Diabetic retinopathy screening and the COVID-19 pandemic in Brazil

Malerbi, Fernando Korn; Morales, Paulo Henrique; Regatieri, Caio V.

doi:10.5935/0004-2749.20200070

Cited by 7 publications

(5 citation statements)

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“…(12) Spurling et al perceberam que, ao utilizarem a retinografia como ferramenta de rastreio de RD, aumenta-se a população atendida, ao passo que diminui a superlotação dos centros ambulatoriais, o que pode ter um impacto relevante na diminuição da população dos cegos por diabetes. (21) No total, após a triagem, 114 (15,68%) (23) Prevê-se que, quando as restrições de contato forem suspensas, os pacientes não rastreados ou tratados durante a pandemia irão aumentar a demanda por rastreamento. Como limitações deste estudo, podemos destacar a falta de dados em relação ao tempo de evolução da doença, a classificação de DM e o controle glicêmico dos pacientes.…”

Section: Discussionunclassified

Retinografia como forma de rastreio de retinopatia diabética em hospital terciário do Sistema Único de Saúde

Bortoli¹,

Silber²,

Picetti³

et al. 2022

Revista Brasileira De Oftalmologia

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Section: Discussionunclassified

Retinografia como forma de rastreio de retinopatia diabética em hospital terciário do Sistema Único de Saúde

Bortoli¹,

Silber²,

Picetti³

et al. 2022

Revista Brasileira De Oftalmologia

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“…Its model, which relies on the retina status as a biomarker of other diabetes complications, was replicated in all five regions of Brazil: during November 2019, Diabetes Campaigns occurred in 24 cities distributed throughout 15 Brazilian states, in commemoration of the month of diabetes awareness and prevention, as established by the International Diabetes Federation 33 ; however, with the COVID-19 pandemic, an alternative to massive gatherings is needed. 34 The current strategy presented herein offers an alternative suitable for this new circumstance, with telemedicine allowing a more dispersed, continuous screening action that does not rely on the presence of specialists, which are scarce in underserved areas; additionally, portable cameras may be operated outside the clinic, even outdoors, rendering this strategy adequate during times of social distancing. A model based on semiautomated screening with mobile units, portable devices, and AI in a primary care setting could contribute to address this novel challenge.…”

Section: Discussionmentioning

confidence: 99%

Diabetic Retinopathy Screening Using Artificial Intelligence and Handheld Smartphone-Based Retinal Camera

Malerbi

Andrade

Morales

et al. 2021

J Diabetes Sci Technol

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Background: Portable retinal cameras and deep learning (DL) algorithms are novel tools adopted by diabetic retinopathy (DR) screening programs. Our objective is to evaluate the diagnostic accuracy of a DL algorithm and the performance of portable handheld retinal cameras in the detection of DR in a large and heterogenous type 2 diabetes population in a real-world, high burden setting. Method: Participants underwent fundus photographs of both eyes with a portable retinal camera (Phelcom Eyer). Classification of DR was performed by human reading and a DL algorithm (PhelcomNet), consisting of a convolutional neural network trained on a dataset of fundus images captured exclusively with the portable device; both methods were compared. We calculated the area under the curve (AUC), sensitivity, and specificity for more than mild DR. Results: A total of 824 individuals with type 2 diabetes were enrolled at Itabuna Diabetes Campaign, a subset of 679 (82.4%) of whom could be fully assessed. The algorithm sensitivity/specificity was 97.8 % (95% CI 96.7-98.9)/61.4 % (95% CI 57.7-65.1); AUC was 0·89. All false negative cases were classified as moderate non-proliferative diabetic retinopathy (NPDR) by human grading. Conclusions: The DL algorithm reached a good diagnostic accuracy for more than mild DR in a real-world, high burden setting. The performance of the handheld portable retinal camera was adequate, with over 80% of individuals presenting with images of sufficient quality. Portable devices and artificial intelligence tools may increase coverage of DR screening programs.

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“…The impact has been seen globally with both the people and providers being apprehensive, but the biggest damage has been in low and middle income countries (LMIC). [ 30 31 ] Data from a leading eye care institution in South India showed that in the initial months of “unlocking phase” following the COVID-19 outbreak and the lockdown, there was a 36.7% decline in footfalls compared to the previous years and the impact was seen across all levels of the eye care system. [ 32 ] At the height of the pandemic, elective services like community-based screening for DR was halted universally.…”

Section: Screening For Diabetic Retinopathymentioning

confidence: 99%

Situational analysis of diabetic retinopathy screening in India: How has it changed in the last three years?

Murthy

2021

Indian J Ophthalmol

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Of all the eye conditions in the contemporary Indian context, diabetic retinopathy (DR) attracts the maximum attention not just of the eye care fraternity but the entire medical fraternity. Countries are at different stages of evolution in structured DR screening services. In most low and middle income countries, screening is opportunistic, while in most of the high income countries structured population-based DR screening is the established norm. To reduce inequities in access, it is important that all persons with diabetes are provided equal access to DR screening and management services. Such programs have been proven to reverse the magnitude of vision-threatening diabetic retinopathy in countries like England and Scotland. DR screening should not be considered an endpoint in itself but the starting point in a continuum of services for effective management of DR services so that the risk of vision loss can be mitigated. Till recently all DR screening programs in India were opportunistic models where persons with diabetes visiting an eye care facility were screened. Since 2016, with support from International funders, demonstration models integrating DR screening services in the public health system were initiated. These pilots showed that a systematic integrated structured DR screening program is possible in India and need to be scaled up across the country. Many DR screening and referral initiatives have been adversely impacted by the COVID-19 pandemic and advocacy with the government is critical to facilitate continuous sustainable services.

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Diabetic retinopathy screening and the COVID-19 pandemic in Brazil

Cited by 7 publications

References 0 publications

Retinografia como forma de rastreio de retinopatia diabética em hospital terciário do Sistema Único de Saúde

Retinografia como forma de rastreio de retinopatia diabética em hospital terciário do Sistema Único de Saúde

Diabetic Retinopathy Screening Using Artificial Intelligence and Handheld Smartphone-Based Retinal Camera

Situational analysis of diabetic retinopathy screening in India: How has it changed in the last three years?

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