{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T14:00:52Z","timestamp":1768572052575,"version":"3.49.0"},"posted":{"date-parts":[[2025,11,15]]},"group-title":"Ophthalmology","reference-count":29,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T00:00:00Z","timestamp":1763164800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,11,15]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Cataract and anterior segment diseases are leading causes of blindness in low-resource settings. Eye camp screenings remain the primary mode of community outreach but are constrained by cost, logistics, and dependence on highly trained specialists. We designed and validated a low-cost, user-friendly smartphone-based anterior segment imaging and teleophthalmology platform to enable community health workers (CHWs) to perform diagnostic-quality eye screening.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\n                    We designed a portable imaging device (Scout\n                    <jats:sup>TM<\/jats:sup>\n                    ) paired with an accessible Android smartphone and mobile application (InSightful) for telemedicine in low-bandwidth settings. CHWs underwent 3 hours of training on using the imaging software and hardware, then screened patients across 19 rural eye camps in South India with anterior segment images and clinical data uploaded to a cloud-based database for remote ophthalmologist (RO) review. Diagnoses and referral decisions made by ROs were compared with those of in-person eye camp ophthalmologists (ECOs). CHWs, ROs, and patients were surveyed on the platform\u2019s feasibility and acceptability.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Findings<\/jats:title>\n                  <jats:p>N=1093 patients underwent eye camp screening by ECOs and CHW-led smartphone screening with RO review. CHWs completed screenings in &lt;2.5 minutes\/eye and obtained diagnostic-quality images for &gt;90% of eyes. ROs and ECOs showed 96.1% concordance for referral decisions (95% CI 94.7-97.1) and substantial agreement in diagnosis of any cataract (\u03ba 0.77, percent agreement [PA] 89%), mature cataract (\u03ba 0.67, PA 96%), immature cataract (\u03ba 0.69, PA 85%), clear crystalline lens (\u03ba 0.65, PA 89%), pseudophakia (\u03ba 0.92, PA 97%), and moderate agreement for pterygium (\u03ba 0.47, PA 94%). Concordance increased with image quality. CHWs, ROs, and patients reported high usability, acceptability, and net promoter scores.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Interpretation<\/jats:title>\n                  <jats:p>\n                    Scout\n                    <jats:sup>TM<\/jats:sup>\n                    anterior segment screening by minimally trained CHWs achieves diagnostic and referral accuracy comparable to in-person ophthalmologist examinations, supporting potential to decentralize cataract screening and expand access to eye care in low-resource settings.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Funding<\/jats:title>\n                  <jats:p>National Eye Institute R21EY034343, National Eye Institute K23EY032988, National Eye Institute P30EY01765 (Biostatistics Core), Microsoft Innovation Acceleration Award, Johns Hopkins Center for Global Health, Stephen F Raab and Mariellen Brickley-Raab Rising Professorship in Ophthalmology, Boone Pickens Rising Professorship in Ophthalmology<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2025.11.11.25339801","type":"posted-content","created":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T23:45:10Z","timestamp":1763250310000},"source":"Crossref","is-referenced-by-count":0,"title":["Development and validation of a user-friendly smartphone imaging and telemedicine platform for remote diagnosis of anterior segment eye disease"],"prefix":"10.64898","author":[{"given":"Kunal S.","family":"Parikh","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan","family":"Shuff","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kamini","family":"Reddy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiangrong","family":"Kong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ximin","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shreya","family":"Hariharakumar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vijay Antony","family":"Santhanaraj","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rashmirita","family":"Kakoty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bharadwaj","family":"Karnam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prabhu Krishna","family":"Ravilla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nishant","family":"Vivekanand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Hoopes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelsey","family":"Detels","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niam","family":"Mohseni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rohan","family":"Verma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dema","family":"Shumeyko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dayakar","family":"Yadalla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rengaraj","family":"Venkatesh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nakul S.","family":"Shekhawat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2025111808300594000_2025.11.11.25339801v1.1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(17)30393-5"},{"key":"2025111808300594000_2025.11.11.25339801v1.2","unstructured":"World report on vision. 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