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Naz H, Nijhawan R, Ahuja NJ. Clinical utility of handheld fundus and smartphone-based camera for monitoring diabetic retinal diseases: a review study. Int Ophthalmol 2024; 44:41. [PMID: 38334896 DOI: 10.1007/s10792-024-02975-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/29/2023] [Indexed: 02/10/2024]
Abstract
Diabetic retinopathy (DR) is the leading global cause of vision loss, accounting for 4.8% of global blindness cases as estimated by the World Health Organization (WHO). Fundus photography is crucial in ophthalmology as a diagnostic tool for capturing retinal images. However, resource and infrastructure constraints limit access to traditional tabletop fundus cameras in developing countries. Additionally, these conventional cameras are expensive, bulky, and not easily transportable. In contrast, the newer generation of handheld and smartphone-based fundus cameras offers portability, user-friendliness, and affordability. Despite their potential, there is a lack of comprehensive review studies examining the clinical utilities of these handheld (e.g. Zeiss Visuscout 100, Volk Pictor Plus, Volk Pictor Prestige, Remidio NMFOP, FC161) and smartphone-based (e.g. D-EYE, iExaminer, Peek Retina, Volk iNview, Volk Vistaview, oDocs visoScope, oDocs Nun, oDocs Nun IR) fundus cameras. This review study aims to evaluate the feasibility and practicality of these available handheld and smartphone-based cameras in medical settings, emphasizing their advantages over traditional tabletop fundus cameras. By highlighting various clinical settings and use scenarios, this review aims to fill this gap by evaluating the efficiency, feasibility, cost-effectiveness, and remote capabilities of handheld and smartphone fundus cameras, ultimately enhancing the accessibility of ophthalmic services.
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Affiliation(s)
- Huma Naz
- Department of Computer Science, University of Petroleum and Energy Studies, Dehradun, India.
| | - Rahul Nijhawan
- Thapar Institute of Engineering and Technology, Patiala, Punjab, India
| | - Neelu Jyothi Ahuja
- Department of Computer Science, University of Petroleum and Energy Studies, Dehradun, India
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Varo R, Postigo M, Bila R, Dacal E, Chiconela H, García-Villena J, Cuadrado D, Vladimirov A, Díez N, Vallés-López R, Sitoe A, Vitorino P, Mucasse C, Beltran-Agullo L, Pujol O, García V, Abdala M, Sallé L, Anton A, Santos A, Ledesma-Carbayo MJ, Luengo-Oroz M, Bassat Q. Evaluation of the Performance of a 3D-Printed Smartphone-Based Retinal Imaging Device as a Screening Tool for Retinal Pathology in Mozambique. Am J Trop Med Hyg 2023; 109:1192-1198. [PMID: 37918001 PMCID: PMC10622463 DOI: 10.4269/ajtmh.23-0378] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/07/2023] [Indexed: 11/04/2023] Open
Abstract
Low-income countries carry approximately 90% of the global burden of visual impairment, and up to 80% of this could be prevented or cured. However, there are only a few studies on the prevalence of retinal disease in these countries. Easier access to retinal information would allow differential diagnosis and promote strategies to improve eye health, which are currently scarce. This pilot study aims to evaluate the functionality and usability of a tele-retinography system for the detection of retinal pathology, based on a low-cost portable retinal scanner, manufactured with 3D printing and controlled by a mobile phone with an application designed ad hoc. The study was conducted at the Manhiça Rural Hospital in Mozambique. General practitioners, with no specific knowledge of ophthalmology or previous use of retinography, performed digital retinographies on 104 hospitalized patients. The retinographies were acquired in video format, uploaded to a web platform, and reviewed centrally by two ophthalmologists, analyzing the image quality and the presence of retinal lesions. In our sample there was a high proportion of exudates and hemorrhages-8% and 4%, respectively. In addition, the presence of lesions was studied in patients with known underlying risk factors for retinal disease, such as HIV, diabetes, and/or hypertension. Our tele-retinography system based on a smartphone coupled with a simple and low-cost 3D printed device is easy to use by healthcare personnel without specialized ophthalmological knowledge and could be applied for the screening and initial diagnosis of retinal pathology.
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Affiliation(s)
- Rosauro Varo
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - Rubao Bila
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - Hélio Chiconela
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | | | | | | | | | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Pio Vitorino
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Campos Mucasse
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - Olivia Pujol
- Institut Català de Retina, Barcelona, Spain
- Hospital Vall d´Hebron, Barcelona, Spain
| | | | - Mariamo Abdala
- Departamento de Oftalmologia, Hospital Central de Maputo, Maputo, Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Lucía Sallé
- Biomedical Image Technologies Group, Departamento de Ingeniería Electrónica, Escuela Técnica Superior de Ingenieros Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | - Alfonso Anton
- Institut Català de Retina, Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Madrid, Spain
| | - Andrés Santos
- Biomedical Image Technologies Group, Departamento de Ingeniería Electrónica, Escuela Técnica Superior de Ingenieros Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Madrid, Spain
| | - María J. Ledesma-Carbayo
- Biomedical Image Technologies Group, Departamento de Ingeniería Electrónica, Escuela Técnica Superior de Ingenieros Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Quique Bassat
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Institut Català de Recerca i Estudis Avançats, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
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Morya AK, Ramesh PV, Kaur K, Gurnani B, Heda A, Bhatia K, Sinha A. Diabetes more than retinopathy, it’s effect on the anterior segment of eye. World J Clin Cases 2023; 11:3736-3749. [PMID: 37383113 PMCID: PMC10294174 DOI: 10.12998/wjcc.v11.i16.3736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/25/2023] [Accepted: 05/06/2023] [Indexed: 06/02/2023] Open
Abstract
Diabetes mellitus (DM) is one of the chronic metabolic noncommunicable diseases that has attained worldwide epidemics. It threatens healthy life around the globe, with mild-to-severe secondary complications and leads to significant illness including nephropathy, neuropathy, retinopathy, and macrovascular abnormalities including peripheral vasculopathy, and ischaemic heart disease. Research into diabetic retinopathy (DR), which affects one-third of persons with diabetes, has made considerable strides in recent years. In addition, it can lead to several anterior segment complications such as glaucoma, cataract, cornea, conjunctiva, lacrimal glands and other ocular surface diseases. Uncontrolled DM also caused gradual damage to corneal nerves and epithelial cells, which raises the likelihood of anterior segment diseases including corneal ulcers, dry eye disease, and chronic epithelial abnormalities. Although DR and other associated ocular complications are well-known, the complexity of its aetiology and diagnosis makes therapeutic intervention challenging. Strict glycaemic control, early detection and regular screening, and meticulous management is the key to halting the progression of the disease. In this review manuscript, we aim to provide an in-depth understanding of the broad spectrum of diabetic complications in the anterior segment of the ocular tissues and illustrate the progression of diabetes and its pathophysiology, epidemiology, and prospective therapeutic targets. This first such review article will highlight the role of diagnosing and treating patients with a plethora of anterior segment diseases associated with diabetes, which are often neglected.
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Affiliation(s)
- Arvind Kumar Morya
- Department of Ophthalmology, All India Institute of Medical Sciences, Hyderabad 508126, Telangana, India
| | - Prasanna Venkatesh Ramesh
- Glaucoma and Research, Mahathma Eye Hospital Private Limited, Tennur, Trichy 620001, Tamil Nadu, India
| | - Kirandeep Kaur
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Sadguru Seva Sangh Trust, Janaki-Kund, Chitrakoot 485334, Madhya Pradesh, India
| | - Bharat Gurnani
- Cornea and Refractive Services, Sadguru Netra Chikitsalaya, Sadguru Seva Sangh Trust, Janaki- Kund, Chitrakoot 485334, Madhya Pradesh, India
| | - Aarti Heda
- Department of Ophthalmology, National Institute of Ophthalmology, Pune 411000, Maharashtra, India
| | - Karan Bhatia
- Department of Ophthalmology, Manaktala Eye and Maternity Home, Meerut 250001, Uttar Pradesh, India
| | - Aprajita Sinha
- Department of Ophthalmology, Worcestershire Acute Hospital, Worcestershire 01601, United Kingdom
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Jayanna S, Padhi TR, Nedhina EK, Agarwal K, Jalali S. Color fundus imaging in retinopathy of prematurity screening: Present and future. Indian J Ophthalmol 2023; 71:1777-1782. [PMID: 37203030 PMCID: PMC10391467 DOI: 10.4103/ijo.ijo_2913_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Advent of pediatric handheld fundus cameras like RetCam, 3netra Forus, and Phoenix ICON pediatric retinal camera has aided in effective screening of retinopathy of prematurity (ROP), especially in countries with limited number of trained specialists. Recent advent of various smartphone-based cameras has made pediatric fundus photography furthermore affordable and portable. Future advances like ultra-wide field fundus cameras, trans-pars-planar illumination pediatric fundus camera, artificial intelligence, deep learning algorithm, and handheld SS-OCTA can help in more accurate imaging and documentation. This article summarizes the features of existing and upcoming imaging modalities in detail, including their features, advantages, challenges, and effectiveness, which can help in implementation of telescreening as a standard screening protocol for ROP across developing as well as developed countries.
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Affiliation(s)
- Sushma Jayanna
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana; Newborn Eye Health Alliance (NEHA), L. V. Prasad Eye Institute Network; Child Sight Institute, L. V. Prasad Eye Institute Network, Bhubaneshwar, Odissa, India
| | - Tapas R Padhi
- Department of Vitreo Retina, Mithun Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneshwar, Odissa, India
| | - E K Nedhina
- Department of Vitreo Retina, Nethra Jyothi Advanced Eye Care, Taliparamba, Kannur, Kerala, India
| | - Komal Agarwal
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana; Newborn Eye Health Alliance (NEHA), L. V. Prasad Eye Institute Network; Child Sight Institute, L. V. Prasad Eye Institute Network, Bhubaneshwar, Odissa, India
| | - Subhadra Jalali
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana; Newborn Eye Health Alliance (NEHA), L. V. Prasad Eye Institute Network; Child Sight Institute, L. V. Prasad Eye Institute Network, Bhubaneshwar, Odissa, India
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Feasibility and clinical utility of handheld fundus cameras for retinal imaging. Eye (Lond) 2023; 37:274-279. [PMID: 35022568 PMCID: PMC9873676 DOI: 10.1038/s41433-021-01926-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/07/2021] [Accepted: 12/22/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND/OBJECTIVES Handheld fundus cameras are portable and cheaper alternatives to table-top counterparts. To date there have been no studies comparing feasibility and clinical utility of handheld fundus cameras to table-top devices. We compare the feasibility and clinical utility of four handheld fundus cameras/retinal imaging devices (Remidio NMFOP, Volk Pictor Plus, Volk iNview, oDocs visoScope) to a table-top camera (Zeiss VisucamNM/FA). SUBJECTS/METHODS Healthy participants (n = 10, mean age ± SD = 21.0 ± 0.9 years) underwent fundus photography with five devices to assess success/failure rates of image acquisition. Participants with optic disc abnormalities (n = 8, mean age ± SD = 26.8 ± 15.9) and macular abnormalities (n = 10, mean age ± SD = 71.6 ± 15.4) underwent imaging with the top three scoring fundus cameras. Images were randomised and subsequently validated by ophthalmologists masked to the diagnoses and devices used. RESULTS Image acquisition success rates (100%) were achieved in non-mydriatic and mydriatic settings for Zeiss, Remidio and Pictor, compared with lower success rates for iNview and oDocs. Image quality and gradeability were significantly higher for Zeiss, Remidio and Pictor (p < 0.0001) compared to iNview and oDocs. For cup:disc ratio estimates, similar levels of bias were seen for Zeiss (-0.09 ± SD:0.15), Remidio (-0.07 ± SD:0.14) and Pictor (-0.05 ± SD:0.16). Diagnostic sensitivities were highest for Zeiss (84.9%; 95% CI, 78.2-91.5%) followed by Pictor (78.1%; 95% CI, 66.6-89.5%) and Remidio (77.5%; 95% CI, 65.9-89.0%). CONCLUSIONS Remidio and Pictor achieve comparable results to the Zeiss table-top camera. Both devices achieved similar scores in feasibility, image quality, image gradeability and diagnostic sensitivity. This suggests that these devices potentially offer a more cost-effective alternative in certain clinical scenarios.
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Shen R, Li VSW, Wong MOM, Chan PPM. Pediatric Glaucoma-From Screening, Early Detection to Management. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020181. [PMID: 36832310 PMCID: PMC9954748 DOI: 10.3390/children10020181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
Pediatric glaucoma (PG) covers a rare and heterogeneous group of diseases with variable causes and presentations. Delayed diagnosis of PG could lead to blindness, bringing emotional and psychological burdens to patients' caregivers. Recent genetic studies identified novel causative genes, which may provide new insight into the etiology of PG. More effective screening strategies could be beneficial for timely diagnosis and treatment. New findings on clinical characteristics and the latest examination instruments have provided additional evidence for diagnosing PG. In addition to IOP-lowering therapy, managing concomitant amblyopia and other associated ocular pathologies is essential to achieve a better visual outcome. Surgical treatment is usually required although medication is often used before surgery. These include angle surgeries, filtering surgeries, minimally invasive glaucoma surgeries, cyclophotocoagulation, and deep sclerectomy. Several advanced surgical therapies have been developed to increase success rates and decrease postoperative complications. Here, we review the classification and diagnosis, etiology, screening, clinical characteristics, examinations, and management of PG.
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Affiliation(s)
- Ruyue Shen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Venice S. W. Li
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
| | - Mandy O. M. Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
| | - Poemen P. M. Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
- Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong, China
- Correspondence: ; Tel.: +852-3943-5807
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Vujosevic S, Limoli C, Luzi L, Nucci P. Digital innovations for retinal care in diabetic retinopathy. Acta Diabetol 2022; 59:1521-1530. [PMID: 35962258 PMCID: PMC9374293 DOI: 10.1007/s00592-022-01941-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/04/2022] [Indexed: 12/02/2022]
Abstract
AIM The purpose of this review is to examine the applications of novel digital technology domains for the screening and management of patients with diabetic retinopathy (DR). METHODS A PubMed engine search was performed, using the terms "Telemedicine", "Digital health", "Telehealth", "Telescreening", "Artificial intelligence", "Deep learning", "Smartphone", "Triage", "Screening", "Home-based", "Monitoring", "Ophthalmology", "Diabetes", "Diabetic Retinopathy", "Retinal imaging". Full-text English language studies from January 1, 2010, to February 1, 2022, and reference lists were considered for the conceptual framework of this review. RESULTS Diabetes mellitus and its eye complications, including DR, are particularly well suited to digital technologies, providing an ideal model for telehealth initiatives and real-world applications. The current development in the adoption of telemedicine, artificial intelligence and remote monitoring as an alternative to or in addition to traditional forms of care will be discussed. CONCLUSIONS Advances in digital health have created an ecosystem ripe for telemedicine in the field of DR to thrive. Stakeholders and policymakers should adopt a participatory approach to ensure sustained implementation of these technologies after the COVID-19 pandemic. This article belongs to the Topical Collection "Diabetic Eye Disease", managed by Giuseppe Querques.
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Affiliation(s)
- Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
- Eye Clinic, IRCCS MultiMedica, Via San Vittore 12, 20123, Milan, Italy.
| | - Celeste Limoli
- Eye Clinic, IRCCS MultiMedica, Via San Vittore 12, 20123, Milan, Italy
- University of Milan, Milan, Italy
| | - Livio Luzi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy
| | - Paolo Nucci
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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Sosa Lockward JA, Abreu Arbaje N, García Méndez M, Juan A, Sosa Peña JA, Batlle Pichardo JF. Telemedicine in retinopathy of prematurity: Crossing borders in pediatric vision health. TELEROP study. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:543-548. [PMID: 36038486 DOI: 10.1016/j.oftale.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
GENERAL OBJECTIVE To evaluate the accuracy and validity of images with smartphone compared to the RetCam® system for the diagnosis of retinopathy of prematurity (ROP). METHODOLOGY Observational, longitudinal and masked study carried out at the Dr. Elías Santana hospital. Infants with birth weight ≤1500 g, gestational age ≤30 weeks and/or patients exposed to risk factors or complications linked to ROP were included. These subjects were screened using images with smartphone or RetCam®, both compared to conventional fundoscopy. The ICROP classification was used for staging. The main results analyzed were sensitivity, specificity, positive predictive values and kappa index. RESULTS 915 images (n = 121) were obtained, distributed in smartphone group (50.4%) and RetCam® group (49.6%) between August 2020 and March 2021. Subjects with ROP had lower gestational age (30.2 sem ± 2.8), birth weight (1361 g ± 398), and greater exposure to oxygen therapy (12.8 days ± 11.3). The RetCam® group presented sensitivity = 80%, specificity = 78%, positive predictive value = 90% and kappa index = 0.70. The smartphone group presented sensitivity = 88%, specificity = 90%, positive predictive value = 93.75% and kappa index = 0.81. CONCLUSIONS Both diagnostic methods were accurate to identify ROP. The smartphone group obtained superior results with excellent resolution, representing a cost-effective method to create a global impact on reducing preventable blindness in the pediatric population.
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Affiliation(s)
- J A Sosa Lockward
- Servicio de Oftalmología, Hospital Dr. Elías Santana, Santo Domingo, Dominican Republic.
| | - N Abreu Arbaje
- Departamento de Retina y Vítreo, Hospital Dr. Elías Santana, Santo Domingo, Dominican Republic
| | - M García Méndez
- Departamento de Retina y Vítreo, Hospital Dr. Elías Santana, Santo Domingo, Dominican Republic
| | - A Juan
- Departamento de Retina y Vítreo, Hospital Dr. Elías Santana, Santo Domingo, Dominican Republic
| | - J A Sosa Peña
- Servicio de Oftalmología Pediátrica y Estrabismo, Hospital Dr. Elías Santana, Santo Domingo, Dominican Republic
| | - J F Batlle Pichardo
- Servicio de Retina y Vítreo y Servicio de Oftalmología, Hospital Dr. Elías Santana, Santo Domingo, Dominican Republic
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