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Diabetic retinopathy screening in urban primary care setting with a handheld smartphone-based retinal camera.
Acta Diabetol. 2020 Dec; 57(12):1493-1499.AD

Abstract

AIMS

To evaluate diabetic retinopathy (DR) screening with a portable handheld smartphone-based retinal camera and telemedicine in an urban primary healthcare setting and to evaluate the learning curve for image acquisition, performed by healthcare personnel without previous experience in retinal imaging.

METHODS

This was a prospective study that enrolled patients with type 2 diabetes mellitus (T2DM) followed at a primary healthcare unit in São Paulo, Brazil. After a brief training in image acquisition, there was further continuous feedback given by a retina specialist during the remote image reading process. Each patient underwent two fundus and one anterior ocular segment images per eye, after mydriasis. Patients were classified according to the need of referral.

RESULTS

A total of 627 adult individuals with T2DM underwent retinal evaluation. The population was composed by 63.2% female individuals, age median of 66 years, diabetes duration 10.7 ± 8.2 years and HbA1c 7.7 ± 1.9% (61 + 20.8 mmol/mol). The most prevalent associated comorbidities were arterial hypertension (80.3%) and dyslipidemia (50.2%). Referral decision was possible in 81.2% patients. Most patients had absent or non-referable DR; the main ocular media opacity detected was cataract. After the 7th day of image acquisition, the daily rate of patients whose images allowed clinical decision was maintained above 80%. A higher HbA1c was associated with referable DR.

CONCLUSIONS

A low-cost DR screening strategy with a handheld device and telemedicine is feasible and has the potential to increase coverage of DR screening in underserved areas; the possibility of mobile units is relevant for DR screening in the context of COVID-19 pandemic. Daily rate of patients whose examinations allowed clinical decision. X-axis: day of examination; Y-axis: rate (%) of patients whose examinations allowed a clinical decision.

Authors+Show Affiliations

Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo, 01504-001, Brazil.Unidade Basica de Saude Dra. Ilza Weltman Hutzler, Rua Coronel Walfrido de Carvalho, Sao Paulo, 02472-180, Brazil.Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo, 01504-001, Brazil.Unidade Basica de Saude Dra. Ilza Weltman Hutzler, Rua Coronel Walfrido de Carvalho, Sao Paulo, 02472-180, Brazil.Unidade Basica de Saude Dra. Ilza Weltman Hutzler, Rua Coronel Walfrido de Carvalho, Sao Paulo, 02472-180, Brazil.Unidade Basica de Saude Dra. Ilza Weltman Hutzler, Rua Coronel Walfrido de Carvalho, Sao Paulo, 02472-180, Brazil.Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo, 01504-001, Brazil.Programa de Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, Sao Paulo, 01504-001, Brazil. fernandokmalerbi@gmail.com. Departamento de Oftalmologia, Universidade Federal de São Paulo, Rua Botucatu 822, São Paulo, 04039-032, Brazil. fernandokmalerbi@gmail.com.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

32748176

Citation

Queiroz, Márcia Silva, et al. "Diabetic Retinopathy Screening in Urban Primary Care Setting With a Handheld Smartphone-based Retinal Camera." Acta Diabetologica, vol. 57, no. 12, 2020, pp. 1493-1499.
Queiroz MS, de Carvalho JX, Bortoto SF, et al. Diabetic retinopathy screening in urban primary care setting with a handheld smartphone-based retinal camera. Acta Diabetol. 2020;57(12):1493-1499.
Queiroz, M. S., de Carvalho, J. X., Bortoto, S. F., de Matos, M. R., das Graças Dias Cavalcante, C., Andrade, E. A. S., Correa-Giannella, M. L., & Malerbi, F. K. (2020). Diabetic retinopathy screening in urban primary care setting with a handheld smartphone-based retinal camera. Acta Diabetologica, 57(12), 1493-1499. https://doi.org/10.1007/s00592-020-01585-7
Queiroz MS, et al. Diabetic Retinopathy Screening in Urban Primary Care Setting With a Handheld Smartphone-based Retinal Camera. Acta Diabetol. 2020;57(12):1493-1499. PubMed PMID: 32748176.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diabetic retinopathy screening in urban primary care setting with a handheld smartphone-based retinal camera. AU - Queiroz,Márcia Silva, AU - de Carvalho,Jacira Xavier, AU - Bortoto,Silvia Ferreira, AU - de Matos,Mozania Reis, AU - das Graças Dias Cavalcante,Cristiane, AU - Andrade,Elenilda Almeida Silva, AU - Correa-Giannella,Maria Lúcia, AU - Malerbi,Fernando Korn, Y1 - 2020/08/04/ PY - 2020/06/05/received PY - 2020/07/21/accepted PY - 2020/8/5/pubmed PY - 2020/11/11/medline PY - 2020/8/5/entrez KW - Blindness KW - COVID-19 KW - Diabetic retinopathy KW - Primary care KW - Screening KW - Telemedicine SP - 1493 EP - 1499 JF - Acta diabetologica JO - Acta Diabetol VL - 57 IS - 12 N2 - AIMS: To evaluate diabetic retinopathy (DR) screening with a portable handheld smartphone-based retinal camera and telemedicine in an urban primary healthcare setting and to evaluate the learning curve for image acquisition, performed by healthcare personnel without previous experience in retinal imaging. METHODS: This was a prospective study that enrolled patients with type 2 diabetes mellitus (T2DM) followed at a primary healthcare unit in São Paulo, Brazil. After a brief training in image acquisition, there was further continuous feedback given by a retina specialist during the remote image reading process. Each patient underwent two fundus and one anterior ocular segment images per eye, after mydriasis. Patients were classified according to the need of referral. RESULTS: A total of 627 adult individuals with T2DM underwent retinal evaluation. The population was composed by 63.2% female individuals, age median of 66 years, diabetes duration 10.7 ± 8.2 years and HbA1c 7.7 ± 1.9% (61 + 20.8 mmol/mol). The most prevalent associated comorbidities were arterial hypertension (80.3%) and dyslipidemia (50.2%). Referral decision was possible in 81.2% patients. Most patients had absent or non-referable DR; the main ocular media opacity detected was cataract. After the 7th day of image acquisition, the daily rate of patients whose images allowed clinical decision was maintained above 80%. A higher HbA1c was associated with referable DR. CONCLUSIONS: A low-cost DR screening strategy with a handheld device and telemedicine is feasible and has the potential to increase coverage of DR screening in underserved areas; the possibility of mobile units is relevant for DR screening in the context of COVID-19 pandemic. Daily rate of patients whose examinations allowed clinical decision. X-axis: day of examination; Y-axis: rate (%) of patients whose examinations allowed a clinical decision. SN - 1432-5233 UR - https://www.unboundmedicine.com/medline/citation/32748176/Diabetic_retinopathy_screening_in_urban_primary_care_setting_with_a_handheld_smartphone_based_retinal_camera_ L2 - https://dx.doi.org/10.1007/s00592-020-01585-7 DB - PRIME DP - Unbound Medicine ER -