Reliability and Accuracy of Smart Eye Camera in Determining Grading of Nuclear Cataract

Purpose: Cataracts are the cause of more than 50% of blindness in the world. Cataract is diagnosed using a slit lamp to evaluate the opacity of the lens. Slit lamps as the primary tools cataract are not available in primary care units. Smart Eye Camera (SEC) is a medical device placed on smartphone, capable of creating slit beam similar to conventional slit lamp. Previous studies have been conducted in Japan. We wanted to further compare ocular examination between SEC and conventional slit lamp with samples taken from UPTD Eye Clinic Ambon Vlissingen in Indonesia. Methods: Observational analytical study with a cross-sectional study design. The research sample consisted of 67 people selected by consecutive sampling. All samples were examined for cataracts using a conventional slit lamp and SEC. To evaluate the accuracy of SEC, diagnosis of cataract was carried out by one observer based on slit-lamp images. The results of examinations were then compared with the examinations by two observers based on the SEC video, where the videos were read two times in a span of 1 week. Results: Sixty-seven eye samples were taken with average age of 61.76 ± 5.83 years, visual acuity was 0.07 ± 0.12, intraocular pressure was 14.12 ± 2.06 mmHg, and SEC video duration was 4.15 ± 1.09 seconds. SEC intraobserver reliability has a κ of 0.795/0.818, SEC interobserver reliability has a κ of 0.795/0.817. SEC assessment accuracy for observer 1 has a κ of 0.606/0.681 and for observer 2 has a κ of 0.629/0.717, with the highest accuracy for cataract grade 3 (86.67% and 91.18%, respectively). Conclusions: This study shows SEC has good consistency and reliability in assessing the degree of nuclear cataract compared to conventional slit lamp. This tool could be used for cataract screening in remote areas.