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Introduction Deep Learning (DL) and Artificial Intelligence (AI) have become widespread due to the advanced technologies and availability of digital data. Supervised learning algorithms have shown human-level performance or even better and are better feature extractor-quantifier than unsupervised learning algorithms. To get huge dataset with good quality control, there is a need of an annotation tool with a customizable feature set. This paper evaluates the viability of having an in house annotation tool which works on a smartphone and can be used in a healthcare setting. Methods We developed a smartphone-based grading system to help researchers in grading multiple retinal fundi. The process consisted of designing the flow of user interface (UI) keeping in view feedback from experts. Quantitative and qualitative analysis of change in speed of a grader over time and feature usage statistics was done. The dataset size was approximately 16,000 images with adjudicated labels by a minimum of 2 doctors. Results for an AI model trained on the images graded using this tool and its validation over some public datasets were prepared. Results We created a DL model and analysed its performance for a binary referrable DR Classification task, whether a retinal image has Referrable DR or not. A total of 32 doctors used the tool for minimum of 20 images each. Data analytics suggested significant portability and flexibility of the tool. Grader variability for images was in favour of agreement on images annotated. Number of images used to assess agreement is 550. Mean of 75.9% was seen in agreement. Conclusion Our aim was to make Annotation of Medical imaging easier and to minimize time taken for annotations without quality degradation. The user feedback and feature usage statistics confirm our hypotheses of incorporation of brightness and contrast variations, green channels and zooming add-ons in correlation to certain disease types. Simulation of multiple review cycles and establishing quality control can boost the accuracy of AI models even further. Although our study aims at developing an annotation tool for diagnosing and classifying diabetic retinopathy fundus images but same concept can be used for fundus images of other ocular diseases as well as other streams of medical science such as radiology where image-based diagnostic applications are utilised.

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Background: Retinal capillary hemangiomas (RCH) are rare, benign, vascular tumours characterized by capillary and glial cell proliferation. We report the management of a patient with a unilateral endophytic papillary RCH with exudations and serous retinal detachment. Methods: Case report Results: A 46-year old female presented with papillary RCH without association with von Hippel-Lindau syndrome. She was given two doses of intravitreal bevacizumab following which the serous detachment resolved. When the edema recurred again, she was given a dose of 4mg intravitreal triamcinolone acetate. The edema resolved and did not recur till the end of three months. She was given the option of photodynamic therapy, however, she did not consent for the procedure due to the high costs involved. Conclusion: Intravitreal injections can be used as a temporary remedy for the treatment of macular edema caused by RCH. However, currently there is no ideal definitive treatment available for papillary RCH. Larger studies are necessary to establish the treatment for this condition.

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