Diabetic retinopathy screening in urban primary care setting with a handheld smartphone-based retinal camera.

Content Provider	Europe PMC
Author	Queiroz, Márcia Silva de Carvalho, Jacira Xavier Bortoto, Silvia Ferreira de Matos, Mozania Reis das Graças Dias Cavalcante, Cristiane Andrade, Elenilda Almeida Silva Correa-Giannella, Maria Lúcia Malerbi, Fernando Korn
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.MethodsThis 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.ResultsA 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.ConclusionsA 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.Graphic abstractDaily rate of patients whose examinations allowed clinical decision. X-axis: day of examination; Y-axis: rate (%) of patients whose examinations allowed a clinical decision
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC7398859&blobtype=pdf
ISSN	09405429
Journal	Acta Diabetologica [Acta Diabetol]
Volume Number	57
DOI	10.1007/s00592-020-01585-7
PubMed Central reference number	PMC7398859
Issue Number	12
PubMed reference number	32748176
e-ISSN	14325233
Language	English
Publisher	Springer Milan
Publisher Date	2020-08-04
Publisher Place	Milan
Access Restriction	Open
Rights License	This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic. © Springer-Verlag Italia S.r.l., part of Springer Nature 2020
Subject Keyword	Diabetic retinopathy Telemedicine Blindness Screening Primary care COVID-19
Content Type	Text
Resource Type	Article
Subject	Endocrinology, Diabetes and Metabolism Internal Medicine Endocrinology