Take Your ‘Pic’: Examining Different Anterior Segment Photography Techniques At Moorfields Eye Hospital

Anterior segment photography (ASP) can be used to capture various structures at the front of the eye. The technique can be used to improve referrals, aid clinical decision-making, streamline the patient journey, and monitor disease progression. ASP leverages the rapidly advancing camera technology in smartphones, enabling the capture of high-definition images in just seconds. The aim of this project was to evaluate clinician experiences with four ASP techniques in the accident & emergency (A&E) and corneal services.

A prospective survey and interview-based mixed-methodology study at Moorfields Eye Hospital (MEH, London, UK).

Four photography modalities were identified for assessment: Magnifier App (Apple, USA), QuikVue Smartphone Adapter (VisuScience Meditech, China), Celestron NexYZ Slit-Lamp Adaptor (Celestron, USA), and the integrated Zeiss SL Imaging System (Carl Zeiss AG, Germany). A validated survey and one-to-one interviews were conducted exploring user experiences – specialty registrars and corneal fellows – with the four ASP techniques. Survey data was analysed using simple descriptive statistics and iterative reflexive thematic analysis was applied to interviews.

A total of 25 survey responses were collected: 17 registrars (68%) and 8 fellows (32%). Twelve interviews were conducted, with a mean duration of 18 minutes (range: 8–45 minutes). Survey results showed the Magnifier App scored highest across all domains: 76% (19/25) found it easy to use, and 92% (23/25) found it cost-effective. Interviews identified five core themes: ‘Obstacles to Clinical Use,’ ‘Advantages for Clinical Use,’ ‘Enhancing Accessibility,’ ‘Effective Photographic Documentation,’ and ‘Clinical Ethics of Personal Devices.’ Thematic analysis indicated clinicians favoured Magnifier, though all devices had pros and cons. Subthemes noted clinicians valued ASP but raised concerns about systems, time demands, and data security.

In a generation of digital natives, technology is steadily infiltrating routine clinical practice. Our study shows there is no perfect ASP solution at MEH, suggesting there is room for improvement to optimise clinical workflow. In general, clinicians preferred the use of Magnifier App in the departments of cornea and A&E due to its software functionality and integration with smartphone technology, not requiring additional hardware. This was followed closely by the Celestron NexYZ Slit-Lamp Adapter. Future work needs to focus on developing data protection policies for smartphone imaging and exploring patient perception of ASP using personal smartphone devices.