Objetivos: Comparar a qualidade das imagens da retina capturadas com um retinógrafo portátil acoplado a um celular smartphone (RPC) com aquelas adquiridas com um retinógrafo de mesa comercial padrão (RMP) e analisar a concordância na determinação da relação escavação/cabeça do nervo óptico em um coorte de pacientes de um serviço oftalmológico. Casuística e Métodos: Cinquenta pacientes de um serviço oftalmológico secundário foram submetidos à avaliação de fundo de olho bilateral, sob midríase, utilizando o RPC e o RMP (quatro imagens por paciente). Os fatores relacionados à qualidade das imagens foram avaliados utilizando análise de regressão multivariada. Dois oftalmologistas determinaram, de forma mascarada, a relação da escavação/cabeça do nervo óptico de cada imagem e a concordância intra (entre os aparelhos) e interobservador foi calculada. Resultados: Noventa e oito imagens de 49 pacientes apresentaram qualidade suficiente para serem incluídas no estudo. As medianas (intervalo interquartil) da qualidade das imagens não apresentou diferença estatística entre o RPC e o RMP (4 [4-5] versus 4 [3-4], respectivamente, p=0.06). As imagens obtidas com o RMP e o diagnóstico de opacidade de meios apresentaram correlação negativa com a qualidade da imagem. A concordância intra e interobservador foi excelente e estatisticamente significativa (p<0,01). Conclusões: Os resultados observados sugerem que o RPC apresenta qualidade de imagem semelhante ao RMP, com concordância significativa na análise da relação escavação/cabeça do nervo óptico. Além dos bons resultados obtidos, o RPC pode ser considerado uma alternativa de baixo custo e portátil para documentação de retina em cenários futuros de telemedicina.

Purpose: To compare the quality of retinal images captured with a smartphone-based, handheld fundus camera with that of retinal images captured with a commercial fundus camera and to analyze their agreement in determining the cup-to-disc ratio for a cohort of ophthalmological patients. Casuistic and Methods: A total of 50 patients from a secondary ophthalmic outpatient service center underwent a bilateral fundus examination under mydriasis with a smartphone-based, handheld fundus camera and with a commercial fundus camera (4 images/patient by each). Two experienced ophthalmologists evaluated all the fundus images and graded them on the Likert 1-5 scale for quality. Multivariate regression analyses was then performed to evaluate the factors associated with the image quality. Two masked ophthalmologists determined the vertical cup-to-disc ratio of each fundus image, and both the intraobserver (between devices) and interobserver agreement between them was calculated. Results: Ninety-eight images from 49 patients were processed in this study for their quality analysis. Ten images from five patients (four from commercial fundus camera and one from smartphone-based, handheld fundus camera) were not included in the analyses due to their extremely poor quality. The medians [interquartile interval] of the image quality were not significantly different between those from the smartphone-based, handheld fundus camera and from the commercial fundus camera (4 [4-5] versus 4 [3-4] respectively, p=0.06); however, both the images captured with the commercial fundus camera and the presence of media opacity presented a significant negative correlation with the image quality. Both the intraobserver [intraclass correlation coefficient (ICC) = 0.82, p<0.001 and 0.83, p<0.001, for examiners 1 and 2, respectively] and interobserver (ICC=0.70, p=0.001 and 0.81; p<0.001, for smartphone-based handheld fundus camera and commercial fundus camera, respectively) agreements were excellent and statistically significant. Conclusions: Our results thus indicate that the smartphone-based, handheld fundus camera yields an image quality similar to that from a commercial fundus camera, with significant agreement in the cup-to-disc ratios between them. In addition to the good outcomes recorded, the smartphone-based, handheld fundus camera offers the advantages of portability and low-cost to serve as an alternative for fundus documentation for future telemedicine approaches in medical interventions.