June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Point-of-care Diabetic Retinopathy screening with a low-cost portable retinal camera, artificial intelligence and staged mydriasis in a rural, underserved area
Author Affiliations & Notes
  • Fernando Korn Malerbi
    Department of Ophthalmology and Visual Sciences, Universidade Federal de Sao Paulo, Sao Paulo, São Paulo, Brazil
    Ophthalmology Department, Brazilian Diabetes Society, Brazil
  • Viviane Cardoso
    Hospital de Olhos de Sergipe, Aracaju, Sergipe, Brazil
  • Lucas Andrade Santos
    Universidade Federal de Sergipe, Aracaju, Sergipe, Brazil
  • Gustavo Barreto Melo
    Department of Ophthalmology and Visual Sciences, Universidade Federal de Sao Paulo, Sao Paulo, São Paulo, Brazil
    Hospital de Olhos de Sergipe, Aracaju, Sergipe, Brazil
  • Footnotes
    Commercial Relationships   Fernando Malerbi Phelcom Technologies, Bayer, Code C (Consultant/Contractor); Viviane Cardoso None; Lucas Santos None; Gustavo Melo Pine Pharmaceuticals, SJJ Solutions, TriboFilm Research, Bayer, Molecular Partners, Roche, West Pharmaceuticals, Code C (Consultant/Contractor)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 5435. doi:
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      Fernando Korn Malerbi, Viviane Cardoso, Lucas Andrade Santos, Gustavo Barreto Melo; Point-of-care Diabetic Retinopathy screening with a low-cost portable retinal camera, artificial intelligence and staged mydriasis in a rural, underserved area. Invest. Ophthalmol. Vis. Sci. 2023;64(8):5435.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The use of mydriasis may discourage attendance at diabetic retinopathy (DR) screening initiatives. However, low gradeability decreases the efficiency of non-mydriatic programs. We performed a retrospective, observational clinical study to assess the gradeability of retinal imaging obtained with a non-mydriatic handheld retinal camera.

Methods : We included 968 persons with diabetes (PWD) followed at the primary care level from a rural, semiarid setting in Northeast Brazil; 65.9% were women. Mean (± SD) age and diabetes duration were 60.3 ± 14.2 years of age and 8.0 ± 7.2 years, respectively. A trained technician obtained ocular images in darkened rooms initially without pupil dilation and then evaluated image quality. Referable DR, defined as nonproliferative severe or proliferative DR or the presence of diabetic maculopathy, was detected automatically by a previously validated artificial intelligence (AI) system, embedded in the device. Patients with inadequate images underwent pupil dilation and then new evaluation; those with ungradable images even after mydriasis, along with cases of referable DR, were sent for ophthalmological evaluation. Exclusion criteria were corneal opacities that precluded DR classification. The main outcome measure was image gradeability. Statistical analysis included Mann-Whitney test, chi-square test and t-test.

Results : Of 986 PWD, 64.2% had systemic hypertension; 17.7% used insulin; 28.5% had undergone fundus examination in the past; 20.6% were illiterate and 50.6% had only elementary education level; only 3.4% had health insurance. Gradeability was possible for 858 individuals (88.6%), 85 of whom (9.9%) presenting with referable DR; ungradeability was associated with older age (p=0.000) and longer diabetes duration (p=0.000). Among patients with gradable images, 81% did not require pupil dilation; need for pharmacological mydriasis was associated with older age (p=0.000), longer diabetes duration (p=0.000), higher rates of hypertension (p=0.002) and more severe DR (p=0.000).

Conclusions : A staged mydriasis strategy with a low-cost portable camera and AI attained a gradeability rate of almost 90% in a real-world, low-resource setting; pupil dilation was not required for 81% of patients with gradable images. Avoiding unnecessary pupil dilation contributes to increased adherence of DR screening programs.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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