Handheld fundus camera performance, image quality and outcomes of diabetic retinopathy grading in a pilot screening study

Pasi Ohtonen,Anna‐Maria Kubin,Antti Keskitalo,Joonas Wirkkala,Nina Hautala

doi:10.1111/aos.14850

Pasi Ohtonen, Anna‐Maria Kubin + Show 3 more

Open Access

https://doi.org/10.1111/aos.14850

Copy DOI

Journal: Acta Ophthalmologica	Publication Date: Mar 16, 2021
Citations: 15	License type: CC BY 4.0

Affiliation: Oulu University Hospital, University of Oulu

Abstract

To compare the performance and image quality of the handheld fundus camera to standard table-top fundus cameras in diabetic retinopathy (DR) screening. The reliability and diagnostic accuracy of DR grading performed by an ophthalmologist and a photographer reader were evaluated. 157 patients with diabetes, attending screening or follow-up of DR, were evaluated by fundus photographs taken in mydriasis by Optomed Aurora and Canon or Zeiss Visucam fundus cameras. The image quality and the severity of DR were evaluated independently by an ophthalmologist and experienced photographer. The sensitivity, specificity and reliability of the assessments were determined. 1884 fundus images from 314 eyes were analysed. In 53% of all eyes, DR was not present. 10% had mild non-proliferative diabetic retinopathy (NPDR), 16% moderate NPDR, 6% severe NPDR and 16% proliferative diabetic retinopathy (PDR). The DR grading outcomes by Aurora highly equalled to those of Canon or Zeiss (κ = 0.93, 95% CI 0.91 to 0.94), and there was almost perfect agreement in grading between the ophthalmologist and photographer (κ = 0.96, 95% CI 0.95 to 0.97). The image quality of Aurora was sufficient for reliable assessment according to both graders in 84-88% of the cases. The Optomed Aurora fundus camera seems appropriate for DR screening. The sufficient image quality and high diagnostic accuracy for DR grading are supportive for a less expensive and easily transportable screening system for DR. Immediate image grading carried out by a photographer would further improve and speed up the screening process in all settings.

Highlights

Diabetic retinopathy (DR) is still one of the primary causes of vision loss worldwide (Leasher et al 2016)
A handheld and movable fundus camera might serve as an alternative tool for organizing screening of DR in a costeffective manner (Davila et al 2017)
A total of 1884 fundus images taken with the commonly used table-top fundus cameras (Canon CF-1 or Zeiss Visucam 524) and Optomed Aurora were analysed. 107 out of the 157 patients included in the study were attending DR screening, and the remaining 50 patients were attending follow-up visits at the hospital’s outpatient clinic as a result of more advanced DR. 68% of the eyes of the patients attending regular DR screening had no DR, 13% had mild non-proliferative diabetic retinopathy (NPDR), 13% moderate NPDR and 1% severe NPDR

Summary

Introduction

Diabetic retinopathy (DR) is still one of the primary causes of vision loss worldwide (Leasher et al 2016). Half of the people living with diabetes lack diagnosis (Saeedi et al 2019). Some form of DR is estimated in 35% of the patients with diabetes and 10% of them have visionthreatening DR (Yau et al 2012). Even early changes of DR can be detected by fundus examination, and timely intervention may prevent or reduce vision loss. It is, important that patients with diabetes are screened regularly in case of DR by ophthalmic examination or, more frequently, by fundus photography

Methods

Results

Conclusion