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Comparison of Smartphone Photography, Single-Lens Reflex Photography, and Field-Grading for Trachoma

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  • 1 Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California;
  • 2 David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California;
  • 3 Department of Ophthalmology, University of California, San Francisco, San Francisco, California;
  • 4 Department of Bioengineering, University of California, Berkeley, Berkeley, California;
  • 5 The Carter Center Ethiopia, Addis Ababa, Ethiopia;
  • 6 The Carter Center, Atlanta, Georgia;
  • 7 Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St. Louis, St. Louis, Missouri;
  • 8 Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California;
  • 9 Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California

ABSTRACT

Conjunctival examination for trachomatous inflammation—follicular (TF) guides public health decisions for trachoma. Smartphone cameras may allow remote conjunctival grading, but previous studies have found low sensitivity. A random sample of 412 children aged 1–9 years received an in-person conjunctival examination and then had conjunctival photographs taken with 1) a single-lens reflex (SLR) camera and 2) a smartphone coupled to a 3D-printed magnifying attachment. Three masked graders assessed the conjunctival photographs for TF. Latent class analysis was used to determine the sensitivity and specificity of each grading method for TF. Single-lens reflex photo-grading was 95.0% sensitive and 93.6% specific, and smartphone photo-grading was 84.1% sensitive and 97.6% specific. The sensitivity of the smartphone-CellScope device was considerably higher than that of a previous study using the native smartphone camera, without attachment. Magnification of smartphone images with a simple attachment improved the grading sensitivity while maintaining high specificity in a region with hyperendemic trachoma.

    • Supplementary Materials

Author Notes

Address correspondence to John M. Nesemann, Francis I Proctor Foundation, 113 South Ferry Dr., Lake Mills, WI 53551. E-mail: jnesemann@mednet.ucla.edu

Financial support: The study was supported by grants U10EY022880 (T. M. L.) from the National Eye Institute and grants from That Man May See, the Fortisure Foundation, the Harper-Inglis Memorial for Eye Research, the Peierls Foundation, the Alta California Eye Research Foundation, the Bofinger Glaucoma Research fund, and research to prevent blindness. This project was supported by the National Eye Institute and the Fogarty International Center of the National Institutes of Health (NIH) under award number D43TW009343 as well as the University of California Global Health Institute (UCGHI) in the form of a Fogarty grant to J. M. N.

Disclaimer: Drs. Fletcher, Maamari and Margolis are co-inventors on patents owned by the University of California Berkeley that pertain to the Cellscope technology. None of the intellectual property is directly related to the Corneal Cellscope used in this study.

Authors’ addresses: John M. Nesemann, Geffen School of Medicine (Medical Student), University of California, Los Angeles, Los Angeles, CA, E-mail: jnesemann@mednet.ucla.edu. Michael I. Seider, Blake M. Snyder, Robi N. Maamari, Nicole E. Varnado, Sun Y. Cotter, Thomas M. Lietman, and Jeremy D. Keenan, Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, E-mails: michael.i.seider@kp.org, blake.snyder@cuanschutz.edu, robimaamari@gmail.com, nicolestoller@gmail.com, sun.cotter@ucsf.edu, tom.lietman@ucsf.edu, and jeremy.keenan@ucsf.edu. Daniel A. Fletcher, Department of Bioengineering, University of California, Berkeley, Berkeley, CA, E-mail: fletch@berkeley.edu. Berhan A. Haile and Zerihun Tadesse, The Carter Center Ethiopia, Addis Ababa, Ethiopia, E-mails: berhanayele@burnet.edu.au and zerihun.tadesse@cartercenter.org. Elizabeth Kelly Callahan and Paul M. Emerson, The Carter Center, Atlanta, GA, E-mails: kelly.callahan@cartercenter.org and pemerson@taskforce.org. Todd P. Margolis, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, E-mail: margolist@wustl.edu.

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