Qualitative and Quantitative Analysis of the Corneal Endothelium With Smartphone Specular Microscopy

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https://journals.lww.com/corneajrnl/Abstract/publishahead/Qualitative_and_Quantitative_Analysis_of_the.96212.aspx

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https://doi.org/10.1097/ICO.0000000000002277
 http://hdl.handle.net/11603/17640

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2020-02-14

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journal articles postprints
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Fliotsos, Michael J.; Deljookorani, Shiva; Dzhaber, Daliya; Chandan, Subhangi; Ighani, Mehrnaz; Eghrari, Allen O.; Qualitative and Quantitative Analysis of the Corneal Endothelium With Smartphone Specular Microscopy; The Journal of Cornea and External Disease (2020); https://journals.lww.com/corneajrnl/Abstract/publishahead/Qualitative_and_Quantitative_Analysis_of_the.96212.aspx

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Abstract

Purpose: We sought to demonstrate the feasibility of a lower-cost, portable method for qualitative and quantitative analysis of the corneal endothelium using a smartphone and slit lamp biomicroscope. Methods: In this study at a single academic center, we recruited healthy participants to undergo imaging of the corneal endothelium using both a smartphone-based method and a specular microscope. Participants first had their eyes imaged with a CellChek® NSP-9900 Specular Microscope (Konan TM Medical, Inc.; Irvine, CA, USA). For image capture on the smartphone, a beam of light approximately 0.2mm in diameter was directed to the center of the cornea with a slit-lamp biomicroscope to achieve specular reflection. With 40x zoom on the slit-lamp and 4K video mode set on an iPhone 7 Plus held to an ocular, the corneal endothelium was recorded until the hexagonal pattern of cells was identified, and the sharpest frame from the video selected. Results: Videos were analyzed from 14 sets of eyes (average length 2 minutes 40 seconds). The average intraclass correlation coefficient was 0.67 (95% CI 0.43-0.82). The mean difference between smartphone endothelial cell count and specular endothelial cell count was -209 cells/mm² (standard deviation = 483 cells/mm²), which did not achieve significance (p=0.14). Bland-Altman analysis with simple linear regression showed no proportional bias when comparing the two modalities (coefficient =-0.20; t-value = -0.42; P = 0.68). Conclusion: Smartphone specular microscopy is capable of qualitative and quantitative analysis of the corneal endothelium. Further refinement to standardize the light source and automate analysis will increase feasibility.