Smart Phone Based Specular Imaging And App Based Analysis Of Corneal Endothelium

Specular microscopes are important tools to monitor the health of the corneal endothelium, but their high costs significantly limit accessibility in

low-resource environments. We developed and validated a low-cost, fully automated method to quantitatively evaluate the corneal endothelium(CE) using smartphone-based specular microscopy

Slit lamp assited smart phone camera based image capturing with in built app based image analysis and reporting

A OnePlus 7 Pro smartphone attached to a Topcon SL-D701 slit-lamp was used to image the central corneal endothelium of 30 eyes using the specular reflection technique.A novel on-device imageprocessing algorithm automatically computed endothelial cell density (ECD), percentage of hexagonal cells (HEX), and coefficient of variation (CV) values. These values were compared with the ECD, HEX, and CV generated by a TomeyEM-4000 specular microscope used to image the same set of eyes.

No significant differences were found in ECD (2799 ± 156 cells/mm2 vs.2779 ± 166 cells/mm2; P= 0.28) and HEX (52 ± 6% vs. 53 ± 6%; P= 0.50) computed by smartphone-based specular imaging and specular microscope,respectively.A statistically significant difference in CV(34±3%vs.30±3%;P < 0.01) was found between the two methods.The concordance achieved between the smartphone-based method and theTomey specular microscope is very similar to the concordance between two specular microscopes reported in the literature.

Smartphone-based specular imaging and automated analysis is a low-cost method to quantitatively evaluate the CE witha ccuracyc omparable to the  clinical standard.