Handheld retinal imaging devices may have utility in screening
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Handheld imaging devices may be useful in the assessment of diabetic retinopathy and diabetic macular edema, according to a study.
Recivall P. Salongcay, MD, MPM, and colleagues compared mydriatic and nonmydriatic handheld retinal imaging cameras with standard ETDRS 7-field color fundus photography to assess whether handheld cameras have the potential to expand the reach of DR screening programs to a more diverse population.
“These devices can potentially be placed in strategic community locations that are easily accessible, which can lead to increased patient participation in surveillance,” they wrote. “Since these devices will be used to guide diagnosis and treatment, they will need rigorous validation to assess agreement with the standard of care and to evaluate which one attains adequate levels of sensitivity and specificity for the detection of DR.”
Researchers collected images from 225 eyes of 116 patients with diabetes using several mydriatic — Aurora (AUMD, Optomed), Smartscope (SSMD, Optomed), RetinaVue 700 (RVMD, Welch Allyn) and iNview (NVMD, Volk Optical) — and nonmydriatic — Aurora (AUNM), Smartscope (SSNM) and RetinaVue 700 (RVNM) — handheld retinal cameras. The main outcome measures were agreement for DR and DME measured by kappa statistics, sensitivity and specificity for any DR, referrable DR and vision-threatening DR, as well as ungradable rates.
After testing for severity using ETDRS photos, researchers found that the weighted kappa for nonmydriatic handheld imaging was 0.7 to 0.73 for DR and 0.76 to 0.83 for DME. For mydriatic handheld imaging, weighted kappa was 0.68 to 0.75 for DR and 0.77 to 0.91 for DME. Additionally, the SSNM, AUMD and RVMD devices met sensitivity and specificity thresholds for any DR, and the AUMD and RVMD devices met the thresholds for referrable DR. The AUMD and RVMD devices met the thresholds for sensitivity and specificity for DME.
“Overall, certain handheld retinal imaging devices when used following a standard protocol with pupil dilation can achieve substantial agreement with standard photography and may be useful in settings where traditional means of retinal evaluation are not possible,” Salongcay and colleagues wrote. “These findings will be helpful to clinicians and public health managers in planning for a DR screening program.”
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