Agreement between retinal images obtained via smartphones and images obtained with retinal cameras or fundoscopic exams – systematic review and meta-analysis

Figures & data

Table 1 Descriptive findings

Author (year)	Design	Sample (n)	Age	Female (%)	Standard	Test	Sensibility (%)	Specificity (%)
Adam et al, 2015^Citation24	CS	188	NF	NF	Canon CR-1 Mark II	HTC Rezound + lente 28D	NF	NF
Rajalakshmi et al, 2015^Citation25	CS	602	53.5 (9.6)	35.5	Carl Zeiss FF450	Remidio adapter	92.7	98.4
Russo et al, 2015^Citation26	CS	240	58.5 (16.4)	54.2	Fundus biomicroscopy	Iphone 5S+D-Eye	79.7	97.1
Ryan et al, 2015^Citation27	CS	600	48 (11)	33	Nidek AFC-230 Carl Zeiss FF450	Iphone 5+20D lens	59	100
Bastawrous et al, 2016^Citation28	CS	1,485	68 (55–99)	47.9	DRS Haag Streit	Samsung SIII GT-I9300+ Peek	NF	NF
Ludwig et al, 2016^Citation29	CS	128	44 (27–56)	31.7	Carl Zeiss Visupac	Iphone 5S+EyeGo + 2.2 Volk panretinal	NF	NF
Russo et al, 2016^Citation30	CS	107	53.5 (11.7)	54.5	Fundus biomicroscopy	Iphone 5S+D-Eye	69.7	95.9
Toy et al, 2016^Citation31	CS	98	60.5 (6)	58	Fundus biomicroscopy	Iphone 5S+ Paxos Scope + VolkClearfield lens	91	99
Muiesan et al, 2017^Citation32	CS	104	67 (17)	50	Fundus biomicroscopy	IPhone 6+ D-Eye	NF	NF

Abbreviations: CS, cross section; n, number; NF, not found.

Figure 1 Flowchart of the studies.

Figure 2 Forest plot of the agreement between smartphones and retinal cameras.

Abbreviations: Q, heterogeneity among studies – fixed effects; I², between-studies variability (%)-fixed effects; Qv, heterogeneity among studies – random effects; I², between-studies variability (%)-random effects; es, effect summary; CI, confidence interval; SE, standard error; CI lower, lower confidence interval; CI upper, upper confidence interval.

Figure 3 ROC curve.

Note: Data from five studies.^{25–27,30,31}
Abbreviations: AUC, area under the curve; ROC, receiver operating characteristic.

Figure 4 Assessment of risk of bias.

Table S1 Search strategy used on databases

Search	Add to builder	Query	Items found
#3	Add	#1 AND #2	121
#2	Add	Search (“smartphone” [MeSH Terms] OR “Smart Phones” OR “Smart Phone” OR “Phone, Smart” OR “Phones, Smart” OR “Phone, Cell” [MeSH]) OR “Phones, Cell” OR “Cellular Phone” OR “Cellular Phones” OR “Phone, Cellular” OR “Phones, Cellular” OR “Telephone, Cellular” OR “Cellular Telephone” OR “Cellular Telephones” OR “Telephones, Cellular” OR “Cell Phones” OR “Portable Cellular Phone” OR “Cellular Phone, Portable” OR “Cellular Phones, Portable” OR “Portable Cellular Phones” OR “Transportable Cellular Phone” OR “Cellular Phone, Transportable” OR “Cellular Phones, Transportable” OR “Transportable Cellular Phones” OR “Mobile Phone” OR “Mobile Phones” OR “Phone, Mobile” OR “Phones, Mobile” OR “Mobile Telephone” OR “Mobile Telephones” OR “Telephone, Mobile” OR “Telephones, Mobile”	16,192
#1	Add	Search (“Retina”[Mesh] OR “Fundus Oculi”[Mesh]) OR “Optic Disk”[Mesh]) OR “Optic Papilla”[Mesh]) OR ”Macula Lutea”[Mesh]) OR “Optic Nerve Head” [Mesh]) OR “Ophthalmoscopes”[Mesh]) OR “Diabetic Retinopathy”[Mesh]) OR “Retinal Neovascularization”[Mesh]) OR “Microaneurysm” [Mesh]) OR “Microvessels” [Mesh]) OR “Hypertensive Retinopathy”[Mesh]) OR “Retinal Hemorrhage”[Mesh]) OR “Subretinal Fluid”[Mesh]) OR “Papilledema”[Mesh]) OR “Macular Degeneration”[Mesh]) OR “Retinal Drusen” [Mesh]) OR “Ophthalmoscopy”[Mesh]) OR “Glaucoma”[Mesh] OR “Diagnostic Techniques, Ophthalmological” OR “retinopathy” OR “maculopathy”	2,75,146

AdamMKBradyCJFlowersAMQuality and diagnostic utility of mydriatic smartphone photography: the smartphone ophthalmoscopy reliability trialOphthalmic Surg Lasers Imaging Retina201546663163726114843

 PubMed Web of Science ®Google Scholar

RajalakshmiRArulmalarSUshaMValidation of smartphone based retinal photography for diabetic retinopathy screeningPLoS One2015109e013828526401839

 PubMed Web of Science ®Google Scholar

RussoAMorescalchiFCostagliolaCDelcassiLSemeraroFComparison of smartphone ophthalmoscopy with slit-lamp biomicroscopy for grading diabetic retinopathyAm J Ophthalmol20151592360364.e125447109

 PubMed Web of Science ®Google Scholar

RyanMERajalakshmiRPrathibaVComparison Among Methods of Retinopathy Assessment (CAMRA) study: smartphone, nonmydriatic, and mydriatic photographyOphthalmology2015122102038204326189190

 PubMed Web of Science ®Google Scholar

BastawrousAGiardiniMEBolsterNMClinical Validation of a smartphone-based adapter for optic disc imaging in KenyaJAMA Ophthalmol2016134215115826606110

 PubMed Web of Science ®Google Scholar

LudwigCAMurthySIPappuruRRJaisAMyungDJChangRTA novel smartphone ophthalmic imaging adapter: User feasibility studies in Hyderabad, IndiaIndian J Ophthalmol201664319120027146928

 PubMed Web of Science ®Google Scholar

RussoAMaphamWTuranoRComparison of smartphone ophthalmoscopy with slit-lamp biomicroscopy for grading vertical Cup-to-Disc ratioJ Glaucoma2016259e777e78127513903

 PubMed Web of Science ®Google Scholar

ToyBCMyungDJHeLSmartphone-based dilated fundus photography and near visual acuity testing as inexpensive screening tools to detect referral warranted diabetic eye diseaseRetina20163651000100826807627

 PubMed Web of Science ®Google Scholar

MuiesanMLSalvettiMPainiAOcular fundus photography with a smartphone device in acute hypertensionJ Hypertens20173581660166528306635

 PubMed Web of Science ®Google Scholar

MEDLINE [database on the Internet] Available from: https://www.ncbi.nlm.nih.gov/pubmedAccessed June 1, 2018

 Google Scholar