On the use of a new monocular-indirect ophthalmoscope for retinal photography in a primary care setting.

AIM: There is consensus among general practitioners regarding the difficulty of direct ophthalmoscopy. Hence, there is increasing interest in smartphone-based ophthalmoscopes; the New Zealand-made oDocs Nun ophthalmoscope is one such device, released in November 2018. This study aims to subjectively assess the quality of the images captured with it in order to determine the feasibility of its use in a primary care setting. METHOD: Twenty-eight general practitioners (GPs) from different practices throughout New Zealand agreed to participate in this prospective observational study and were sent an oDocs Nun ophthalmoscope. Using the device, clinicians took retinal photographs of patients who presented with visual complaints and uploaded one image per eye onto a database. Three hundred and fifty-seven photographs were collated and rated by four professionals (two ophthalmologists and two optometrists) on the basis of image quality and the anatomical features visible. RESULTS: On a Likert scale from 1 (poor quality) to 4 (very good quality), the median and mode values for each professional's rating of all photographs were both 2. On average, 94.5% of the photographs were deemed to have visible optic discs and 50.0% to have visible maculae adequate for detecting an abnormality. Pairwise comparison showed 93.7% agreement among the four professionals for optic disc visibility, and 74.2% agreement for macula visibility. CONCLUSION: The oDocs Nun is a promising tool which GPs could use to circumvent the challenges associated with direct ophthalmoscopy. With appropriate training to ensure proficiency, it may have a valuable role in telemedicine and tele-referral.