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    Detecting DR With Smartphone-Based Widefield Imaging


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    Smartphone-based widefield imaging has high sensitivity and specificity for detecting sight-threatening diabetic retinopathy (DR), report researchers from Dr. Mohan’s Diabetes Specialities Centre and Madras Diabe­tes Research Foundation, in Chennai, India. It also helped locate predomi­nantly peripheral lesions. Their study results, published in the journal Eye, suggest this technology can be an accessible, cost-effective method for DR screening in areas with few health resources.1

    Study details. The researchers tested 318 eyes of 160 patients with type 2 diabetes who had varying grades of DR. These individuals underwent screen­ing with nonmydriatic ultra-widefield (UWF) imaging with a Daytona Plus camera followed by mydriatic widefield imaging with a smartphone-based Vis­taro camera. Two graders assessed each device’s specificities and sensitivities in identifying sight-threatening diabetic eye diseases, including predominantly peripheral lesions.

    Two images of the retina. One shows an individual’s right eye with sight-threatening diabetic retinopathy using Vistaro and Daytona Plus cameras. The other shows an individual’s left eye with moderate to severe non-proliferative diabetic retinopathy.

    TWO RETINAL IMAGING METHODS. (1A) Retinal images of an individual’s right eye with sight-threatening diabetic retinopathy using Vistaro and Day tona Plus cameras. (1B) Retinal images of an individual’s left eye with moderate to severe non-proliferative diabetic retinopathy using Vistaro and Daytona Plus cameras.

    “UWF photography is getting considered as the gold standard for DR screening in some of the developed countries like the United States,” the researchers wrote, but it is an expensive modality for regular DR screening for low- and middle-income countries like India. They said smartphone-based fundus cameras that are portable and easy to handle in remote places are popular, cost-effective DR screening options.

    What the study found. The study results showed that the sensitivity and specificity for detection of sight-threatening DR by the UWF camera was 95.1% and 95.7% versus 92.7% and 96.6% when a smartphone-based widefield camera was used.

    The UWF camera detected predomi­nantly peripheral lesions in 50.3% of the eyes tested, while the smartphone-based widefield camera detected these lesions in 27.9% of the eyes. However, the authors noted that this did not translate to a significant difference in the grading of sight-threatening DR between the two imaging systems.

    With both cameras, predominantly peripheral lesions were most commonly found in the superotemporal quadrant, and the prevalence of these lesions in­creased with worsened severity of DR. Agreement between the graders was rated as substantial, and no ungradable images were reported in the study.

    A viable screening alternative? The study highlights the opportunity this smartphone-based technology presents to potentially increase access to care and screening for retinal dis­ease, said Avni Finn, MD, a vitreoreti­nal surgeon and Assistant Professor in the Department of Ophthalmolo­gy and Visual Sciences at Vanderbilt University Medical Center, in Nashville, Tennessee. Dr. Finn, who was not involved in the study, called the technology a “via­ble alternative to standard ultra-wide­field photography” in settings with few resources.

    “It is exciting that smartphone-based technology has progressed to the point of being able to capture high-quality and reliable widefield fundus images,” she said. “Beyond the comparable sensitivity and specificity between the smartphone-based device and the widefield fundus camera, it was striking that no ungradable images were obtained by the device.”

    Future research. One limitation of the research is the cross-sectional study method, and the authors noted that a longitudinal follow-up assess­ment of peripheral DR lesions with smartphone-based widefield cameras would enable the assessment of risk of progression and development of sight-threatening DR.

    Dr. Finn would also like to see as­sessments of different types of smart­phone-based retinal imaging.

    “This imaging with the smartphone-based device in this study was mounted and mydriatic,” she said. “In order for this type of imaging to be more broadly applicable to a larger patient population and different resource settings, it would be nice to see further studies with the camera as a nonmydriatic device and as a nonmounted device.”

    —Ashley Welch


    1 Rajalakshmi R et al. Eye. Published online Jan. 31, 2024.


    Relevant financial disclosures—Dr. Finn: Allergan: C; Apellis: C; EyePoint: C; Genentech: C; Iveric Bio: C.

    For full disclosures and the disclosure key, see below.

    Full Financial Disclosures

    Dr. Finn Allergan: C; Apellis: C; EyePoint: C; Genentech: C; Iveric Bio: C.

    Dr. Arevalo AbbVie: C; Alimera Sciences: C; Apellis: C; DORC: C; Elsevier: P; EyePoint Pharmaceuticals: C; Genentech: C; Iveric Bio: C; Springer SBM: P; Théa Laboratories: C; Topcon Medical Systems: S.

    Dr. Cha None.

    Dr. Rahi National Institute for Health and Care Research: S.

    Disclosure Category



    Consultant/Advisor C Consultant fee, paid advisory boards, or fees for attending a meeting.
    Employee E Hired to work for compensation or received a W2 from a company.
    Employee, executive role EE Hired to work in an executive role for compensation or received a W2 from a company.
    Owner of company EO Ownership or controlling interest in a company, other than stock.
    Independent contractor I Contracted work, including contracted research.
    Lecture fees/Speakers bureau L Lecture fees or honoraria, travel fees or reimbursements when speaking at the invitation of a commercial company.
    Patents/Royalty P Beneficiary of patents and/or royalties for intellectual property.
    Equity/Stock/Stock options holder, private corporation PS Equity ownership, stock and/or stock options in privately owned firms, excluding mutual funds.
    Grant support S Grant support or other financial support from all sources, including research support from government agencies (e.g., NIH), foundations, device manufacturers, and\or pharmaceutical companies. Research funding should be disclosed by the principal or named investigator even if your institution receives the grant and manages the funds.
    Stock options, public or private corporation SO Stock options in a public or private company.
    Equity/Stock holder, public corporation US Equity ownership or stock in publicly traded firms, excluding mutual funds (listed on the stock exchange).


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