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Smart phone ophthalmoscopy: a potential replacement for the direct ophthalmoscope

Eyevolume 32pages17661771 (2018) | Download Citation



The purpose of this study is to evaluate a commercially available smartphone ophthalmoscope, D-EYE, as compared with the direct ophthalmoscope when used by a cohort of final-year medical students in a prospective study.


Two-hundred fundal examinations were performed on the eyes of 10 mannequins featuring 5 unique fundal images by 20 final-year medical students from Newcastle University. Each student examined the five fundal images twice, once each with a direct ophthalmoscope and D-EYE in a random order. Students recorded their findings at the optic nerve, macula, and retina in an objective questionnaire, and the findings were analysed by an observer masked to the examination technique.


Students provided more accurate clinical descriptions of their findings when using D-EYE as opposed to using the direct ophthalmoscope (p < 0.05). In addition, we found that students were overall more likely to make a correct diagnosis based on their findings when using D- EYE compared with the direct ophthalmoscope.


Our study suggests that the use of a smartphone-based alternative to the direct ophthalmoscope may improve the accuracy and quality of fundal examinations by non-ophthalmologists.

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  1. 1.

    Williams KM, Bertelsen G, Cumberland P, Wolfram C, Verhoeven VJ, Anastasopoulos E, et al. Increasing prevalence of myopia in Europe and the impact of education. Ophthalmology. 2015;122:1489–97.

  2. 2.

    Ah-kee EY, Egong E, Shafi A, Lim LT, Yim JL. A review of drug-induced acute angle closure glaucoma for non-ophthalmologists. Qatar Med J. 2015;2015:6.

  3. 3.

    Pandit RJ, Taylor R. Mydriasis and glaucoma: exploding the myth. A systematic review. Diabet Med. 2000;17:693–9.

  4. 4.

    Gupta RR, Lam WC. Medical students’ self-confidence in performing direct ophthalmoscopy in clinical training. Can J Ophthalmol. 2006;41:169–74.

  5. 5.

    Baylis O, Murray PI, Dayan M. Undergraduate ophthalmology education–a survey of UK medical schools. Med Teach. 2011;33:468–71.

  6. 6.

    Lippa LM, Boker J, Duke A, Amin A. A novel 3-year longitudinal pilot study of medical students’ acquisition and retention of screening eye examination skills. Ophthalmology. 2006;113:133–9.

  7. 7.

    Yusuf IH, Salmon JF, Patel CK. Direct ophthalmoscopy should be taught to undergraduate medical students-yes. Eye (Lond). 2015;29:987–9.

  8. 8.

    Purbrick RM, Chong NV. Direct ophthalmoscopy should be taught to undergraduate medical students--no. Eye (Lond). 2015;29:990–1.

  9. 9.

    Nicholl DJ, Yap CP, Cahill V, Appleton J, Willetts E, Sturman S. The TOS study: can we use our patients to help improve clinical assessment? J R Coll Physicians Edinb. 2012;42:306–10.

  10. 10.

    Colleges AoMR. The UK Foundation Programme Curriculum. 2012.

  11. 11.

    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;119:617–24.

  12. 12.

    Alexander SM, Nerminathan A, Harrison A, Phelps M, Scott KM. Prejudices and perceptions: patient acceptance of mobile technology use in health care. Intern Med J. 2015;45:1179–81.

  13. 13.

    MP DoHaTRHJH. New plans to expand the use of digital technology across the NHS. 2016.

  14. 14.

    Bolster NM, Giardini ME, Livingstone IAT, Bastawrous A. How the smartphone is driving the eye-health imaging revolution. Expert Rev Ophthalmol. 2014;9:475–85.

  15. 15.

    Bastawrous A, Giardini M, Bolster NM, et al. CLinical validation of a smartphone-based adapter for optic disc imaging in kenya. JAMA Ophthalmol. 2016;134:151–8.

  16. 16.

    Muiesan ML, Salvetti M, Paini A, Riviera M, Pintossi C, Bertacchini F, et al. Ocular fundus photography with a smartphone device in acute hypertension. J Hypertens. 2017;35:1660–5.

  17. 17.

    Russo A, Mapham W, Turano R, Costagliola C, Morescalchi F, Scaroni N, et al. Comparison of smartphone ophthalmoscopy with slit-lamp biomicroscopy for grading vertical cup-to-disc ratio. J Glaucoma. 2016;25:e777–81.

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Author information


  1. Sunderland Eye Infirmary, Sunderland, UK

    • Sunil Mamtora
    •  & Maria Teresa Sandinha
  2. Sunderland Royal Hospital, Sunderland, UK

    • Amritha Ajith
  3. Newcastle University, Newcastle upon Tyne, UK

    • Anna Song
  4. Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK

    • David H. W. Steel


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The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Sunil Mamtora.

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