Inexpensive retinal diagnostics via smartphone

May 25, 2020

Retinal damage due to diabetes is now considered the most common cause of blindness in working-age adults. In low- and middle-income countries, an eye examination via smartphone could help to detect changes at an early stage. This is shown by a new study carried out by scientists from the University of Bonn together with colleagues from Sankara Eye Hospital Bangalore (India). The results are published in the journal Ophthalmology.

One of the most dangerous long-term complications of diabetes is vascular damage. In the eye's photosensitive layer, the retina, this also impacts the capillaries. This network of small vessels supplies the sensory cells with oxygen and nutrients. If it deteriorates, abnormal new vessels form instead and further harm the damaged retina. Left untreated, this often result in loss of vision and ultimately blindness.

"If such a retinopathy is recognized and treated in time, vision loss can often be prevented," emphasizes Dr. Maximilian Wintergerst from the Department of Ophthalmology at the University Hospital Bonn. "An important aspect of therapy is better control of the diabetes; in addition, it is also possible to treat the undersupplied retina with laser light before further problems occur." Laser treatment destroys the undersupplied retina so that it can no longer cause problems by releasing growth factors. These can otherwise cause the formation of abnormal vessels and fluid accumulation in the retina.

Screening alternative with potential

A lack of exercise and an increasingly high-calorie diet mean that diabetes is currently on the rise globally. It is estimated that 8 out of 10 people with diabetes worldwide live in developing and emerging countries, which often have a poorly resourced health system. Systematic retinal screening of diabetics is therefore usually not possible in these countries.

This could be overcome by using devices that were actually designed for a completely different purpose - smartphones. The increasingly affordable devices nowadays usually come with high-quality cameras. And these are surprisingly useful for diagnosing diseases of the retina. The current study conducted by Wintergerst together with colleagues from Bonn and Bangalore in southern India points in this direction.

In the study, the researchers compared four different approaches aimed at enabling ophthalmoscopy with a standard mid-range smartphone. Not all of them fulfilled this promise equally well. "The best result in our test was achieved by an adapter with an additional lens that is attached to the smartphone," Wintergerst concludes. "It allowed almost 80 percent of eyes with any retinal changes to be detected, even in the early stages. Advanced damage could even be diagnosed 100 percent of the time."

The scientists had trained optometrists (ophthalmic assistants) from the Sankara Eye Hospital in Bangalore for their study. On average, they needed one to two minutes per examination. This involved documenting changes in the retina by filming the back of the eye with a smartphone camera. The co-author of the study, Prof. Dr. Robert Finger from the Department of Ophthalmology at the University Hospital Bonn, considers these capabilities to be what makes the method so appealing: "This means that the examination can also be enabled by trained laypersons," he says. "The images are then sent via the Internet to the ophthalmologist for diagnosis."

"COVID-19 has further necessitated the need for us to explore methods of reducing patients visiting hospital. This modality is promising in increasing efficiency of screening for retinal changes in diabetics", added co-author Dr. Mahesh P. Shanmugam, Head VitreoRetina & Ocular Oncology, Sankara Eye Foundation India.

Next step: artificial intelligence supports diagnostics

The researchers are currently developing an app in collaboration with their colleagues from the Sankara Eye Foundation in India. This app will make it possible to create an encrypted electronic patient file for each patient on the smartphones used for the examination. It not only stores the images, but also the findings of the doctor who ultimately reviewed them. Furthermore, the researchers are working on an automatic pre-evaluation of the images using artificial intelligence. In such methods, a software "learns" to recognize pathological changes independently on the basis of thousands of retinal images.

The researchers hope that their work will improve eye care in developing and emerging countries. The project is funded by the German Federal Ministry for Economic Cooperation and Development and the Else Kröner-Fresenius Foundation. Recently, it was also presented with the special award of the "bytes4diabetes Award" for innovative digital approaches in the fight against diabetes.
-end-
Publication: Maximilian W. M. Wintergerst, Divyansh K. Mishra, Laura Hartmann, Payal Shah, Vinaya K. Konana, Pradeep Sagar, Moritz Berger, Kaushik Murali, Frank G. Holz, Mahesh P. Shanmugam*, Robert P. Finger*: Diabetic retinopathy screening using smartphone-based fundus imaging in India; Ophthalmology, *these authors contributed equally, DOI: 10.1016/j.ophtha.2020.05.025 http://www.aaojournal.org/article/S0161-6420(20)30463-2/fulltext

Contact:

Dr. Maximilian W. M. Wintergerst
Universitäts-Augenklinik Bonn
Tel. +49(0)228-28715505
E-mail: Maximilian.Wintergerst@ukbonn.de

University of Bonn

Related Diabetes Articles from Brightsurf:

New diabetes medication reduced heart event risk in those with diabetes and kidney disease
Sotagliflozin - a type of medication known as an SGLT2 inhibitor primarily prescribed for Type 2 diabetes - reduces the risk of adverse cardiovascular events for patients with diabetes and kidney disease.

Diabetes drug boosts survival in patients with type 2 diabetes and COVID-19 pneumonia
Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy.

Making sense of diabetes
Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units.

Helping teens with type 1 diabetes improve diabetes control with MyDiaText
Adolescence is a difficult period of development, made more complex for those with Type 1 diabetes mellitus (T1DM).

Diabetes-in-a-dish model uncovers new insights into the cause of type 2 diabetes
Researchers have developed a novel 'disease-in-a-dish' model to study the basic molecular factors that lead to the development of type 2 diabetes, uncovering the potential existence of major signaling defects both inside and outside of the classical insulin signaling cascade, and providing new perspectives on the mechanisms behind insulin resistance in type 2 diabetes and possibly opportunities for the development of novel therapeutics for the disease.

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.

Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.

People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

Read More: Diabetes News and Diabetes Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.