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

  • Queiroz, Márcia Silva1
  • de Carvalho, Jacira Xavier2
  • Bortoto, Silvia Ferreira1
  • de Matos, Mozania Reis2
  • das Graças Dias Cavalcante, Cristiane2
  • Andrade, Elenilda Almeida Silva2
  • Correa-Giannella, Maria Lúcia1
  • Malerbi, Fernando Korn1, 3
  • 1 Universidade Nove de Julho (UNINOVE),
  • 2 Unidade Basica de Saude Dra. Ilza Weltman Hutzler, Rua Coronel Walfrido de Carvalho, Sao Paulo, 02472-180 Brazil
  • 3 Universidade Federal de São Paulo,
Published Article
Acta Diabetologica
Springer Milan
Publication Date
Aug 04, 2020
DOI: 10.1007/s00592-020-01585-7
PMID: 32748176
PMCID: PMC7398859
PubMed Central


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. Graphic abstract 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

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