Non-contact smartphone-based fundus imaging compared to conventional fundus imaging: a low-cost alternative for retinopathy of prematurity screening and documentation

Frank G. Holz,Moritz Berger,Maximilian W. M. Wintergerst,Tim U. Krohne,Jeany Q. Li,Robert P. Finger,Petra P. Larsen,Michael Petrak

doi:10.1038/s41598-019-56155-x

Frank G. Holz, Moritz Berger + Show 6 more

Open Access

https://doi.org/10.1038/s41598-019-56155-x

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Abstract

Retinopathy of prematurity (ROP) is a frequent cause of treatable childhood blindness. The current dependency of telemedicine-based ROP screening on cost-intensive equipment does not meet the needs in economically disadvantaged regions. Smartphone-based fundus imaging (SBFI) allows for affordable and mobile fundus examination and, therefore, could facilitate cost-effective telemedicine-based ROP screening in low-resources settings. We compared non-contact SBFI and conventional contact fundus imaging (CFI) in terms of feasibility for ROP screening and documentation. Twenty-six eyes were imaged with both SBFI and CFI. Field-of-view was smaller (ratio of diameters, 1:2.5), level of detail was equal, and examination time was longer for SBFI as compared to CFI (109.0 ± 57.8 vs. 75.9 ± 36.3 seconds, p < 0.01). Good agreement with clinical evaluation by indirect funduscopy was achieved for assessment of plus disease and ROP stage for both SBFI (squared Cohen’s kappa, 0.88 and 0.81, respectively) and CFI (0.86 and 0.93). Likewise, sensitivity/specificity for detection of plus disease and ROP was high for both SBFI (90%/100% and 88%/93%, respectively) and CFI (80%/100% and 100%/96%). SBFI is a non-contact and low-cost alternative to CFI for ROP screening and documentation that has the potential to considerably improve ROP care in middle- and low-resources settings.

Highlights

Retinopathy of prematurity (ROP) is a frequent cause of treatable childhood blindness
As conventional digital fundus imaging systems for ROP are an enormous financial burden, for health systems in middle- and low-resources settings, there is a huge need for novel and more cost-effective strategies for ROP screening[5,6,11]
Smartphone-based fundus imaging (SBFI) is a less costly alternative to conventional imaging systems for ROP and may have the potential to facilitate telemedicine-based ROP screening in lower-resources settings

Summary

Introduction

Retinopathy of prematurity (ROP) is a frequent cause of treatable childhood blindness. Conventional digital fundus imaging systems for ROP are still a high financial burden, for health systems in middle- and low-resources settings and, a considerable barrier for telemedicine-based ROP screening. We performed a study on the feasibility and accuracy of a non-contact indirect SBFI adapter for ROP documentation and its comparison with an established contact-based fundus imaging system for ROP.

Results

Conclusion