exploratory and require future work to examine workflow integration, data governance for smartphone imaging, and patient perspectives on ASP workflows.