Evaluation of a new portable corneal topography system for self-measurement using smartphones: a pilot study

PURPOSE

Herein, we propose the use of the "KeraVio Ring", which is a portable, selfie-based, smartphone-attached corneal topography system that is based on the Placido ring videokeratoscope. The goal of this study was to evaluate and compare corneal parameters between KeraVio Ring and conventional corneal tomography images.

METHODS

We designed the KeraVio Ring as a device comprising 3D-printed LED rings for generating Placido rings that can be attached to a smartphone. Two LED rings are attached to a cone-shaped device, and both corneas are illuminated. Selfies were taken using the KeraVio Ring attached to the smartphone without assistance from any of the examiners. Captured Placido rings on the cornea were analysed by intelligent software to calculate corneal parameters. Patients with normal, keratoconus, or LASIK-treated eyes were included. Anterior segment optical coherence tomography (AS-OCT) was also performed for each subject.

RESULTS

We found highly significant correlations between the steepest and flattest keratometry, corneal astigmatism, and vector components obtained with the KeraVio Ring and AS-OCT. In subjects with normal, keratoconus, and LASIK-treated eyes, the mean difference in corneal astigmatism between the two devices was -0.8 ± 1.4 diopters (D) (95% limits of agreement (LoA), -3.6 to 2.0), -1.8 ± 3.7 D (95% LoA, -9.1 to 5.5), and -1.5 ± 1.3 D (95% LoA, -4.0 to 1.1), respectively.

CONCLUSIONS

The experimental results showed that the corneal parameters obtained by the KeraVio Ring were correlated with those obtained with AS-OCT. The KeraVio Ring has the potential to address an unmet need by providing a tool for portable selfie-based corneal topography.

Perception of frontal facial images compared with their mirror images: chirality, enantiomorphic discrimination, and relevance to clinical practice

BACKGROUND

What we think we see consists of models constructed in our brains, which may be constrained, limited and perhaps modified at a cerebral level. Patients may view their mirror image differently to how others and the clinical team view them. Understanding potential variations in perception between real and mirror images is important in clinical practice. The aims were to assess differences in self-perception between frontal facial and mirrored photographs, comparing the results with selfie photographs.

METHODS

Facial photographs were taken by one investigator under standardized conditions for preclinical and clinical students. Each student took a selfie photograph at rest and smiling using his/her smartphone. A mirror image was generated for each image. Each student was shown his/her original and mirror image, without being informed which was which. For each pair of images, students were asked to choose which photograph they perceived as more attractive. A set of photographs of a male volunteer was shown to all participants, to choose either the original or mirror image as the more attractive.

RESULTS

Most observers preferred the true image of the volunteer (P < 0.05), which may be evidence that most people prefer the true image of others, which is how they normally view them. Most observers preferred their own original photograph in frontal view at rest and smiling (P < 0.05), but preferred the mirror image of their selfie photograph at rest and smiling (P < 0.05).

CONCLUSIONS

Significant differences in perceptions of attractiveness between true and mirror-reversed frontal and selfie images were found. Observers preferred their image the way they view themselves in a mirror. The selfie is how other people view an individual. If a selfie is flipped horizontally, that is how an individual sees themselves in a mirror. Most observers preferred the mirror image of their selfie, which is how they would view themselves in a mirror.

'Fake' Instagram use is associated with real differences in users' self-photo activities: An exploratory investigation considering body satisfaction

BACKGROUND

Creating private spaces on social media (SM) for authentic self-presentation has rapidly gained popularity amongst young people. This pattern of use is particularly prevalent on Instagram in women under 25 as these users often report creating a second, low stakes account for authentic self-presentation, commonly referred to as a Finsta (a portmanteau of 'Fake' and 'Instagram'). Previous research has associated Instagram use with body dissatisfaction in young women, but it remains unclear whether this association is applicable when considering different patterns of use.

METHOD

The present study investigates the association between self-photo activities (i.e., photo selection, investment, and manipulation) and body satisfaction in a sample of undergraduate female Instagram users (N = 224) with (n = 112) and without (n = 112) a Finsta.

RESULTS

A series of analyses of covariance (ANCOVA) controlling for minutes on Instagram and age revealed that, when comparing their Finsta to their own main account and to the main account of users without a Finsta, Finsta users reported taking fewer photos of themselves, engaging in less photo editing, and feeling less invested in their posts. Furthermore, body satisfaction was differentially associated with self-photo activities in Finsta users and non-users. Specifically, body satisfaction was negatively associated with photo selection, investment, and editing in users without a Finsta only.

CONCLUSION

Finsta users do not show the same associations between body satisfaction and self-photo activities as Instagram users without a Finsta. The implications of these results, limitations of the present study, and suggestions for future research are discussed.

Selfie-related deaths using web epidemiological intelligence tool (2008-2021): a cross-sectional study

The quest for extreme selfies killed 379 people since 2008. One in three was a traveller. Falls from height, transport and drowning were the top three causes. Many selfie deaths are the result of tourists taking risks in unfamiliar terrain. Travel medicine practitioners should routinely counsel travellers on responsible self-photography.

The effects of engaging in digital photo modifications and receiving favorable comments on women's selfies shared on social media

The present study explores how the construction and distribution of selfies might interact with features of newer media to affect women who share selfies on social media. In particular, this study focuses on how specific types of photo modification and the nature of favorable audience feedback received on one's images might exert influence on women's state self-objectification and body image concerns. A 3 × 2 between-subjects lab experiment was conducted to explore how the type of photo modification (appearance modifications, nonappearance modifications, or no modifications [control]) and nature of positive feedback (appearance comments vs. nonappearance comments) affect state self-objectification, state appearance satisfaction, pro-cosmetic surgery attitudes, and willingness to distribute selfies on social media in the future. Results indicate that modifying selfies leads to less appearance satisfaction and lower pro-cosmetic surgery attitudes. Receiving appearance comments on selfies heightens state self-objectification, regardless of the type of photo modification. In addition, the more women self-objectified, the more inclined they were to share similarly objectifying selfies on social media in the future. The findings of this work provide a more comprehensive understanding of how women are impacted by the images they share online.

Cell Phone Selfies: Clinching the Diagnosis of Iris Microhemangiomatosis

Four patients presented with a history of "blood" or a "dark spot" in the eye captured on cell phone photos. These episodes prompted presentation to an ophthalmologist where they all had normal slit lamp exams without a hyphema at initial evaluation. With evidence of a spontaneous hyphema seen on photos, further testing was performed including iris fluorescein angiography which revealed hyperfluorescent iris margin vascular tufts, confirming the diagnosis of iris microhemangiomatosis in each patient. All cases were managed conservatively, and only 1 needed topical antihypertensives. Without these patient-initiated photos, the diagnosis of iris microhemangiomatosis would likely remain elusive as slit lamp exam was normal at the time of initial examination in all 4 cases. Ophthalmologists should be aware of this rare diagnosis in the event a patient comes with a cell phone selfie documenting a spontaneous hyphema, especially when emanating from pupillary border.

#nomakeupselfie: The impact of natural no-makeup images and positive appearance comments on young women's body image

Presenting no-makeup selfies interspersed with idealized made-up images may be beneficial for women's body image. However, the impact of viewing only no-makeup selfies is still unknown, as is the influence of any positive appearance-related comments from others accompanying those images on social media. Thus, in the present study, we examined the impact of viewing either: (1) idealized images with appearance-related comments, (2) idealized images with appearance-neutral comments, (3) no-makeup images with appearance-related comments, or (4) no-makeup images with appearance-neutral comments, on young women's (N = 394) appearance satisfaction, mood, appearance comparison frequency, and perceived attainability. Viewing idealized selfies of attractive women reduced women's satisfaction with their overall and facial appearance. Viewing natural no-makeup images of those attractive women also reduced women's facial satisfaction but had no impact on overall appearance satisfaction. No-makeup selfies resulted in less frequent appearance comparisons and higher perceived attainability than idealized images. There was no impact of appearance-related comments on any of the outcomes. The results suggest that no-makeup images are less detrimental to young women's body image than idealized images.

The Selfie View: Perioperative Photography in the Digital Age

BACKGROUND

The aesthetics of social media have become increasingly important to cosmetic surgery patients in recent years; however, aesthetic treatments have not kept pace with the desires of modern patients. The current study investigates the most common angles employed by various user cohorts when posting a selfie on social media platforms and proposes that aesthetic surgeons consider utilizing a selfie angle alongside standard pre- and postoperative photographic views.

METHODS

Full face photographs published on the social media platform Instagram™ with the tag #selfie were divided into three cohorts: female models/influencers, amateur females, and amateur males. Each cohort contained 100 photographs. The photographs were analyzed using cloud-based facial analysis software for facial pan, roll, and tilt relative to the camera.

RESULTS

One hundred photographs from each cohort were analyzed and demonstrated that amateur females (AF) take photographs from higher angles than amateur males (AM) or model females (MF). Roll-off-midline was significantly greater for AF and MF as compared to AM. The MF group had significantly a greater pan-off-midline as compared to AF and AM, while AF had significantly a greater pan-off-midline than AM.

CONCLUSIONS

Common photography practices employed within selfie photographs utilize angles not captured in standard perioperative photographs. This study supports the implementation of a selfie photograph into the standard set of pre- and postoperative photographs taken by aesthetic surgeons to evaluate the effects of interventions in the context of selfie photography. The angle employed can vary depending upon the demographic profile of the patient.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Prevalence and determinants of the dangerous selfie among medical and nursing students: a cross-sectional study from eastern India

BACKGROUND

Globally, there has been an exponential rise in smartphone use and selfie taking among youth. To make selfies exciting, dangerous selfies are often taken that may lead to catastrophic consequences, including death. This study aims to estimate the prevalence of dangerous selfies and to determine the factors associated with dangerous selfies among medical and nursing students in India.

METHODS

The study was conducted at the All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India, in April-August 2018. The inclusion criteria were students enrolled in the Bachelor of Medicine and Bachelor of Surgery (MBBS) and nursing courses of AIIMS, Bhubaneswar. Students who did not use smartphones were excluded from the study. The interview schedule and Selfitis Behaviour Scale (SBS) were used to collect information on sociodemographic variables, smartphone use and variables related to selfies and dangerous selfies. Forward stepwise logistic regression was undertaken with the probability of entry and removal as 0.05 and 0.10, respectively.

RESULTS

Of 633 eligible participants, 595 were included in the study. The mean (SD) age of the participants was 21.2 (1.6) years. More than half (56.8%) of the participants were female, 384 (64.5%) were medical students and 211 (35.5%) were nursing students. Nearly two-thirds of the participants (70.6%) preferred to take selfie. One hundred thirty three (40.3%) of the participants posted selfies on social media daily. The prevalence of dangerous selfies was 8.74% (95% CI: 6.73-11.28). Eight injury episodes while taking selfies were reported by seven (1.2%) participants. Being male (AOR 4.96, 95% CI 2.53-9.74), posting selfies on social media daily (AOR 3.33, 95% CI 1.71-6.47) and an SBS score > 75 (AOR 4.97, 95% CI 1.43-17.28) were independent predictors of dangerous selfies.

CONCLUSION

Nearly one in ten medical and nursing students reported having taken a dangerous selfie, and one in one hundred reported having been injured while attempting to take a selfie. Being male, posting selfies on social media daily and an SBS score > 75 were independent predictors of dangerous selfies. Further research is required to identify the community burden of dangerous selfies and to develop strategies to prevent selfie-related fatalities among youths.

The effect of #enhancement-free Instagram images and hashtags on women's body image

Instagram is a popular social networking site where users can post and share photos. One increasing trend on the site is the posting of natural and unaltered images. The present study aimed to experimentally investigate the effect of enhancement-free (i.e., no makeup, no digital alteration) Instagram images and their accompanying hashtags on women's body image. Participants were 204 female undergraduate students who were randomly assigned to view one of three sets of Instagram images: standard (i.e., idealised) images, enhancement-free images, or the same set of enhancement-free images with hashtags indicating their enhancement-free nature. As predicted, exposure to enhancement-free images resulted in significantly lower facial dissatisfaction than exposure to the standard images. However, the addition of hashtags resulted in significantly greater facial dissatisfaction than the same enhancement-free images with no hashtags. There were no significant effects for body dissatisfaction. Effects on facial dissatisfaction were moderated by self-photo manipulation, whereby the difference between standard and enhancement-free images was greater for women who digitally manipulate their own photos. Overall, the findings suggest that, under some conditions, enhancement-free images have the potential to protect Instagram users against appearance concerns.

A study of Singapore adolescent girls' selfie practices, peer appearance comparisons, and body esteem on Instagram

Social media allow users to play multiple roles as receivers, exhibitors, and evaluators of idealized images through photo browsing, posting, and editing. In this study, we examined the associations between adolescent girls' various types of Instagram selfie practices and their body esteem. The mediating role of appearance comparisons and the moderating role of direction of comparisons were also tested. A survey was distributed to 303 adolescent girls from three secondary schools in Singapore. Results indicated that the negative associations between participants' photo browsing and editing behaviors and body esteem were fully mediated by peer appearance comparisons. Contrarily, selfie posting had a direct and positive association with body esteem that was not mediated by peer appearance comparisons. The findings suggested that objectifying standards of beauty may permeate adolescent girls' value systems through frequent appearance comparisons on social media. When peer influence was presented in the form of appearance comparisons, it had a strong negative association with body esteem, regardless of the direction of the comparisons involved. The positive relationship between selfie posting and body esteem suggested that peer interactions may benefit adolescent girls' body image development in specific ways that warrants further inquiry.

The impact of no-makeup selfies on young women's body image

Viewing idealized images of attractive women on social media can negatively impact women's body image and mood. Although women tend to post idealized images on social media, some also post natural no-makeup images. This study examined the impact of viewing both made up and no-makeup selfies on young women's body image and mood. Female undergraduate students (N = 175) viewed either images of a woman wearing no makeup interspersed among idealized made up images of that woman (no-makeup condition), only idealized made up images of a woman (makeup only condition), or appearance-neutral travel images (control condition). Participants rated their state appearance satisfaction and mood pre- and post-exposure to the study images and rated their desire to change aspects of the face, hair, and skin post-exposure to the study images. Participants in the makeup only condition were less satisfied with their facial appearance and were more motivated to change aspects of their face, hair, and skin after exposure to the study images. Viewing the study images had no impact on the body image or mood of participants in the no-makeup condition. These results suggest that no-makeup selfies may reduce any negative impact of idealized made up images on women's facial concerns.

Can a selfie promote public engagement with skin cancer?

Social media may provide new opportunities to promote skin cancer prevention, but research to understand this potential is needed. In April of 2015, Kentucky native Tawny Willoughby (TW) shared a graphic skin cancer selfie on Facebook that subsequently went viral. We examined the volume of comments and shares of her original Facebook post; news volume of skin cancer from Google News; and search volume for skin cancer Google queries. We compared these latter metrics after TWs announcement against expected volumes based on forecasts of historical trends. TWs skin cancer story was picked up by the media on May 11, 2015 after the social media post had been shared approximately 50,000 times. All search queries for skin cancer increased 162% (95% CI 102 to 320) and 155% (95% CI 107 to 353) on May 13th and 14th, when news about TW's skin cancer selfie was at its peak, and remained higher through May 17th. Google searches about skin cancer prevention and tanning were also significantly higher than expected volumes. In practical terms, searches reached near-record levels - i.e., May 13th, 14th and 15th were respectively the 6th, 8th, and 40th most searched days for skin cancer since January 1, 2004 when Google began tracking searches. We conclude that an ordinary person's social media post caught the public's imagination and led to significant increases in public engagement with skin cancer prevention. Digital surveillance methods can rapidly detect these events in near real time, allowing public health practitioners to engage and potentially elevate positive effects.

Can a selfie promote public engagement with skin cancer?

Social media may provide new opportunities to promote skin cancer prevention, but research to understand this potential is needed. In April of 2015, Kentucky native Tawny Willoughby (TW) shared a graphic skin cancer selfie on Facebook that subsequently went viral. We examined the volume of comments and shares of her original Facebook post; news volume of skin cancer from Google News; and search volume for skin cancer Google queries. We compared these latter metrics after TWs announcement against expected volumes based on forecasts of historical trends. TWs skin cancer story was picked up by the media on May 11, 2015 after the social media post had been shared approximately 50,000 times. All search queries for skin cancer increased 162% (95% CI 102 to 320) and 155% (95% CI 107 to 353) on May 13th and 14th, when news about TW's skin cancer selfie was at its peak, and remained higher through May 17th. Google searches about skin cancer prevention and tanning were also significantly higher than expected volumes. In practical terms, searches reached near-record levels - i.e., May 13th, 14th and 15th were respectively the 6th, 8th, and 40th most searched days for skin cancer since January 1, 2004 when Google began tracking searches. We conclude that an ordinary person's social media post caught the public's imagination and led to significant increases in public engagement with skin cancer prevention. Digital surveillance methods can rapidly detect these events in near real time, allowing public health practitioners to engage and potentially elevate positive effects.

Selfie Telemedicine - What Are the Legal and Regulatory Issues?

Selfies, self-taken photographs using mobile phones or tablet computers, have become a way of life. People are now sending selfies to health professionals for medical advice or dermatology triage or postoperative wound assessment. These selfies may be unsolicited and sent to clinicians with whom the patient may or may not have a prior doctor-patient relationship or on the instruction of the attending doctor or even to social media groups. They may be sent by email, or by mobile phone and instant messaging applications, or sent to Websites, or telemedicine specific application sites. These photographs and accompanying information are legal documents, should form part of the patient's record, and should be securely transmitted and stored to maintain patient confidentiality and privacy. This paper reviews the legal, ethical and regulatory issues associated with the different forms of selfie telemedicine.

METHOD

A scoping literature review was undertaken using PubMed, Scopus, Science Direct, Ebsco Host and Google Scholar which were searched for Selfie and any of medicine, telemedicine, telehealth, eHealth, or mHealth. Inclusion criteria were that the paper was in English and described the use of a selfie in relation to healthcare. These were then reviewed for reference to legal, ethical issues and regulatory issues.

RESULTS

68 papers met the inclusion criteria. Legal and ethical issues identified were consent, confidentiality, privacy, the doctor-patient relationship, data security, responsibility, record keeping, licensure, continuity of care, quality of care, image quality, concordance, phone stewardship and patient satisfaction.

CONCLUSION

The literature provides little guidance on how legal and ethical issues and shortcomings of selfie telemedicine should be addressed especially the responsibilities of the patient and physician for unsolicited requests. Nor does it provide advice on how records are to be kept, or how images and information stored and sent to and from mobile phones or computers are to be managed. The new issues that arise need to be addressed.

Association between physiological oscillations in self-esteem, narcissism and internet addiction: A cross-sectional study

Internet addiction is a novel and relatively uninvestigated form of dependence that is fairly common in adolescent population. Previous research has indicated that it may be associated with other mental health problems, such as dysthymic mood and narcissistic behavior. In our study, we tested the existence and strength of relationship between Internet addiction, self-esteem and narcissism in a student population. On a sample of 244 students, we also investigated social networking activities, such as number of self-portrait photographs ("selfies"), and their potential connection with self-esteem and narcissism. Each participant completed a questionnaire consisting of Young Internet Addiction Test, Rosenberg Self-Esteem scale, and Narcissistic Personality Inventory. There was a statistically significant negative correlation between internet addiction score and self-esteem. Internet addiction increased as self-esteem decreased and vice versa. On the other hand, there was a positive correlation between internet addiction and narcissism. NPI score and number of self-portrait photographs (selfies) on Facebook were also in a positive relationship. Conversely, NPI score increased as the self-esteem decreased. The results of the study are in accordance with our previous findings on Internet use and mental health, confirming that Internet addiction is a potentially a serious public health problem.

"Selfie-epilepsy": A novel photosensitivity

PURPOSE

Photosensitivity is a well-described phenomenon; affecting a relatively small proportion of individuals with epilepsy. Typically people with photosensitive epilepsies are at risk of seizures induced by shimmering natural light, strobe lights and with particular patterns or flicker frequencies on television and video games.

METHODS & RESULTS

We present a novel case of photosensitivity captured during video EEG monitoring showing reproducible photosensitivity with the ever-popular social phenomenon; the "selfie." The patient had previously demonstrated photosensitive myoclonus with intermittent photic stimulation on routine EEG.

CONCLUSION

This case suggests that taking "selfies" may represent a new area of caution for those with photosensitive epilepsies.

The 'selfie' phenomenon: reducing the risk of harm while using smartphones during international travel

BACKGROUND

Photography is an integral component of the international travel experience. Self-photography is becoming a mainstream behaviour in society and it has implications for the practice of travel medicine. Travellers who take selfies, including with the use of selfie sticks, may be subject to traumatic injuries associated with this activity. This review article is the first in the medical literature to address this emerging phenomenon.

METHODS

Articles indexed on PubMed and Scopus databases through 2015 were retrieved, using the search terms 'travel', combined with 'selfie', 'self-photography', 'smartphone', 'mobile phone' and 'social media'. The reference lists of articles were manually searched for additional publications, and published media reports of travel-related self-photography were examined.

RESULTS

The lack of situational awareness and temporary distraction inherent in selfie-taking exposes the traveller to potential hazards. A diverse group of selfie injuries has been reported, including injury and death secondary to selfie-related falls, attacks from wild animals, electrocution, lightning strikes, trauma at sporting events, road traffic and pedestrian accidents. Public health measures adopted by the Russian Federation in response to over 100 reported selfie injuries in 2015 alone are presented. The review also discusses the potential for direct trauma from the use of selfie sticks. Travel-related scenarios where selfies should be avoided include photographs taken from a height, on a bridge, in the vicinity of vehicular traffic, during thunderstorms, at sporting events, and where wild animals are in the background. Recommendations exist which discourage use of mobile phones in drivers and pedestrians.

CONCLUSIONS

The travel medicine practitioner should routinely counsel travellers about responsible self-photography during international travel and should include this advice in printed material given to the patient. The travel and mobile phone industries should reinforce these health promotion messages. Future research should offer greater insights into traveller selfie-taking behaviour.