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This paper outlines ARCELE – Computer Assisted Detection of Leukocoria. This is an iPhone app developed to increase early detection of retinoblastoma by detecting leukocoria. The aim of this study was to determine the use of CRADLE as a screening tool in clinical practice. This was a prospective study of 244 eyes of 122 children aged one to six years; 52% were males. Of these children, nine had cataract, one stage five retinopathy of prematurity (ROP) and three had retinoblastoma. Leukocoria was evaluated in all by penlight or ophthalmoscope. The app detected two eyes of the same patient with bilateral retinoblastoma. None of the cataract eyes were detected by the app. Therefore, there were 11 false negatives and 0 false positives. Sensitivity of the app was 15.38% and 100% specificity. Negative likelihood ratio was 0.85. The authors conclude the app may be a valuable support to parents. However, it cannot be considered as an alternative to the use of an ophthalmoscope. 

Evaluation of a free public smartphone application to detect leukocoria in high-risk children aged 1 to 6 years.
Vagge A, Wangtiraumnuay N, Pellegrini M, et al.
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Fiona Rowe (Prof)

Institute of Population Health, University of Liverpool, UK.

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