Non-mydriatic fundus photography as an alternative to indirect ophthalmoscopy for screening of diabetic retinopathy in community settings: a comparative pilot study in rural and tribal India

Abstract

ObjectivesThe impending and increasing prevalence of diabetic retinopathy (DR) in India has necessitated a need for affordable and valid community outreach screening programme for DR, especially in rural and far to reach indigenous local communities. The present study is a pilot study aimed to compare non-mydriatic fundus photography with indirect ophthalmoscopy for its utilisation as a feasible and logistically convenient screening modality for DR in an older age, rural, tribal population in Western India.Design and settingThis community-based, cross-sectional, prospective population study was a part of a module using Rapid Assessment of Avoidable Blindness and DR methodology in 8340 sampled participants with ≥50 years age. In this study, the diabetics identified were screened for DR using two methods: non-mydriatic fundus photography on the field by trained professionals, that were then graded by a retina specialist at the base hospital and indirect ophthalmoscopy by expert ophthalmologists in the field with masking of each other’s findings for its utility and comparison.ResultsThe prevalence of DR, sight threatening DR and maculopathy using indirect ophthalmoscopy was found to be 12.1%, 2.1% and 6.6%, respectively. A fair agreement (κ=0.48 for DR and 0.59 for maculopathy) was observed between both the detection methods. The sensitivity and specificity of fundus photographic evaluation compared with indirect ophthalmoscopy were found to be 54.8% and 92.1% (for DR), 60.7% and 90.8% (for any DR) and 84.2% and 94.8% (for only maculopathy), respectively.ConclusionNon-mydriatic fundus photography has the potential to identify DR (any retinopathy or maculopathy) in community settings in Indian population. Its utility as an affordable and logistically convenient cum practical modality is demonstrable. The sensitivity of this screening modality can be further increased by investing in better resolution cameras, capturing quality images and training and validation of imagers.Trial registration numberCTRI/2020/01/023025; Clinical Trial Registry, India (CTRI).

Effect of Conbercept for macular edema secondary to branch retinal vein occlusion in different ethnic groups in Southeast Guizhou

“…BRVO-ME is the most important cause of central vision loss in patients [15] . The clinical manifestations of patients often include visual acuity reduction and visual object deformation, which can be clearly diagnosed according to optical coherence tomography(OCT) [16] , fundus photography [17] ,…”

Diagnostic Accuracy of Hand-Held Fundus Camera and Artificial Intelligence in Diabetic Retinopathy Screening

“…In the present study, the DOR for detecting DR by a hand-held camera compared to the clinical examination was 936.48, and compared to the standard camera, it was 574.6. A comparative pilot study performed in rural and tribal India, another developing country, compared the images taken with a hand-held non-mydriatic fundus camera (Horus scope 200, Medical Imaging Innovation Solution Partner, Taiwan) by two different trained technicians and graded by a retinal specialist to the indirect ophthalmoscopy completed by expert ophthalmologists and found a sensitivity, specificity, PPV, and NPV of 54.8%, 92.1%, 59.6%, and 83.9%, while the kappa agreement for DR between both detection methods was 0.48 [30]. In the present study, PPV and LR+ were 100% and infinity when comparing the hand-held camera with both diagnostic methods, while NPV and LR-were 91.4% and 0.11 when comparing the hand-held camera with the clinical examination and 87.3% and 0.17 with the standard camera.…”

Treatment of Conbercept for macular edema secondary to branch retinal vein occlusion in minority areas of Southeast Guizhou

“…BRVO-ME is the most important cause of central vision loss in patients [15] . The clinical manifestations of patients often include visual acuity reduction and visual object deformation, which can be clearly diagnosed according to optical coherence tomography(OCT) [16] , fundus photography [17] , Fluorescein fundus angiography(FFA) [18] , etc. At present, the treatment methods for BRVO-ME mainly include retinal laser photocoagulation and intravitreal injection (anti VEGF drugs and glucocorticoids) [19] .…”