Validation of Smartphone-Based Retinal Photography for Diabetic Retinopathy Screening

• Published in: Ophthalmic surgery, lasers & imaging Vol. 50; no. 5; pp. S18 - S22
• Main Authors: Bilong, Yannick, Katte, Jean-Claude, Koki, Godefroy, Kagmeni, Giles, Obama, Odile Pascale Nga, Fofe, Hermann Rossi Ngoufo, Mvilongo, Caroline, Nkengfack, Oliver, Bimbai, Andre Michel, Sobngwi, Eugene, Mbacham, Wilfred, Mbanya, Jean Claude, Bella, Lucienne Assumpta, Sharma, Ashish
• Format: Journal Article
• Language: English
• Published: United States Slack, Inc 01.05.2019; SLACK INCORPORATED
• Subjects: Blindness; Blood pressure; Cameras; Comparative analysis; Cross-Sectional Studies; Diabetes; Diabetic retinopathy; Diabetic Retinopathy - diagnosis; Diabetics; Edema; Equipment Design; Eye (anatomy); Eyes & eyesight; Female; Hospitals; Humans; Low income groups; Male; Mass Screening - methods; Medical research; Medicine, Experimental; Middle Aged; Patients; Photography; Photography - instrumentation; Public health; Quality; Reproducibility of Results; Retina; Retina - diagnostic imaging; Retinal images; Retrospective Studies; Screening; Sensitivity analysis; Smart phones; Smartphone; Smartphones; Studies; Cameroon; India
• DOI: 10.3928/23258160-20190108-05
• ISSN: 2325-8160

Screening for diabetic retinopathy (DR) is cost-effective when compared with disability loss for those who go blind in the absence of a screening program. We aimed to evaluate the sensitivity and specificity of a smartphone-based device for the screening and detection of DR. A cross-sectional study of 220 patients with diabetes (440 eyes, all patients age 25 years or older) was completed. Tropicamide 0.5% was used for iris dilation followed by an indirect ophthalmoscopy using a 20-D lens. Retinal images were later obtained using a smartphone attached to an adaptable camera device. Retinal images permitted the visualization of the macular and papillary regions and were sent without compression via the internet to a retinal specialist for interpretation. Sensitivity and specificity were calculated for all cases and stages of DR. Using our standard examination method, the prevalence of DR and macular edema were 13.6% and 6.4%, respectively. With the smartphone-based retinal camera, the prevalence of DR and macular edema were 18.2% and 8.2%, respectively. Sensitivity and specificity for the detection of all stages of DR was 73.3% and 90.5%, respectively. For the detection of macular edema, sensitivity was 77.8%, and specificity was 95%. For severe nonproliferative DR (NPDR), sensitivity and specificity were 80% and 99%, respectively; for proliferative DR (PDR), they were both 100%. In the early stages of DR, specificity was 89.8% for mild NPDR and 97.1% for moderate NPDR. Sensitivity was 57.1% and 42.9%, respectively. Screening for DR using a smartphone-based retinal camera has a satisfactory specificity at all DR stages. Its sensitivity seems to be high only in the stages of DR necessitating a specific therapeutic decision (eg, macular edema, severe NPDR, and PDR). A smartphone-based retinal camera may be a useful device to screen for DR in resource-limited settings. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:S18-S22.].