Reliability and Accuracy of Smart Eye Camera for Detection of Optic Disc Abnormalities in Optic Neuropathies

Purpose To evaluate the interobserver reliability of the Smart Eye Camera (SEC) and assess its diagnostic accuracy compared with fundus photography in detecting optic disc abnormalities among patients with optic neuropathies. Design Cross-sectional observational study conducted in two phases (interobserver reliability, diagnostic accuracy) from July 2024 to January 2025. Participants Participants were 68 adults aged 18–60 years with confirmed optic neuropathy. Methods The study was conducted in two phases: Phase I assessed interobserver reliability of SEC recordings by two neuro-ophthalmologists. Phase II compared SEC findings with fundus photography to determine diagnostic accuracy. Statistical analysis included Kappa coefficients for reliability and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy for diagnostic performance. Results Interobserver agreement for optic disc abnormalities assessed via SEC showed moderate to very good agreement (Kappa = 0.649–0.862, p < 0.001). Compared with fundus photography, SEC showed high diagnostic performance for several optic disc abnormalities, with the highest accuracy observed for optic disc edema (94.1%), followed by optic disc pallor/atrophy (80.8%) and disc at risk (88.2%). Reliability and accuracy for peripapillary hemorrhage and optic disc drusen could not be robustly established because of the limited number of cases. Conclusion SEC demonstrated good interobserver reliability and high diagnostic accuracy in assessing optic disc abnormalities in patients with optic neuropathy. Its portability, affordability, and usability suggest potential as a reliable screening tool, particularly in settings with limited access to conventional imaging. Future larger studies should investigate whether diagnostic performance differs across specific etiologies of optic neuropathy.