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      Development and Preliminary Evaluation of a Smartphone App for Measuring Eye Alignment

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          Abstract

          Purpose

          We evaluate a smartphone application (app) performing an automated photographic Hirschberg test for measurement of eye deviations.

          Methods

          Three evaluation studies were conducted to measure eye deviations in the horizontal direction. First, gaze angles were measured with respect to the ground truth in nonstrabismic subjects ( n = 25) as they fixated monocularly on targets of known eccentricity covering an angular range of approximately ±13°. Second, phoria measurements with the app at near fixation (distance = 40 cm) were compared with the modified Thorington (MT) test in normally-sighted subjects ( n = 14). Third, eye deviations using the app were compared to a cover test with prism neutralization (CTPN; n = 66) and Synoptophore ( n = 34) in strabismic subjects. Regression analyses were used to compare the app and clinical measurements of the magnitude and direction of eye deviations (prism diopters, Δ).

          Results

          The gaze angles measured by the app closely followed the ground truth (slope = 1.007, R 2 = 0.97, P < 0.001), with a root mean squared error (RMSE) of 2.4Δ. Phoria measurements with the app were consistent with MT (slope = 0.94, R 2 = 0.97, P < 0.001, RMSE = 1.7Δ). Overall, the strabismus measurements with the app were higher than with Synoptophore (slope = 1.15, R 2 = 0.91, P < 0.001), but consistent with CTPN (slope = 0.95, R 2 = 0.95, P < 0.001). After correction of CTPN values for near fixation, the consistency of the app measurements with CTPN was improved further (slope = 1.01).

          Conclusions

          The app measurements of manifest and latent eye deviations were consistent with the comparator clinical methods.

          Translational Relevance

          A smartphone app for measurement of eye alignment can be a convenient clinical tool and has potential to be beneficial in telemedicine.

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          Most cited references36

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          Factors associated with childhood strabismus: findings from a population-based study.

          Annette Kifley, M Ip, K. Rose … (2006)
          To describe strabismus prevalence and associated factors in a representative sample of 6-year-old Australian children. Population-based cross-sectional study. One thousand seven hundred thirty-nine predominantly 6-year-old children resident in Sydney examined in 2003 and 2004. Cover testing was performed at near and distance fixation, and with spectacles if worn. Logarithm of the minimum angle of resolution visual acuity was measured in both eyes before and after pinhole correction, after correcting any cylindrical refraction >0.50 diopters and with spectacles, if worn. Cycloplegic autorefraction (cyclopentolate) and detailed dilated fundus examination were performed. Each child's medical and perinatal histories were sought in a detailed parental questionnaire. Strabismus was defined as any heterotropia at near or distance fixation, or both, on cover testing. Microstrabismus was defined as a deviation of fewer than 10 prism diopters. Strabismus was diagnosed in 48 children (2.8% of the population), 5 of whom had previously undergone surgical correction; 26 children (54%) had esotropia, 14 (29%) had exotropia, 7 (15%) had microstrabismus, and 1 child had VIth cranial nerve palsy. Prematurity was associated with a 5-fold increase in the risk of esotropia (odds ratio, 5.0; 95% confidence interval, 1.8-14.1). Visual impairment (with presenting correction) was significantly more common in children with (22.9%) than without (1.3%) strabismus (P<0.0001). The presence of strabismus was significantly associated with hyperopia, astigmatism, anisometropia, and amblyopia (P<0.0001). This report documents the prevalence of strabismus and its relation to other ocular signs and visual impairment in a representative sample of Australian school children. Presence of strabismus was significantly associated with prematurity.
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            Axial length, anterior chamber depth-a study in different age groups and refractive errors.

            Veena Bhardwaj, Gandhi Parth Rajeshbhai (2013)
            Axial length and anterior chamber depth play an important role in refractive status of the eye in different age groups.
            Article 0 comments Cited 39 times – based on 0 reviews     Review now
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              Early screening for amblyogenic risk factors lowers the prevalence and severity of amblyopia.

              M Eibschitz-Tsimhoni, T Friedman, Z Friedman … (2000)
              To evaluate the efficacy of a mass screening program for amblyopia and amblyogenic risk factors in infants. Since 1968, children between the ages of 1 and 2(1/2) years in the city of Haifa, Israel, have been systematically screened for amblyopia and amblyogenic risk factors. The screening is performed by the Ophthalmology Department of Bnai-Zion Medical Center (formerly known as Rothchild Hospital). In 1995, we compared the prevalence and severity of amblyopia in two populations of 8-year-old children in elementary school: one group was a cohort of 808 children from the city of Haifa and its vicinity, who had been screened in infancy (between 1988 and 1990); and the second group, the control group, was a cohort of 782 children from Hadera and its vicinity, where this early screening program is not conducted. Amblyopia was defined as corrected visual acuity of 1 line difference in corrected visual acuity between the two eyes. Referral rate, treatment rate, sensitivity, specificity, and positive predictive value and negative predictive value of the screening test in detecting factors that later resulted in the development of amblyopia were examined. The prevalence of amblyopia in the 8-year-old population screened in infancy was found to be 1.0% compared with 2.6% in the 8-year-old population that had not been screened in infancy (P =.0098). The prevalence of amblyopia with visual acuity of < or =5/15 (20/60) in the amblyopic eye was 0.1% in the screened population compared with 1.7% in the non-screened population (P =.00026). In the screened infant population, 3.6% were referred from the screening examination to a confirmatory examination and 2.2% were treated. The screening examination had a sensitivity of 85.7% and a specificity of 98.6% for amblyopia. The positive predictive value of the screening examination was 62.1% and the negative predictive value was 99.6%. The screening program for amblyopia and amblyogenic risk factors in infants, followed by appropriate treatment, is effective in significantly reducing the prevalence and severity of amblyopia in children.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Transl Vis Sci Technol
                Journal ID (iso-abbrev): Transl Vis Sci Technol
                Journal ID (hwp): tvst
                Journal ID (pmc): Transl Vis Sci Technol
                Journal ID (publisher-id): TVST
                Title: Translational Vision Science & Technology
                Publisher: The Association for Research in Vision and Ophthalmology
                ISSN (Electronic): 2164-2591
                Publication date Collection: January 2019
                Publication date (Electronic): 8 February 2019
                Volume: 8
                Issue: 1
                Electronic Location Identifier: 19
                Affiliations
                [1 ]Schepens Eye Research Institute of Mass Eye & Ear, Harvard Medical School, Boston, MA, USA
                [2 ]Eye & ENT Hospital, Fudan University, Shanghai, China
                [3 ]NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
                Author notes
                Correspondence: Rui Liu, Eye & ENT Hospital, 83 Fenyang Road, Shanghai, China 200031. e-mail: rui_liu@ 123456aliyun.com
                Article
                Serial Item and Contribution ID: tvst-08-01-16 Publisher ID: TVST-18-0930
                DOI: 10.1167/tvst.8.1.19
                PMC ID: 6369861
                PubMed ID: 30766761
                SO-VID: 49a6a271-b720-49d3-9b4e-1731e158612d
                Copyright © Copyright 2019 The Authors
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                Date received : 11 June 2018
                Date accepted : 20 October 2018
                Categories
                Subject: Articles

                Keywords: smartphone app,eye alignment,strabismus
                Data availability:
                Keywords: smartphone app, eye alignment, strabismus

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