Comparing the effectiveness of retina funduscopy using direct ophthalmoscope and handheld non-mydriatic digital retina fundus camera in medical practice.

Abstract

Introduction: Retinal examination plays an essential role in ocular assessment and serves as a key tool for diagnosing various eye conditions. The traditional direct ophthalmoscope (DO) remains widely used due to its affordability, accessibility, and rapid application. However, it presents several limitations, including a steep learning curve, narrow field of view, and strong dependence on user expertise. In contrast, the handheld fundus camera (HFC) is a newer innovation that provides high-resolution digital imaging and is more user-friendly. This study compared the usability, diagnostic confidence, and user preference between the DO and HFC among medical students and practitioners.

Materials and methods: This quasi-experimental study was conducted among 70 participants comprising medical students and practitioners. All participants had prior exposure to the DO and were recruited through convenience sampling. The study took place at the Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia (USIM), Negeri Sembilan and USIM's mobile eye screening sites. Participants received a 15-minute hands-on training with both the DO (Welch Allyn) and HFC (New Eyes) before performing non-mydriatic retinal examinations on separate patients. A structured questionnaire was used to assess device usability, comfort, diagnostic confidence, ability to identify retinal structures, and System Usability Scale (SUS) scores. Data were analysed using paired t-tests, Fisher's exact test, and chi-square tests.

Results: Among the participants, 70% were female and 62.9% were medical students. The mean(SD) time to identify retinal structures was significantly shorter with the HFC (2.8(1.84) minutes) compared to the DO (6.4(5.77) minutes; p<0.001). While red reflex detection was higher with the DO (97.1%), the HFC significantly outperformed in locating key structures: optic nerve (88.6% vs. 42.9%, p<0.001) and fovea (82.9% vs. 41.4%, p<0.001). No significant difference was found in identifying retinal vessels. Confidence in findings (92.9% vs. 32.9%) and image clarity (94.3% vs. 45.7%) favoured the HFC, with both differences being statistically significant (p<0.001). The HFC scored higher in usability with a mean SUS score of 64.0(9.37) versus 58.6(9.91) for the DO (p<0.001). Notably, 97.1% of participants preferred the HFC over the DO.

Conclusion: Our findings show that the HFC offers clear advantages over the traditional DO, especially in ease of use, diagnostic confidence, and user experience. These strengths make it a more effective tool in clinical practice and medical education.