Validation of using smartphone based non-mydriatic camera for retinal photography to diagnose diabetic retinopathy

Abstract

Purpose: To assess the sensitivity and specificity of retinal imaging captured by portable non-mydriatic ‘fundus on phone’ camera as a screening tool against the conventional seven field digital fundus photography. Design: Prospective comparative study design. Methods: Study was performed over 300 diabetic patients (600 eyes). First fundus pictures were taken with non-mydriatic ‘fundus-on-phone’ camera and then with Zeiss seven field fundus camera after pupillary dilation. Images were analysed and compared by two observers. Results: Out of all the 600 undilated fundus images, 15.5% were ungradable, 76% were graded as poor and average quality by both observers. From the dilated fundus images taken using Zeiss camera, only 0.8% images were found ungradable by both observers. The sensitivity and specificity for detecting any diabetic retinopathy changes and its severity by using ‘fundus-on-phone’ camera against Zeiss fundus camera were found to be 54.92% and 85.5%, respectively, by observer one and 56.48% and 85.5%, respectively, by observer two. Conclusion: Non-mydriatic retinal imaging using fundus-on-phone camera is not a feasible method for screening diabetic retinopathy due to low sensitivity and high number of poor-quality images.