Non-mydriatic Fundus Camera Research Articles

Diabetic Retinopathy Screening Using Non-Mydriatic Fundus Camera in Primary Health Care Settings - A Multicenter Study from Saudi Arabia.

Screening of diabetic retinopathy (DR) using the current digital imaging facilities in a primary health care setting is still in its early stages in Saudi Arabia. This study aims to reduce the risk of vision impairment and blindness among known diabetic people through early identification by general practitioners (GP) in a primary health care setting in Saudi Arabia. The objective of this study was to evaluate the accuracy of diabetic retinopathy (DR) detection by general practitioners (GPs) by comparing the agreement of DR assessment between GPs and ophthalmologists' assessment as a gold standard. A hospital-based, six-month cross-sectional study was conducted, and the participants were type 2 diabetic adults from the diabetic registries of seven rural PHCs, in Saudi Arabia. After medical examination, the participants were then evaluated by fundus photography using a non-mydriatic fundus camera without medication for mydriasis. Presence or absence of DR was graded by the trained GPs in the PHCs and then compared with the grading of an ophthalmologist which was taken as a reference or a gold standard. A total of 899 diabetic patients were included, and the mean age of the patients was 64.89 ± 11.01 years. The evaluation by the GPs had a sensitivity of 80.69 [95% CI 74.8-85.4]; specificity of 92.23 [88.7-96.3]; positive predictive value, 74.1 [70.4-77.0]; negative predictive value, 73.34 [70.6-77.9]; and an accuracy of 84.57 [81.8-89.88]. For the consensus of agreement the adjusted kappa coefficient was from 0.74 to 0.92 for the DR. This study demonstrates that trained GPs in rural health centers are able to provide reliable detection results of DR from fundus photographs. The study highlights the need for early DR screening programs in the rural areas of Saudi Arabia to facilitate early identification of the condition and to lessen impact of blindness due to diabetes.

Ocular counter-roll during a Mŕnière’s attack: evidence of ictal utricle pathway imbalance using fundus photography (P3-9.004)

<h3>Objective:</h3> To call attention to unrecognized ictal vestibular manifestations of Mŕnière’s disease. <h3>Background:</h3> During Mŕnière’s disease (MD) attacks, static semicircular canal (SCC) asymmetry causes spontaneous nystagmus (ipsilesional when excitatory, and contralesional when inhibitory). Acute dynamic SCC dysfunction can cause an abnormal head impulse test (HIT, e.g., acute vestibular neuritis), although the HIT can be normal during a MD attack. Documentation of ictal otolith (utricle and saccule) dysfunction using vestibular evoked myogenic potentials (VEMPs) has rarely been reported. We describe the first case, to our knowledge, of a patient presenting with a Mŕnière’s attack in whom an ocular counter-roll (OCR, from static utricle pathway imbalance) was documented using fundus photography. <h3>Design/Methods:</h3> One case report of a patient with an OCR observed during a MD attack. <h3>Results:</h3> A 65-year-old man with known history of bilateral MD presented during a typical vertigo attack, and testing demonstrated: 1) Video-oculography (VOG) – spontaneous horizontal-torsional, unidirectional right beating nystagmus, following Alexander’s law; 2) Video HIT (vHIT) – low gain (0.49 where &lt;0.7 is considered abnormal) in the plane of the left horizontal SCC; 3) fundus photography – OCR with the top poles of both eyes rotated toward the left ear, in the absence of other features of the ocular tilt reaction (OTR, including OCR, head tilt, skew deviation). The HINTS exam (head impulse, nystagmus, test of skew) suggested a left peripheral vestibulopathy, and a Mŕnière’s attack was diagnosed given his history. Three weeks later testing was repeated while asymptomatic: 1) VOG – no nystagmus; 2) vHIT – normal horizontal SCC gain (0.73); 3) fundus photography – no OCR. For more, visit the NOVEL collection: https://collections.lib.utah.edu/ark:/87278/s6k97g27 <h3>Conclusions:</h3> Using a non-mydriatic fundus camera, we were able to document an ictal OCR in MD. Its presence suggested utricle pathway imbalance, offering insight into the labyrinthine structures that may be involved during a MD attack. <b>Disclosure:</b> Dr. Fracica has nothing to disclose. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer .

Commentary: The never-ending story of COVID-19: Accustoming to the new abnormal in glaucoma practice.

Commentary: The never-ending story of COVID-19: Accustoming to the new abnormal in glaucoma practice.

Lifestyle Changes Reduced Estimated White Matter Hyperintensities Based on Retinal Image Analysis.

This study evaluates if there is an association between lifestyle changes and the risk of small vessel disease (SVD) as measured by cerebral white matter hyperintensities (WMH) estimated by the automatic retinal image analysis (ARIA) method. We recruited 274 individuals into a community cohort study. Subjects were assessed at baseline and annually with the Health-Promoting Lifestyle Profile II Questionnaire (HPLP-II) and underwent a simple physical assessment. Retinal images were taken using a non-mydriatic digital fundus camera to evaluate the level of WMH estimated by ARIA (ARIA-WMH) to measure the risk of small vessel disease. We calculated the changes from baseline to one year for the six domains of HPLP-II and analysed the relationship with the ARIA-WMH change. A total of 193 (70%) participants completed both the HPLP-II and ARIA-WMH assessments. The mean age was 59.1 ± 9.4 years, and 76.2% (147) were women. HPLP-II was moderate (Baseline, 138.96 ± 20.93; One-year, 141.97 ± 21.85). We observed a significant difference in ARIA-WMH change between diabetes and non-diabetes subjects (0.03 vs. -0.008, respectively, p = 0.03). A multivariate analysis model showed a significant interaction between the health responsibility (HR) domain and diabetes (p = 0.005). For non-diabetes subgroups, those with improvement in the HR domain had significantly decreased in ARIA-WMH than those without HR improvement (-0.04 vs. 0.02, respectively, p = 0.003). The physical activity domain was negatively related to the change in ARIA-WMH (p = 0.02). In conclusion, this study confirms that there is a significant association between lifestyle changes and ARIA-WMH. Furthermore, increasing health responsibility for non-diabetes subjects reduces the risk of having severe white matter hyperintensities.

Using deep learning to detect diabetic retinopathy on handheld non-mydriatic retinal images acquired by field workers in community settings

Diabetic retinopathy (DR) at risk of vision loss (referable DR) needs to be identified by retinal screening and referred to an ophthalmologist. Existing automated algorithms have mostly been developed from images acquired with high cost mydriatic retinal cameras and cannot be applied in the settings used in most low- and middle-income countries. In this prospective multicentre study, we developed a deep learning system (DLS) that detects referable DR from retinal images acquired using handheld non-mydriatic fundus camera by non-technical field workers in 20 sites across India. Macula-centred and optic-disc-centred images from 16,247 eyes (9778 participants) were used to train and cross-validate the DLS and risk factor based logistic regression models. The DLS achieved an AUROC of 0.99 (1000 times bootstrapped 95% CI 0.98–0.99) using two-field retinal images, with 93.86 (91.34–96.08) sensitivity and 96.00 (94.68–98.09) specificity at the Youden’s index operational point. With single field inputs, the DLS reached AUROC of 0.98 (0.98–0.98) for the macula field and 0.96 (0.95–0.98) for the optic-disc field. Intergrader performance was 90.01 (88.95–91.01) sensitivity and 96.09 (95.72–96.42) specificity. The image based DLS outperformed all risk factor-based models. This DLS demonstrated a clinically acceptable performance for the identification of referable DR despite challenging image capture conditions.

Digital solution for detection of undiagnosed diabetes using machine learning-based retinal image analysis

IntroductionUndiagnosed diabetes is a global health issue. Previous studies have estimated that about 24.1%–75.1% of all diabetes cases are undiagnosed, leading to more diabetic complications and inducing huge healthcare costs....

Prevalence of hypertensive retinopathy among the known diabetics in a community-based setting using a non-mydriatic fundus camera

Hypertension is a leading cause of morbidity and mortality and is associated with the risk of cardiovascular, cerebrovascular disease, and target organ damage. The risk increases exponentially in individuals with diabetes. Hypertensive retinopathy is a marker for target organ damage, so screening for hypertensive retinopathy helps in cardiovascular risk stratification. This study was conducted with an objective to screen for hypertensive retinopathy among known diabetics using a portable non-mydriatic fundus camera to ascertain its prevalence. The study was conducted in three selected field practice areas of the Department of Community Medicine. A house-to-house survey was performed using a predesigned, pretested questionnaire among 302 known diabetics. The study participants were subjected to visual acuity examination using Snellen's chart and retinal fundus examination using a portable non-mydriatic Bosch Mobile Eye Care Solutions fundus camera. The fundus images were transferred to a laptop and were reviewed and graded by an experienced Ophthalmologist. Among the 302 participants studied, 60 were diagnosed with hypertensive retinopathy. The prevalence of hypertensive retinopathy among diabetic patients was 19.9 % (95% CI: 15.7% - 24.6%). The prevalence was found to be higher in ** (21.8%; 95% CI: 16% - 28.6%) as compared to ** (17.5%; 95% CI: 11.8% - 24.6%). Early detection of hypertensive retinopathy with cardiovascular risk stratification and initiation of prompt treatment among the high-risk individuals will help reduce the morbidity caused due to end-organ damage and premature mortality to a greater extent and will pave the way forward to achieving sustainable developmental goals.

Validity of Hand Held Fundus Camera by Optometrist using Slit lamp 90D bio microscopy as a reference standard for screening of Diabetes Retinopathy.

To find out the validity of hand-held fundus camera by optometrist using slit lamp 90D biomicroscopy as reference standard for screening of diabetes retinopathy. The observational cross-sectional study was conducted at the diabetic clinic of Al-Ibrahim Eye Hospital, Karachi, from August 2020 to May 2021, and comprised diabetics of either gender aged >16 years visiting the outpatient department. Un-dilated fundus photograph of both eyes were taken with non-mydriatic fundus camera. Pupils were then mid-dilated with one drop of tropicamide 1% before capturing retinal images by handheld fundus camera by another optometrist. Both the optometrists identified and recorded the presence and absence of diabetic retinopathy. Subsequently, a retinal specialist examined the fundus with slit lamp 90 D biomicroscopy. Data was analysed using SPSS 23. Of the 500 subjects, 291(58.2%) were males and 209(41.8%) were females. The overall mean age was 54.49±9.16 years (range: 16-83 years). Of the 1000 eyes, fundus was not readable in 130(13%) by hand-held fundus camera, 296(29.6%) eyes by non-mydriatic fundus camera and 76(7.6%) eyes by slit lamp. Sensitivity and specificity of hand-held fundus camera compared to non-mydriatic fundus camera was 89.86% and 80.36%, respectively. In comparison with slit lamp, the sensitivity was 91.71% and specificity was 71.10%. Kappa statistic for diabetic retinopathy detection by hand-held fundus camera versus non-mydriatic fundus camera was 0.705, indicating substantial agreement. Kappa statistic for diabetic retinopathy detection with hand-held fundus camera with semi-dilated pupil was found to be a valid screening tool in the hand of optometrist for preliminary screening of diabetic retinopathy. Handheld fundus camera with semi-dilated pupil was found to be a valid screening tool in the hand of optometrist for preliminary screening of diabetic retinopathy.

Influence of Different Types of Retinal Cameras on the Performance of Deep Learning Algorithms in Diabetic Retinopathy Screening.

Background: The aim of this study was to assess the performance of regional graders and artificial intelligence algorithms across retinal cameras with different specifications in classifying an image as gradable and ungradable. Methods: Study subjects were included from a community-based nationwide diabetic retinopathy screening program in Thailand. Various non-mydriatic fundus cameras were used for image acquisition, including Kowa Nonmyd, Kowa Nonmyd α-DⅢ, Kowa Nonmyd 7, Kowa Nonmyd WX, Kowa VX 10 α, Kowa VX 20 and Nidek AFC 210. All retinal photographs were graded by deep learning algorithms and human graders and compared with a standard reference. Results: Images were divided into two categories as gradable and ungradable images. Four thousand eight hundred fifty-two participants with 19,408 fundus images were included, of which 15,351 (79.09%) were gradable images and the remaining 4057 (20.90%) were ungradable images. Conclusions: The deep learning (DL) algorithm demonstrated better sensitivity, specificity and kappa than the human graders for all eight types of non-mydriatic fundus cameras. The deep learning system showed, more consistent diagnostic performance than the human graders across images of varying quality and camera types.

An unusual occurrence of a swollen battery in a non-mydriatic fundus camera - An alarming potential occupational hazard in an ophthalmic outpatient department

An unusual occurrence of a swollen battery in a non-mydriatic fundus camera - An alarming potential occupational hazard in an ophthalmic outpatient department

Screening of Diabetic Retinopathy Using Teleophthalmology to Complement Human Resources for Eye Health: A Systematic Review and Meta-Analysis.

Diabetic retinopathy is a vascular disease of the retina that affects patients with uncontrolled diabetes. Untreated diabetic retinopathy (DR) can eventually lead to blindness. To date, diabetic retinopathy is the third leading cause of vision loss in the working class globally. Frequent retinal screening for all diabetic people is an effective method of preventing diabetic retinopathy blindness. This has relied on the use of ophthalmologists, but due to scarce resources, such as a shortage of human resources for eye health, this has denied many patients quality eye health care in a resource-limited setting. The recent advances on the use of teleophthalmology are promising to close this gap. This study aimed to map available evidence on the use of teleophthalmology in the screening of DR globally and to explore how this can be used to complement short-staffed eye clinics, especially in resource-constrained contexts. Studies were sourced from Google Scholar, PubMed, Science Direct, and EBSCO host. The final study selection was presented using a PRISMA chart. The mixed method appraisal tool was used to assess the quality of the nine studies included. The random effect model was used to estimate pooled prevalence estimates. Levels of heterogeneity were evaluated using Cochran’s Q statistic and I2. Of nine included studies, eight were from high-income countries. The screening was performed at the primary healthcare level in eight of nine included studies. Only one study used a mydriatic agent, and the commonly used fundus camera was the non-mydriatic fundus camera. The overall estimated pooled prevalence of DR was 29 (95%CI: 10–34). Teleophthalmology at the primary health care level showed that early intervention in diabetic retinopathy reduced avoidable blindness and ensured remote access to eye health professionals, thus alleviating the burden on them.

STUDY OF EARLY RETINAL CHANGES IN PATIENTS WITH NEWLY DIAGNOSED TYPE 2 DIABETES MELLITUS

Objective: Retina and endothelium constitute fields in which the hyperglycemia’s pathological effects of type 2 diabetes mellitus (T2DM) can be detected. However, the precise time of these lesions’ appearance and factors contributing to it are still under investigation. Thus, we studied the early retinal lesions and endothelial function in patients with a recent diagnosis of T2DM (&lt;6 months) and their association with adverse prognostic factors. Design and method: Patients with a recent diagnosis of T2DM receiving no other diabetic medication except from Metformin, and volunteers matched for age and blood pressure (BP) participated in the study. Somatometric data, BP measurements (ambulatory and office) and hematological parameters (lipids, renal function, fasting glucose, glycosylated hemoglobin) were recorded. Endothelial function was assessed by Asymmetric Dimethylarginine (ADMA). Retinal vessel diameters (central retinal arteriolar equivalent-CRAE / central retinal venular equivalent-CRVE) and their ratio (arteriovenous ratio-AVR) were assessed with a non-mydriatic fundus camera using special software. Results: We studied 165 participants, 81 T2DM patients and 84 non-T2DM volunteers. No differences were found between the 2 groups in retinopathy and ADMA measurements. ADMA was associated with female sex (p = 0.037), Body Mass Index (p = 0.033) and AVR (p = 0.047). AVR was significantly associated with age, male sex, ADMA, estimated Glomerular Filtration Rate (eGFR), smoking, office, day and nighttime diastolic, 24-hour, and nighttime systolic BP. Linear regression analysis showed the independent correlation of AVR with nighttime systolic blood pressure (p = 0.002) and age (p = 0.019) taking into consideration gender, smoking, eGFR, ADMA and T2DM. Conclusions: In patients with a very recent diagnosis of Type 2 Diabetes Mellitus, the retinal vessels diameters do not differ compared with individuals of similar age and blood pressure. However, the AVR index correlates with age and nighttime BP, highlighting the important contribution of the latter in early target organ damage in this population.

Commentary: Shifting our focus to diabetic retinopathy is the need of the hour.

The initiatives started under the VISION 2020 program have made a huge impact on global eye health, especially in developing countries like India. One such initiative is the organization of outreach camps to identify and treat patients with avoidable blindness. The programs related to the diseases requiring one-time treatment like cataract and refractive errors have achieved huge success.[1] On the contrary, the programs associated with the diseases requiring long-term follow-up like diabetic retinopathy (DR) and glaucoma are still in their nascent steps. With the increasing life expectancy, sedentary lifestyle, and changing dietary pattern, diabetic retinopathy is expected to become a major health problem of the community.[2] We congratulate the authors for performing a thorough systemic review on the prevalence of DR in India in the published article in the current issue of the Indian Journal of Ophthalmology.[3] The authors have performed an excellent meta-analysis of the various risk factors evaluated by the previous studies, gender being the only exception.[3] The evaluation of gender as a risk factor in epidemiological studies is important as several studies have shown a gender bias in health-seeking behavior.[4] The authors have correctly highlighted that most of the previous studies have been performed in South India and it is difficult to extrapolate the prevalence of DR in one region to other parts of the country as India is a conglomerate of people with different ethnicity, dietary habits, and probably genetic makeup. Hence, a nationwide study or multiple studies with the same inclusion/exclusion and evaluation criteria to determine the prevalence of DR, sight-threatening DR (STDR), and diabetic macular edema (DME) are needed. The dietary habits vary with the geographical, cultural as well as socio-economic profile of people. Studies are warranted to evaluate the influence of different Indian dietary habits on DR and the indigenous diet(s) found to be beneficial should be promoted.[5] The job profile and sedentary lifestyle have also been found to influence the incidence of DR. Sedentary behavior is defined as any activity (sitting or reclining position) that is associated with minimal energy expenditure, i.e., ≤1.5 metabolic equivalents.[6] Kohli et al.[7] showed that the incidence of DR in state bus drivers was higher than that reported among the general diabetic population in India, which they hypothesized may be due to long working hours. Similarly, other professions which predispose to high risk of developing DR should be established. The sample size of the study needs to be carefully calculated so that it has adequate power to evaluate the influence of the region and different parameters like dietary habits, rural-urban status, age, gender, socio-economic status, per-capita income, level of education, level of health-seeking behavior, and access to general and ophthalmic health care. The presence of other systemic diseases like hypertension, dyslipidemia, and chronic renal disease has a significant effect on the prevalence of DR, STDR, and DME. Such studies will go a long way in projecting the prevalence of DR in the future. This will help to formulate government policies and plan strategies for capacity building to screen and treat the ever-increasing load of patients of DR. One of the difficulties in performing such studies is the availability of retina specialists for diagnosing and grading DR. However, the recent technological advances can be used to fill in this gap. The use of nonmydriatic fundus cameras and telemedicine has reduced the need for the retina specialist to travel to the various sites of cluster selection. The use of artificial intelligence (AI) to analyze retinal images can further enhance speed, accuracy, and consistency. However, a legal framework for the use of AI in DR screening is necessary before planning any large-scale studies.[8] The last step is to create public awareness. It should be highlighted that in contrast to cataract, the management of DR is complex and needs life-long treatment. Just like diabetes itself, the management of DR does not end with a single time intervention. The need for a regular life-long follow-up as well as multiple sessions and modalities of treatment like laser, intravitreal injections, and vitrectomy should be emphasized.

A new approach to non-mydriatic portable fundus imaging

ABSTRACT Introduction The present study proposes a new hand-held non-mydriatic fundus camera for retinal imaging. The goal is to design a fundus camera which is equally effective in both clinical and telemedicine scenarios. Areas covered A new retinal illumination approach is proposed to address the main dilemma of the optical design, i.e. balancing efficacy with structural simplicity. This is achieved by symmetrical and co-axial placement of multiple illumination sources along the optical pathway. Each illumination source includes a white and a Near Infra-Red (NIR) LED, which are placed adjacent to each other. Hence, the camera can produce a view-finder with NIR illumination without the need for additional beam-splitters and filters. Expert Opinion The proposed design blends the structural simplicity of the ‘off-axis illumination with the wide field of view and uniform illumination of the ‘ring’ illumination. Moreover, the camera is designed to work with Android-based smartphones, which can easily be mounted and interfaced. The efficacy of the proposed camera is determined by ocular safety analysis and comparative evaluation with a table-top fundus camera. The results convincingly demonstrate the ability of the proposed camera as a primary driver of a wide-scale screening program in both clinical and remote resource constraint environments.

Diabetic Retinopathy Trends in a Digital Screening Program of Eight and Half Years

Objectives: To share the trending of Diabetic Retinopathy (DR) over eight and half years period digital screening program of DR in Bangladesh at a tertiary eye hospital. Methods: This study analyze 8 and 1/2 years (102 months, from July 2010 to December 2018) findings of a digital screening and subsequent grading programs of DR in a tertiary eye care centre. A total 45289 eyes of 22645 diabetic person underwent retinal photography.7818 (17.26%) retinal Photographs were excluded because of unassessable for grading remaining 37471 retinal photographs were analyzed. Screening was performed by non-mydriatic digital fundus camera. Optometrist &amp; Ophthalmologist review of all photographs were done at three level of grading system. Evaluation of the percentage distribution of degree of retinopathy was done. Data analysis was done by SPSS software version 16.0. Results: A total of 22645 patients (64.12 % male,35.88 % female) with mean age of 55.58 ± 9.88 (±SD) years were under went DR screening during a 8.5 years period. Features of DR was found in 18958 of 37471 (50.59%) retinal photographs. Non-proliferative diabetic retinopathy (NPDR) was documented in 14457 of 37471 photographs (38.59 %), while 4501 of 37471 photographs (12.00%) showed proliferative diabetic retinopathy (PDR). Diabetic Macular Edema (DME) was found in 10788 (28.79 %) of total 37471 assessable photograph and (56.90 %) of a total 18958 DR. Conclusion: DR is highly prevalent among Bangladeshi patients. In order to provide a sensitive, cost effective and easily accessible DR screening, digital imaging is a useful means

Optic Nerve Head Morphology in Adults Born Extreme, Very, and Moderate Preterm With and Without Retinopathy of Prematurity: Results From the Gutenberg Prematurity Eye Study

This study aimed to investigate associations of prematurity and associated factors with optic disc morphology in adulthood as long-term effects. Retrospective cohort study. The Gutenberg Prematurity Eye Study (GPES) is a retrospective cohort study with a prospective ophthalmologic examination of adults (age 18-52 years) in Germany. In every participant, photography of optic discs was performed with a nonmydriatic fundus camera, and optic disc measurements were done manually. The vertical cup-to-disc ratio (VCDR), optic disc area, and torted and tilted discs were assessed and exploratively compared between individuals with retinopathy of prematurity (ROP) with treatment, an ROP group without treatment and groups of individuals of different gestational ages (GAs) without ROP (GA ≤ 28 weeks, GA 29-32 weeks, GA 33-36 weeks, and GA ≥ 37 weeks [control group]). The present analysis included 743 eyes of 393 individuals born preterm and full-term (aged 28.4 ± 8.6 years, 223 females). The VCDR was significantly larger in subjects with a GA ≤28 weeks without ROP compared to the full-term control group (GA ≥37 weeks) (P=.002). Subjects with ROP without treatment also had a larger VCDR (P=.001), whereas those with ROP treatment showed a smaller VCDR than the full-term control group (P=.02). In addition, individuals with ROP treatment were more likely to have a torted disc than the full-term control group (P=.006). The present study provides evidence that individuals born extremely preterm have increased VCDR in adulthood. Furthermore, these results indicate that fetal origins affect optic disc morphology until adulthood, which might predispose the affected individual to degenerative optic nerve head diseases or being incorrectly diagnosed to glaucoma.

Cross-Camera External Validation for Artificial Intelligence Software in Diagnosis of Diabetic Retinopathy.

Aims To investigate the applicability of deep learning image assessment software VeriSee DR to different color fundus cameras for the screening of diabetic retinopathy (DR). Methods Color fundus images of diabetes patients taken with three different nonmydriatic fundus cameras, including 477 Topcon TRC-NW400, 459 Topcon TRC-NW8 series, and 471 Kowa nonmyd 8 series that were judged as “gradable” by one ophthalmologist were enrolled for validation. VeriSee DR was then used for the diagnosis of referable DR according to the International Clinical Diabetic Retinopathy Disease Severity Scale. Gradability, sensitivity, and specificity were calculated for each camera model. Results All images (100%) from the three camera models were gradable for VeriSee DR. The sensitivity for diagnosing referable DR in the TRC-NW400, TRC-NW8, and non-myd 8 series was 89.3%, 94.6%, and 95.7%, respectively, while the specificity was 94.2%, 90.4%, and 89.3%, respectively. Neither the sensitivity nor the specificity differed significantly between these camera models and the original camera model used for VeriSee DR development (p = 0.40, p = 0.065, respectively). Conclusions VeriSee DR was applicable to a variety of color fundus cameras with 100% agreement with ophthalmologists in terms of gradability and good sensitivity and specificity for the diagnosis of referable DR.

Validation of Computer-Aided Diagnosis of Diabetic Retinopathy from Retinal Photographs of Diabetic Patients from Telecamps

Objective: To validate an algorithm previously developed by the Healthcare Technology Innovation Centre, IIT Madras, India for screening of diabetic retinopathy (DR), in fundus images of diabetic patients from telecamps to examine the screening performance for DR. Design: Photographs of patients with diabetes were examined using the automated algorithm for the detection of DR Setting: Mobile Teleophthalmology camps were conducted in two districts in Tamil Nadu, India from Jan 2015 to May 2017. Participants: 939 eyes of 472 diabetic patients were examined at Mobile Teleophthalmology camps in Thiruvallur and Kanchipuram districts, Tamil Nadu, India,. Fundus images were obtained (40-45-degree posterior pole in each eye) for all patients using a nonmydriatic fundus camera by the fundus photographer. Main Outcome Measures: Fundus images were evaluated for presence or absence of DR using a computer-assisted algorithm, by an ophthalmologist at a tertiary eye care centre (reference standard) and by a fundus photographer. Results: The algorithm demonstrated 85% sensitivity and 80% specificity in detecting DR compared to ophthalmologist. The area under the receiver operating characteristic curve was 0.69 (95%CI=0.65 to 0.73). The algorithm identified 100% of vision-threatening retinopathy just like the ophthalmologist. When compared to the photographer, the algorithm demonstrated 81% sensitivity and 78% specificity. The sensitivity of the photographer to detect DR was found to be 86% and specificity was 99% in detecting DR compared to ophthalmologist. Conclusions: The algorithm can detect the presence or absence of DR in diabetic patients. All findings of vision-threatening retinopathy could be detected with reasonable accuracy and will help to reduce the workload for human graders in remote areas.

TREND database: Retinal images of healthy young subjects visualized by a portable digital non-mydriatic fundus camera.

Topological characterization of the Retinal microvascular nEtwork visualized by portable fuNDus camera (TREND) is a database comprising of 72 color digital retinal images collected from the students of the Faculty of Medicine at the University of Montenegro, in the period from February 18th to March 11th 2020. The database also includes binarized images of manually segmented microvascular networks associated with each raw image. The participant demographic characteristics, health status, and social habits information such as age, sex, body mass index, smoking history, alcohol use, as well as previous medical history was collected. As proof of the concept, a smaller set of 10 color digital fundus images from healthy older participants is also included. Comparison of the microvascular parameters of these two sets of images demonstrate that digital fundus images recorded with a hand-held portable camera are able to capture the changes in patterns of microvascular network associated with aging. The raw images from the TREND database provide a standard that defines normal retinal anatomy and microvascular network geometry in young healthy people in Montenegro as it is seen with the digital hand-held portable non-mydriatic MiiS HORUS Scope DEC 200.This knowledge could facilitate the application of this technology at the primary level of health care for large scale telematic screening for complications of chronic diseases, such as hypertensive and diabetic retinopathy. In addition, it could aid in the development of new methods for early detection of age-related changes in the retina, systemic chronic diseases, as well as eye-specific diseases. The associated manually segmented images of the microvascular networks provide the standard that can be used for development of automatic software for image quality assessment, segmentation of microvascular network, and for computer-aided detection of pathological changes in retina. The TREND database is freely available at https://doi.org/10.5281/zenodo.4521043.

Magnitude and Determinants of Diabetic Retinopathy Among Indian Diabetic Patients Undergoing Telescreening in India.

Purpose: To determine the magnitude, determinants, and public health issues related to diabetic retinopathy (DR) in India using 2019 data from a for-profit telescreening program. Methods: Digital retinal images were captured using a nonmydriatic fundus camera and transferred via the telescreening program to a reading center. Ophthalmologists trained in DR image reading created the DR status reports. Age/sex-adjusted rates of DR, sight-threatening DR (STDR), and diabetic macular edema (DME) were calculated and correlated with known risk factors. Results: Images of 51,760 Indian diabetic patients (103,520 eyes) were reviewed. The prevalence of DR, STDR, and DME was 19.1% (95% confidence interval [CI]: 18.9-19.5), 5.1% (95% CI: 4.9-5.3), and 3.9% (95% CI: 3.7-4.1), respectively. Based on these data, we projected 14.7 million cases of DR, 3.9 million with STDR, and 3.0 million DME cases in India. Statistically significant risk factors for DR were male gender (odds ratio [OR] = 1.19, p < 0.001), older age (χ2 = 270, df = 3, p < 0.001), history of cataract surgery (OR = 2.0, p < 0.001), longer duration of diabetes (χ2 = 1084, p < 0.001), and type 1 diabetes (OR = 3.9, p = 0.01). There was a statistically significant variation of DR by geographic zones (χ2 = 310, p < 0.001). Laser treatment coverage for STDR was 22%. Duration of diabetes (p < 0.001), cataract surgery in the past (p = 0.02), and females (p = 0.001) were predictors of STDR. Conclusion: This model of telescreening for DR provides an additional pathway for screening and preventing diabetes-related visual morbidity in India. The data from this study can be used for epidemiologic and ophthalmic health policies related to diabetes.