Selfie Fundus Imaging (SFI) for Diabetic Retinopathy Screening During COVID 19 Pandemic

Abstract

Background: Regular screening for retinopathy and timely intervention reduces blindness from diabetes by 90%. Screening is currently dependent on interpretation of images captured by trained technicians. Inherent barriers of accessibility and affordability with this approach impedes widespread success of retinopathy screening programs. Herein, we report our observations on the potential of a novel approach, Selfie Fundus Imaging (SFI), to enhance retinopathy screening.Methods: The study was undertaken over a two-month period during COVID 19 lockdown. 60 diabetic patients participated in the study. Retinal images were captured using three different approaches, handheld smartphone based photographs captured by patients themselves after a short video assisted training session (SFI group), smartphone based photographs captured by a trained technician and photographs taken on desktop conventional digital fundus camera (Gold standard). Sensitivity and kappa statistics was determined for retinopathy and macular edema grading.Findings: Mean age of the study participants was 52.4 years +/- 9.8 years and 78% were men. Of 120 images captured using SFI, 90% were centred-gradable, 8% were decentred-gradable and 2% were ungradable. 82% patients captured the image within a minute (majority by 31-45 seconds). The sensitivity of SFI to detect diabetic retinopathy was 88.39%. Agreement between SFI grading and standard fundus photograph grading was 85.86% with substantial kappa (0.77). For the detection of diabetic macular edema, the agreement between SFI images and standard images was 93.67, with almost perfect kappa (0.91).Interpretation: Fundus images were captured by patients using SFI without major difficulty and were comparable to images taken by trained specialist. With greater penetrance, advances, and availability of mobile photographic technology, we believe that SFI would positively impact success of diabetic retinopathy screening programs by breaking the barriers of availability, accessibility, and affordability. SFI could ensure continuation of screening schedules for diabetic retinopathy, even in the face a highly contagious pandemic.Funding: The study was not funded by any intramural or extramural agencies/ companies/ sponsors. It was carried out independently by the authors without seeking any funding.Conflict of Interest: None to declare. Ethical Approval: This prospective, comparative study was initiated after obtaining due ethical clearance (IECPG-646/19/12/2018) from the institutional ethics committee and followed the tenets of the Helsinki Declaration.