TY - JOUR
T1 - Evaluation of photography using head-mounted display technology (Icaps) for district trachoma surveys
AU - Naufal, Fahd
AU - Brady, Christopher J.
AU - Wolle, Meraf A.
AU - Kashaf, Michael Saheb
AU - Mkocha, Harran
AU - Bradley, Christopher
AU - Kabona, George
AU - Ngondi, Jeremiah
AU - Massof, Robert W.
AU - West, Sheila K.
N1 - Funding Information:
Grants provided by the United States Agency for International Development (7200AA18CA00040), National Institute of General Medical Sciences (P20GM103644), The Conrad N. Hilton Foundation (17332) and the Seeing is Believing Foundation. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Publisher Copyright:
© 2021 Naufal et al.
PY - 2021/11
Y1 - 2021/11
N2 - Background As the prevalence of trachoma declines worldwide, it is becoming increasingly expensive and challenging to standardize graders in the field for surveys to document elimination. Photography of the tarsal conjunctiva and remote interpretation may help alleviate these chal-lenges. The purpose of this study was to develop, and field test an Image Capture and Processing System (ICAPS) to acquire hands-free images of the tarsal conjunctiva for upload to a virtual reading center for remote grading. Methodology/Principal findings This observational study was conducted during a district-level prevalence survey for tracho-matous inflammation—follicular (TF) in Chamwino, Tanzania. The ICAPS was developed using a Samsung Galaxy S8 smartphone, a Samsung Gear VR headset, a foot pedal trigger and customized software allowing for hands-free photography. After a one-day training course, three trachoma graders used the ICAPS to collect images from 1305 children ages 1–9 years, which were expert-graded remotely for comparison with field grades. In our expe-rience, the ICAPS was successful at scanning and assigning barcodes to images, focusing on the everted eyelid with adequate examiner hand visualization, and capturing images with sufficient detail to grade TF. The percentage of children with TF by photos and by field grade was 5%. Agreement between grading of the images compared to the field grades at the child level was kappa = 0.53 (95%CI = 0.40–0.66). There were ungradable images for at least one eye in 199 children (9.1%), with more occurring in children ages 1–3 (18.5%) than older children ages 4–9 (4.2%) (χ2 = 145.3, p<0.001). Conclusions/Significance The prototype ICAPS device was robust, able to image 1305 children in a district level survey and transmit images from rural Tanzania to an online grading platform. More work is needed to improve the percentage of ungradable images and to better understand the causes of disagreement between field and photo grading.
AB - Background As the prevalence of trachoma declines worldwide, it is becoming increasingly expensive and challenging to standardize graders in the field for surveys to document elimination. Photography of the tarsal conjunctiva and remote interpretation may help alleviate these chal-lenges. The purpose of this study was to develop, and field test an Image Capture and Processing System (ICAPS) to acquire hands-free images of the tarsal conjunctiva for upload to a virtual reading center for remote grading. Methodology/Principal findings This observational study was conducted during a district-level prevalence survey for tracho-matous inflammation—follicular (TF) in Chamwino, Tanzania. The ICAPS was developed using a Samsung Galaxy S8 smartphone, a Samsung Gear VR headset, a foot pedal trigger and customized software allowing for hands-free photography. After a one-day training course, three trachoma graders used the ICAPS to collect images from 1305 children ages 1–9 years, which were expert-graded remotely for comparison with field grades. In our expe-rience, the ICAPS was successful at scanning and assigning barcodes to images, focusing on the everted eyelid with adequate examiner hand visualization, and capturing images with sufficient detail to grade TF. The percentage of children with TF by photos and by field grade was 5%. Agreement between grading of the images compared to the field grades at the child level was kappa = 0.53 (95%CI = 0.40–0.66). There were ungradable images for at least one eye in 199 children (9.1%), with more occurring in children ages 1–3 (18.5%) than older children ages 4–9 (4.2%) (χ2 = 145.3, p<0.001). Conclusions/Significance The prototype ICAPS device was robust, able to image 1305 children in a district level survey and transmit images from rural Tanzania to an online grading platform. More work is needed to improve the percentage of ungradable images and to better understand the causes of disagreement between field and photo grading.
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U2 - 10.1371/journal.pntd.0009928
DO - 10.1371/journal.pntd.0009928
M3 - Article
C2 - 34748543
AN - SCOPUS:85120645208
SN - 1935-2727
VL - 15
JO - PLoS neglected tropical diseases
JF - PLoS neglected tropical diseases
IS - 11
M1 - e0009928
ER -