The Diabetic Retinopathy Screening Workflow

Abstract

Complications of diabetes mellitus, namely diabetic retinopathy and diabetic maculopathy, are the leading cause of blindness in working aged people. Sufferers can avoid blindness if identified early via retinal imaging. Systematic screening of the diabetic population has been shown to greatly reduce the prevalence and incidence of blindness within the population. Many national screening programs have digital fundus photography as their basis. In the past 5 years several techniques and adapters have been developed that allow digital fundus photography to be performed using smartphones. We review recent progress in smartphone-based fundus imaging and discuss its potential for integration into national systematic diabetic retinopathy screening programs. Some systems have produced promising initial results with respect to their agreement with reference standards. However further multisite trialling of such systems' use within implementable screening workflows is required if an evidence base strong enough to affect policy change is to be established. If this were to occur national diabetic retinopathy screening would, for the first time, become possible in low-and middle-income settings where cost and availability of trained eye care personnel are currently key barriers to implementation. As diabetes prevalence and incidence is increasing sharply in these settings, the impact on global blindness could be profound.

A review of smartphone point‐of‐care adapter design

“…To date, much advancement has been made by the manufacturers of smartphones, and thus, proper selection of the available smartphone technology promises a comparable performance between smartphone‐based and conventional techniques. Bolster et al reviewed the diabetic retinopathy (DR) screening methods based on a smartphone and concluded that although pilot studies and single‐site trials have yielded hopeful results for the validation of smartphone‐based DR assessment in comparison with reference standards, more efforts should be made to further develop the smartphone‐based approach. Giardini et al designed a smartphone ophthalmoscope that was integrated on a Galaxy S3 smartphone and employed Java programming to create software that enables video capture, magnification, and segmentation and enables creating measurements.…”

A smartphone-based tool for rapid, portable, and automated wide-field retinal imaging

“…There is particularly great interest in the validation and integration of smartphone-based retinal photography in local community screening programs for diseases such as glaucoma and diabetic retinopathy (DR) [13][14][15][16] , as well as in the emergency department and inpatient settings where the fundus examination is under-performed [17][18][19] . DR is the most common microvascular complication of diabetes and the leading cause of vision loss in working-age adults aged 20 to 74 in the United States, accounting for 12% of new cases annually [20][21][22][23] .…”

Diabetic Retinopathy: Focus on Minority Populations

“…Importantly, retinal imaging in primary care offices has been quite successful in eradicating some of the obstacles that impede diabetic patients from undergoing diabetic retinopathy screening [113,122,123,125,126]. Patients with diabetic retinopathy (or ungradeable disease) noted on photographs may be referred to ophthalmologists for further evaluation and treatment; this may eventually lower the number of overall screening referrals to ophthalmology for disease not warranting treatment, thus allowing more resources for evaluation of patients with ungradeable pathology on photos or treatment of those with clearly noted disease [124].…”