Background

Regular screening for retinopathy and timely intervention reduces blindness from diabetes by 90%. Screening is currently dependent on the interpretation of images captured by trained technicians. Inherent barriers of accessibility and affordability with this approach impede widespread success of retinopathy screening programs. Herein, we report our observations on the potential of a novel approach, Selfie Fundus Imaging (SFI), to enhance diabetic retinopathy screening.

Methods

The study was undertaken over a two-month period during COVID 19 lockdown. 60 diabetic patients participated in the study. Retinal images were captured using three different approaches, handheld smartphone-based photographs captured by patients themselves after a short video-assisted training session (SFI group), and smartphone-based photographs captured by a trained technician and photographs taken on desktop conventional digital fundus camera (Gold standard). Sensitivity and kappa statistics was determined for retinopathy and macular oedema grading.

Findings

Mean age of the study participants was 52.4 years ± 9.8 years and 78% were men. Of 120 images captured using SFI, 90% were centred-gradable, 8% were decentred-gradable and 2% were ungradable. 82% patients captured the image within a minute (majority by 31–45 s). The sensitivity of SFI to detect diabetic retinopathy was 88.39%. Agreement between SFI grading and standard fundus photograph grading was 85.86% with substantial kappa (0.77). For the detection of diabetic macular oedema, the agreement between SFI images and standard images was 93.67, with almost perfect kappa (0.91).

Conclusion

Fundus images were captured by patients using SFI without major difficulty and were comparable to images taken by trained specialist. With greater penetrance, advances, and availability of mobile photographic technology, we believe that SFI would positively impact the success of diabetic retinopathy screening programs by breaking the barriers of availability, accessibility, and affordability. SFI could ensure continuation of screening schedules for diabetic retinopathy, even in the face a highly contagious pandemic.

中文翻译：

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用于糖尿病视网膜病变筛查的自拍眼底成像

背景

定期筛查视网膜病变和及时干预可将糖尿病失明率降低 90%。目前，筛查依赖于对训练有素的技术人员捕获的图像的解释。这种方法的可及性和可负担性的固有障碍阻碍了视网膜病变筛查项目的广泛成功。在此，我们报告了我们对一种新方法——自拍眼底成像 (SFI) 增强糖尿病视网膜病变筛查的潜力的观察。

方法

该研究是在 COVID 19 锁定期间进行的，历时两个月。60名糖尿病患者参加了这项研究。视网膜图像是使用三种不同的方法拍摄的，在短视频辅助培训课程（SFI 组）后由患者自己拍摄的基于智能手机的手持照片，由受过训练的技术人员拍摄的基于智能手机的照片和在台式传统数字眼底相机上拍摄的照片（黄金标准）。确定视网膜病变和黄斑水肿分级的敏感性和 kappa 统计数据。

发现

研究参与者的平均年龄为 52.4 岁 ± 9.8 岁，其中 78% 为男性。在使用 SFI 拍摄的 120 幅图像中，90% 是可中心分级的，8% 是可偏心分级的，2% 是不可分级的。82% 的患者在一分钟内捕捉到图像（大多数为 31-45 秒）。SFI检测糖尿病视网膜病变的敏感性为88.39%。SFI 分级和标准眼底照片分级之间的一致性为 85.86%，具有显着的 kappa (0.77)。对于糖尿病黄斑水肿的检测，SFI 图像与标准图像之间的一致性为 93.67，kappa 几乎完美 (0.91)。

结论

眼底图像由使用 SFI 的患者毫无困难地捕获，并且与训练有素的专家拍摄的图像相当。随着移动摄影技术的普及、进步和可用性的提高，我们相信 SFI 将打破可用性、可及性和可负担性的障碍，对糖尿病视网膜病变筛查项目的成功产生积极影响。即使面对高度传染性的大流行，SFI 也可以确保糖尿病视网膜病变筛查计划的继续进行。