Evaluation of corneal infections using a smartphone macro lens for synchronous telemedicine

PURPOSE: To determine the efficacy of synchronous telemedicine consultation with a corneal specialist using a macro lens attachment to a smartphone to evaluate corneal infections. METHODS: Patients aged 18 years or older who presented to the Cornea Clinic at Wills Eye Hospital between June 2020 and March 2021 with a corneal infection were examined by two fellowship-trained cornea specialists. One examiner (CJR) performed face-to-face (FTF) slit-lamp evaluations, whereas another examiner (ZAS) performed synchronous telemedicine visit (STV) evaluations via a smartphone with a macro lens of 7× magnification (Olloclip; Foothill Ranch, CA, USA) held by trained study coordinators. Agreement between examinations was measured. RESULTS: Twenty patients were enrolled with an average age of 53.1 ± 13.5 years. When comparing FTF and STV approaches, perfect or excellent concordance or agreement was detected when documenting lagophthalmos (100% agreement), quadrants of conjunctival injection (100% agreement), epithelial defect size (intraclass correlation coefficient [ICC] = 0.964 and 0.946 for maximum and minimum dimensions, respectively), infiltrate size (ICC = 0.920 and 0.831 for maximum and minimum dimensions, respectively), Seidel positivity (100% agreement), presence of hypopyon (κ = 1.000), size of hypopyon (ICC = 0.979), and posterior synechiae (100% agreement). Good concordance was observed for the presence of conjunctival injection (κ = 0.643). Fair concordance was noted for percentage corneal thinning (ICC = 0.504) and presence of Descemet folds (κ = 0.400). Poor concordance was observed for the presence and number of keratic precipitates (κ = −0.184 and − 0.042, respectively) and for anterior chamber cells (κ = 0.286). CONCLUSION: Synchronous telemedicine enabled by a macro lens-supplemented smartphone camera may be a valuable method for evaluating various key features of infectious keratitis.