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Effectiveness of smartphone-based fundus photography taken by non-medical professionals in screening and early diagnosis of Diabetic Retinopathy

Grant number: 20/11986-8
Support Opportunities:Scholarships in Brazil - Scientific Initiation
Effective date (Start): December 01, 2020
Effective date (End): November 30, 2021
Field of knowledge:Health Sciences - Medicine - Medical Clinics
Principal Investigator:Rodrigo Jorge
Grantee:Victor Bellanda Candido Ferreira
Host Institution: Faculdade de Medicina de Ribeirão Preto (FMRP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil


Diabetic retinopathy (DR) is a serious complication of Diabetes Mellitus (DM) that occurs as a result of long-term accumulated damage to the blood vessels in the retina. Having a chronic and progressive character, it is considered to be the main cause of hypo-vision and blindness in individuals of working age in developed countries. Retinal image obtained through a traditional retinography machine is commonly accepted as gold standard for diagnosing this condition. Nevertheless, it has a considerable cost, and its use implies on difficulties of a logistical nature and usually requires the presence of an ophthalmologist who is used to the exam.Considering the recent advances in mobile telephony and technology in general, it is evident that so-called smartphones are becoming increasingly accessible, in addition to being powerful in terms of image and data processing capacity. The combination of accessories specially developed for the exam, such as adapters and lenses, allows the smartphone to register the peripheral visualization of the ocular fundus, allowing the registration of images through video recording by the device itself. Since that is an uncomplicated method, the photograph can be taken by a paramedic professional previously trained and then easily sent to an ophthalmologist for analysis. Considering the parameters of telemedicine, this method appears to be a potential low-cost alternative for screening and early diagnosis of DR.The present study proposes an evaluation of the effectiveness of non-medical professionals in obtaining the ocular fundus image by a smartphone-based device in the context of screening and early diagnosing DR in diabetic patients being followed up at Ribeirão Preto General Hospital (HC-FMRP).In order to do so, about 100 diabetic patients will be submitted to an ophthalmic examination for screening of DR at the clinics where they are currently followed-up for DM. Upon examination, paramedical professionals from the unit, after receiving training to record the image, will capture a fundus photograph using the smartphone-based device. At the time, the same patients will be submitted to an indirect ophthalmoscopy or computerized retinography examination performed by a specialist ophthalmologist, whose diagnosis and staging will be used as a reference in the evaluation of results.The images documented via the smartphone method will also be evaluated by specialists, who must determine the presence or absence of diabetic retinopathy and point out the severity of the condition in each of the images, which will be randomized and not identified to the evaluators. At the end, the results of the images obtained in the new proposed method and by the traditional examination performed by the specialist will be contrasted in order to determine its sensitivity and specificity.

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