Integrating smartphone photography for trachoma, smartphone visual acuity assessment, and mobile autorefraction to enhance community-based public health monitoring

世界卫生组织（世卫组织）的目标是消除沙眼，这是世界上主要的传染性疾病， 失明为了确定一个地区是否需要沙眼治疗，世界卫生组织建议进行眼部检查 由沙眼分级认证人员对基于人群的儿童样本进行检测。世界卫生组织成功 消除沙眼运动造成的局面，其中一些地区有太多的沙眼病例 宣布消灭了沙眼，但沙眼病例太少，无法认证沙眼分级人员。采用基于智能手机 沙眼远程医疗解决了这一问题，允许几乎没有临床经验的工作人员进行 用于远程沙眼诊断的沙眼照片调查。然而，世卫组织目前的数据收集平台 对于沙眼调查，Tropical Data目前不支持目视摄影。我们在此提议， 将智能手机摄影与Tropical Data集成，并添加功能，将其转变为一个更 用户友好、开放访问的基于智能手机的调查模块套件。这将提高灵活性， 促进更广泛的健康调查，可用于更好地针对有限的卫生资源。 本研究的第一部分旨在开发和完善集成所需的硬件和软件 智能手机结膜摄影到热带数据平台，并评估的可行性， 在秘鲁的偏远社区环境中生产。第一，摄影、视觉敏锐度模块 评估、自动验光、样本采集和用户自定义问卷将添加到现有的 热带数据应用。其次，不同智能手机型号和/或环境照明的影响将是 评估每个模块。第三，更新后的移动的应用程序将在少数村庄进行测试， 确定每个孩子测试多个模块的可行性。 该研究的第二部分验证了基于智能手机的系统的组件， 秘鲁的不同现场位置（例如，丛林、山脉、沙漠）。我们将检查灵敏度和特异性 智能手机摄影相对于认证的人类分级员，智能手机视力相对于标准 ETDRS视力和相对于人类屈光的自动屈光，并假设这些指标将 上级于预定义的最低可接受标准。 加州大学旧金山分校普罗克特基金会和秘鲁的卡耶塔诺大学将合作实现这些目标。我们 将与世卫组织和热带数据组织密切合作，后者将积极参与这项研究 在整个开发和测试过程中。这项研究具有广泛传播和积极的潜力 对健康的影响

The World Health Organization (WHO) aims to eliminate trachoma, the world's leading infectious cause of blindness. To determine if trachoma treatment is needed in an area, the WHO recommends eye examinations on a population-based sample of children by personnel certified in trachoma grading. The WHO's successful trachoma elimination campaign has created a situation in which some areas have too many to trachoma cases to declare elimination but too few trachoma cases to certify trachoma graders. Adopting smartphone-based trachoma telemedicine addresses this issue by allowing workers with little clinical experience to perform trachoma photo-surveys for remote trachoma diagnoses. However, the WHO's current data collection platform for trachoma surveys, Tropical Data, does not currently support ocular photography. We propose here to integrate smartphone photography with Tropical Data and add functionality that will transform it into a more user-friendly, open access suite of smartphone-based survey modules. This would enhance flexibility and facilitate broader health surveys that can be used to better target limited health resources. This first part of the study aims to develop and refine the hardware and software necessary to integrate smartphone conjunctival photography into the Tropical Data platform, and to assess the feasibility of the resulting product in remote community-based settings in Peru. First, modules for photography, visual acuity assessment, autorefraction, sample collection, and user-defined questionnaires will be added to the existing Tropical Data application. Second, the impact of varying smartphone models and/or ambient lighting will be assessed for each module. Third, the updated mobile application will be tested in a small number of villages to determine the feasibility of testing multiple modules per child. The second part of the study validates the components of the smartphone-based system when used in three different field locations in Peru (e.g., jungle, mountains, desert). We will examine the sensitivity and specificity of smartphone photography relative to certified human graders, smartphone visual acuity relative to standard ETDRS visual acuity, and autorefraction relative to human refraction, and hypothesize that these metrics will be superior to pre-defined minimally acceptable criteria. The UCSF Proctor Foundation and Cayetano University in Peru will collaborate to achieve these goals. We will work in close cooperation with the WHO and Tropical Data, who will be actively engaged in this research throughout development and testing. This research has great potential for wide dissemination and positive impact on health.