Diabetic retinopathy screening using MII Ret Cam assisted smartphone-based fundus imaging

Abstract

BackgroundDiabetes Mellitus is a tremendous health implication and is proposed to be the seventh leading cause of death in 2030 by WHO. Diabetic retinopathy is one of the top complications of diabetes leading to preventable blindness. This investigation highlights the importance of timely screening and counseling using MII Ret cCam-assisted smartphone-based fundus imaging. Our study is a boon for bed-ridden and seriously ill patients who could not be evaluated on a fundus camera. MethodsThis is an observational prospective study conducted at the Ophthalmology unit, wards, and intensive care unit (ICU) of a single tertiary teaching hospital between 1 May to 31 November 2022. A total of 268 subjects with diabetes were included. The fundus of all the diabetic patients during the study period were examined by a single-trained ophthalmologist. Those diagnosed with diabetic retinopathy were taken for acquisition of fundus picture with MII Ret Cam. Images were captured using Apple iPhone 5s and 20D mounted in MII Ret Cam device. ResultsOut of 268 subjects (536 eyes) screened during the study period,86 patients (154 eyes) were found to have DR. Maleto Female ratio was 1.4:1. The mean age was 56.37 ± 15.26 years and the mean duration of diabetes was 10.60 ± 6.97 years. Grading of DR revealed proliferative diabetic retinopathy (PDR) to be the topmost (n=84 eyes, 54.5%), followed by mild non-proliferative diabetic retinopathy (NPDR) in 26 eyes (16%) and moderate NPDR in 24 eyes (15%) while severe NPDR was seen in 10 eyes (6.5%) and very severe NPDR was found in 8 eyes (5.2%) and diabetic papillopathy in 2 eyes. Grading of vitreous hemorrhage revealed Grade 1 in one eye (1.8%); Grade 2 in 19 eyes (34.54%); Grade 3 in 33 eyes (60%) and Grade 4 in 2 eyes (3.63%). Grading of macular edema according to the distribution of hard exudates as Grade 1(No Clinically significant macular edema) in 33 eyes (34.37%) and Grade 2 (Clinically significant macular edema) in 63 eyes (65.62%). The duration of diabetes had a direct association with the occurrence of DR, 13patients (15.1%) had a duration of diabetes less than five years; 31patients(36%) had a duration of diabetes between 6 years to 10 years; 28 patients (32.6%) had a duration between 11 years to 20 years. 14 patients (16.3%) had a duration of more than twenty years. The Mean duration of diabetes in Group I was 11.40+/- 7.09 years and was 9.10+/- 6.48 in Group II. The mean HbA1c in Group I is 7.44+/- 1.24 and 6.54 +/- 1.09 in Group II. The mean fasting blood sugar in Group I was 130.87 +/- 29.57 and 106.62+/- 29.85 in Group II. The mean of random blood sugar was 202.15 +/- 60.84 in Group I and 155.13 +/- 55.95 in Group II. Results are suggestive of the association of DR occurrence with fasting, random blood sugar, duration of diabetes, and HbA1c. ConclusionsDiabetic Retinopathy Screening using MII Ret Cam assisted Smartphone-based fundus imaging may be a useful device to screen for referable and vision-threatening diabetic retinopathy. MII Ret Cam is portable equipment and is easily accessible to counsel patients in resource-limited countries.