Clinical Ophthalmology (Aug 2023)

Accuracy of Low-Cost, Smartphone-Based Retinal Photography for Diabetic Retinopathy Screening: A Systematic Review

  • Prayogo ME,
  • Zaharo AF,
  • Damayanti NNR,
  • Widyaputri F,
  • Thobari JA,
  • Susanti VY,
  • Sasongko MB

Journal volume & issue
Vol. Volume 17
pp. 2459 – 2470

Abstract

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Mohammad Eko Prayogo,1,2 Alfia Fatma Zaharo,1 Novandriati Nur Rizky Damayanti,1 Felicia Widyaputri,1 Jarir At Thobari,3,4 Vina Yanti Susanti,5 Muhammad Bayu Sasongko1 1Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada – Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta, Indonesia; 2Department of Ophthalmology, Universitas Gadjah Mada Academic Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia; 3Department of Pharmacology and Therapy, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; 4Clinical Epidemiology and Biostatistics Unit (CE&BU), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; 5Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, IndonesiaCorrespondence: Muhammad Bayu Sasongko, Department of Ophthalmology, Faculty of Medicine, Universitas Gadjah Mada/Prof. Dr. Sardjito General Hospital, Jalan Farmako Sekip Utara, Yogyakarta, Indonesia, Tel/Fax +62 274 552850, Email [email protected]: Diabetic retinopathy (DR) is a leading cause of blindness. Early DR screening is essential, but the infrastructure can be less affordable in low resource countries. This study aims to review the accuracy of low-cost smartphone-based fundus cameras for DR screening in adult patients with diabetes.Methods: We performed a systematic literature search to find studies that reported the sensitivity and specificity of low-cost smartphone-based devices for fundus photography in adult patients with diabetes. We searched three databases (MEDLINE, Google Scholar, Scopus) and one register (Cochrane CENTRAL). We presented the accuracy values by grouping the diagnosis into three: any DR, referrable DR, and diabetic macular oedema (DMO). Risk of bias and applicability of the studies were assessed using QUADAS-2.Results: Five out of 294 retrieved records were included with a total of six smartphone-based devices reviewed. All of the reference diagnostic methods used in the included studies were either indirect ophthalmoscopy or slit-lamp examinations and all smartphone-based devices’ imaging protocols used mydriatic drops. The reported sensitivity and specificity for any DR were 52– 92.2% and 73.3– 99%; for referral DR were 21– 91.4% and 64.9– 100%; and for DMO were 29.4– 81% and 95– 100%, respectively.Conclusion: Sensitivity available low-cost smartphone-based devices for DR screening were acceptable and their specificity particularly for detecting referrable DR and DMO were considerably good. These findings support their potential utilization for DR screening in a low resources setting.Keywords: diabetic retinopathy screening, smartphone-based funduscopy, low-cost retinal photography, tele-screening

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