Validation of handheld fundus camera with mydriasis for retinal imaging of diabetic retinopathy screening in China: a prospective comparison study

ObjectivesTo investigate the clinical validity of using a handheld fundus camera to detect diabetic retinopathy (DR) in China.Design and settingsProspective comparison study of the handheld fundus camera with a standard validated instrument in detection of DR in hospital and a community screening clinic in Guangdong Province, China.ParticipantsParticipants aged 18 years and over with diabetes who were able to provide informed consent and agreed to attend the dilated eye examination with handheld tests and a standard desktop camera.Primary and secondary outcome measuresPrimary outcome was the proportion of those with referable DR (R2 and above) identified by the handheld fundus camera (the index test) compared with the standard camera. Secondary outcome was the comparison of proportion of gradable images obtained from each test.ResultsIn this study, we examined 304 people (608 eyes) with each of the two cameras under mydriasis. The handheld camera detected 119 eyes (19.5%) with some level of DR, 81 (13.3%) of them were referable, while the standard camera detected 132 eyes (21.7%) with some level of DR and 83 (13.7%) were referable. It seems that the standard camera found more eyes with referable DR, although McNemar’s test detected no significant difference between the two cameras.Of the 608 eyes with images obtained by desktop camera, 598 (98.4%) images were of sufficient quality for grading, 12 (1.9%) images were not gradable. By the handheld camera, 590 (97.0%) were gradable and 20 (3.2%) images were not gradable.The two cameras reached high agreement on diagnosis of retinopathy and maculopathy at all the levels of retinopathy.ConclusionAlthough it could not take the place of standard desktop camera on clinic fundus examination, the handheld fundus camera showed promising role on preliminary DR screening at primary level in China. To ensure quality images, mydriasis is required.

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Diabetic Retinopathy Screening Using Telemedicine Tools: Pilot Study in Hungary

Journal of Diabetes Research ◽

10.1155/2016/4529824 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Dóra J. Eszes ◽

Dóra J. Szabó ◽

Greg Russell ◽

Phil Kirby ◽

Edit Paulik ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Pilot Study ◽

Socioeconomic Factors ◽

Fundus Camera ◽

Diabetic Retinopathy Screening ◽

Patients Satisfaction ◽

Retinal Screening ◽

Self Administered Questionnaire ◽

Southeastern Region ◽

Retinopathy Screening

Introduction.Diabetic retinopathy (DR) is a sight-threatening complication of diabetes. Telemedicine tools can prevent blindness. We aimed to investigate the patients’ satisfaction when using such tools (fundus camera examination) and the effect of demographic and socioeconomic factors on participation in screening.Methods.Pilot study involving fundus camera screening and self-administered questionnaire on participants’ experience during fundus examination (comfort, reliability, and future interest in participation), as well as demographic and socioeconomic factors was performed on 89 patients with known diabetes in Csongrád County, a southeastern region of Hungary.Results.Thirty percent of the patients had never participated in any ophthalmological screening, while 25.7% had DR of some grade based upon a standard fundus camera examination and UK-based DR grading protocol (Spectra™ software). Large majority of the patients were satisfied with the screening and found it reliable and acceptable to undertake examination under pupil dilation; 67.3% were willing to undergo nonmydriatic fundus camera examination again. There was a statistically significant relationship between economic activity, education and marital status, and future interest in participation.Discussion.Participants found digital retinal screening to be reliable and satisfactory. Telemedicine can be a strong tool, supporting eye care professionals and allowing for faster and more comfortable DR screening.

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The Nonmydriatic Fundus Camera in Diabetic Retinopathy Screening: A Cost-Effective Study with Evaluation for Future Large-Scale Application

Journal of Ophthalmology ◽

10.1155/2016/4625096 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Giuseppe Scarpa ◽

Francesca Urban ◽

Stela Vujosevic ◽

Michele Tessarin ◽

Giovanni Gallo ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Early Detection ◽

Large Scale ◽

Screening Programme ◽

Cost Effective ◽

Diabetic Patients ◽

Local Health Authority ◽

Local Health ◽

Fundus Camera ◽

Diabetic Retinopathy Screening

Aims. The study aimed to present the experience of a screening programme for early detection of diabetic retinopathy (DR) using a nonmydriatic fundus camera, evaluating the feasibility in terms of validity, resources absorption, and future advantages of a potential application, in an Italian local health authority. Methods. Diabetic patients living in the town of Ponzano, Veneto Region (Northern Italy), were invited to be enrolled in the screening programme. The “no prevention strategy” with the inclusion of the estimation of blindness related costs was compared with screening costs in order to evaluate a future extensive and feasible implementation of the procedure, through a budget impact approach. Results. Out of 498 diabetic patients eligible, 80% was enrolled in the screening programme. 115 patients (34%) were referred to an ophthalmologist and 9 cases required prompt treatment for either proliferative DR or macular edema. Based on the pilot data, it emerged that an extensive use of the investigated screening programme, within the Greater Treviso area, could prevent 6 cases of blindness every year, resulting in a saving of €271,543.32 (−13.71%). Conclusions. Fundus images obtained with a nonmydriatic fundus camera could be considered an effective, cost-sparing, and feasible screening tool for the early detection of DR, preventing blindness as a result of diabetes.

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Determining diabetic retinopathy screening interval based on time from no retinopathy to laser therapy

Journal of Medical Screening ◽

10.1177/0969141316672687 ◽

2016 ◽

Vol 24 (4) ◽

pp. 170-175 ◽

Cited By ~ 1

Author(s):

Daniel Hughes ◽

Sunil Nair ◽

John N Harvey

Keyword(s):

Diabetic Retinopathy ◽

Laser Therapy ◽

Visual Outcome ◽

Population Based ◽

Proliferative Retinopathy ◽

Early Years ◽

Diabetic Patients ◽

Community Screening ◽

Diabetic Retinopathy Screening ◽

Screening Interval

Objectives To determine the necessary screening interval for retinopathy in diabetic patients with no retinopathy based on time to laser therapy and to assess long-term visual outcome following screening. Methods In a population-based community screening programme in North Wales, 2917 patients were followed until death or for approximately 12 years. At screening, 2493 had no retinopathy; 424 had mostly minor degrees of non-proliferative retinopathy. Data on timing of first laser therapy and visual outcome following screening were obtained from local hospitals and ophthalmology units. Results Survival analysis showed that very few of the no retinopathy at screening group required laser therapy in the early years compared with the non-proliferative retinopathy group ( p < 0.001). After two years, <0.1% of the no retinopathy at screening group required laser therapy, and at three years 0.2% (cumulative), lower rates of treatment than have been suggested by analyses of sight-threatening retinopathy determined photographically. At follow-up (mean 7.8 ± 4.6 years), mild to moderate visual impairment in one or both eyes due to diabetic retinopathy was more common in those with retinopathy at screening (26% vs. 5%, p < 0.001), but blindness due to diabetes occurred in only 1 in 1000. Conclusions Optimum screening intervals should be determined from time to active treatment. Based on requirement for laser therapy, the screening interval for diabetic patients with no retinopathy can be extended to two to three years. Patients who attend for retinal screening and treatment who have no or non-proliferative retinopathy now have a very low risk of eventual blindness from diabetes.

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Diabetic retinopathy screening with nonmydriatic fundus camera(1 and 3 fields) vs ETDRS standard

Acta Ophthalmologica Scandinavica ◽

10.1111/j.1600-0420.2007.01063_3274.x ◽

2007 ◽

Vol 85 ◽

pp. 0-0

Author(s):

F MASSIGNAN ◽

S VUJOSEVIC ◽

E BENETTI ◽

E PILOTTO ◽

E MIDENA

Keyword(s):

Diabetic Retinopathy ◽

Fundus Camera ◽

Diabetic Retinopathy Screening ◽

Retinopathy Screening

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Diabetic Retinopathy Screening Ratio Is Improved When Using a Digital, Nonmydriatic Fundus Camera Onsite in a Diabetes Outpatient Clinic

Journal of Diabetes Research ◽

10.1155/2016/4101890 ◽

2016 ◽

Vol 2016 ◽

pp. 1-10 ◽

Cited By ~ 7

Author(s):

Pia Roser ◽

Hannes Kalscheuer ◽

Jan B. Groener ◽

Daniel Lehnhoff ◽

Roman Klein ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Outpatient Clinic ◽

Microvascular Complications ◽

Diabetic Polyneuropathy ◽

Cross Sectional Study ◽

Newly Diagnosed ◽

Cross Sectional ◽

Fundus Camera ◽

Diabetic Retinopathy Screening ◽

Single Field

Objective. To evaluate the effect of onsite screening with a nonmydriatic, digital fundus camera for diabetic retinopathy (DR) at a diabetes outpatient clinic.Research Design and Methods. This cross-sectional study included 502 patients, 112 with type 1 and 390 with type 2 diabetes. Patients attended screenings for microvascular complications, including diabetic nephropathy (DN), diabetic polyneuropathy (DP), and DR. Single-field retinal imaging with a digital, nonmydriatic fundus camera was used to assess DR. Prevalence and incidence of microvascular complications were analyzed and the ratio of newly diagnosed to preexisting complications for all entities was calculated in order to differentiate natural progress from missed DRs.Results. For both types of diabetes, prevalence of DR was 25.0% (n=126) and incidence 6.4% (n=32) (T1DM versus T2DM: prevalence: 35.7% versus 22.1%, incidence 5.4% versus 6.7%). 25.4% of all DRs were newly diagnosed. Furthermore, the ratio of newly diagnosed to preexisting DR was higher than those for DN (p=0.12) and DP (p=0.03) representing at least 13 patients with missed DR.Conclusions. The results indicate that implementing nonmydriatic, digital fundus imaging in a diabetes outpatient clinic can contribute to improved early diagnosis of diabetic retinopathy.

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