A smartphone lens attachment improves the quality of referrals to eye casualty

BACKGROUND/OBJECTIVES: In recent years, eye casualty clinics have seen significant increases in patient numbers with reduced capacity. COVID-19 has exacerbated this issue and demonstrated the potential of telemedicine as a solution. Our study evaluated the potential benefit of a smartphone-based lens attachment to improve the referral pathway for anterior segment related complaints in eye casualty. SUBJECTS/METHODS: Fifty-four consecutive patients with anterior segment complaints were recruited. A questionnaire was completed with each patient to simulate the history from the point of referral. White light and cobalt blue photos were captured using a smartphone lens. The clinician reviewing the patient was asked to document the actual diagnosis and the appropriate time-frame within which they felt the patient could safely have been seen within; both with and without the option of management advice at the time of triage. The subsequent images and questionnaires were reviewed by a single consultant Ophthalmologist who was independent to the data collection process. The assessor was asked to make a diagnosis and management plan based upon the questionnaire (‘History’), and the questionnaire with the photo (‘History with Image’), as well as rate their clinical confidence on a 1–5 scale. RESULTS: Diagnostic accuracy was significantly higher in “History with Image” (98.2%), when compared to “History” only (48.2%). “History with Image” prevented significantly more appointments when compared to “History” alone, at similar levels to retrospective clinic review. Preventable appointments were increased if clinical advice was possible. Timeframe of appointments between ‘History with Image’ and ‘Clinic’ appointments was similar. Clinical’Confidence was significantly higher at 4.5 with ‘History with Image’ when compared to 2.37 with ‘History Only’. CONCLUSION: A low-cost smartphone lens attachment, alongside a standardised clinical questionnaire, can improve the referral pathway to the hospital eye service by reducing unnecessary appointments, while improving clinical confidence and diagnostic accuracy during triage. Further work to evaluate referral pathways, including the development of systems that allow for secure image transmission are needed to understand the feasibility for the widespread adoption of this technology.