Accuracy of Low-Cost, Smartphone-Based Retinal Photography for Diabetic Retinopathy Screening: A Systematic Review

Abstract

Purpose

Diabetic retinopathy (DR) is a leading cause of blindness. Early DR screening is essential, but the infrastructure can be less affordable in low resource countries. This study aims to review the accuracy of low-cost smartphone-based fundus cameras for DR screening in adult patients with diabetes.

Methods

We performed a systematic literature search to find studies that reported the sensitivity and specificity of low-cost smartphone-based devices for fundus photography in adult patients with diabetes. We searched three databases (MEDLINE, Google Scholar, Scopus) and one register (Cochrane CENTRAL). We presented the accuracy values by grouping the diagnosis into three: any DR, referrable DR, and diabetic macular oedema (DMO). Risk of bias and applicability of the studies were assessed using QUADAS-2.

Results

Five out of 294 retrieved records were included with a total of six smartphone-based devices reviewed. All of the reference diagnostic methods used in the included studies were either indirect ophthalmoscopy or slit-lamp examinations and all smartphone-based devices’ imaging protocols used mydriatic drops. The reported sensitivity and specificity for any DR were 52–92.2% and 73.3–99%; for referral DR were 21–91.4% and 64.9–100%; and for DMO were 29.4–81% and 95–100%, respectively.

Conclusion

Sensitivity available low-cost smartphone-based devices for DR screening were acceptable and their specificity particularly for detecting referrable DR and DMO were considerably good. These findings support their potential utilization for DR screening in a low resources setting.

Keywords:

• diabetic retinopathy screening
• smartphone-based funduscopy
• low-cost retinal photography
• tele-screening

Acknowledgments

The authors thank Roihan Muhamad Iqbal (RMI) for providing valuable input in developing the systematic search strategy and involved in the article screening process.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was partially supported by the National Endowment Fund (LPDP) (contract no. PRJ-73/LPDP/2019).