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Comparative Study
. 2015 Oct;122(10):2038-43.
doi: 10.1016/j.ophtha.2015.06.011. Epub 2015 Jul 16.

Comparison Among Methods of Retinopathy Assessment (CAMRA) Study: Smartphone, Nonmydriatic, and Mydriatic Photography

Martha E Ryan  1 , Ramachandran Rajalakshmi  2 , Vijayaraghavan Prathiba  2 , Ranjit Mohan Anjana  2 , Harish Ranjani  2 , K M Venkat Narayan  3 , Timothy W Olsen  1 , Viswanathan Mohan  2 , Laura A Ward  3 , Michael J Lynn  3 , Andrew M Hendrick  4
Affiliations
Comparative Study

Comparison Among Methods of Retinopathy Assessment (CAMRA) Study: Smartphone, Nonmydriatic, and Mydriatic Photography

Martha E Ryan et al. Ophthalmology. 2015 Oct.

Abstract

Purpose: We compared smartphone fundus photography, nonmydriatic fundus photography, and 7-field mydriatic fundus photography for their abilities to detect and grade diabetic retinopathy (DR).

Design: This was a prospective, comparative study of 3 photography modalities.

Participants: Diabetic patients (n = 300) were recruited at the ophthalmology clinic of a tertiary diabetes care center in Chennai, India.

Methods: Patients underwent photography by all 3 modalities, and photographs were evaluated by 2 retina specialists.

Main outcome measures: The sensitivity and specificity in the detection of DR for both smartphone and nonmydriatic photography were determined by comparison with the standard method, 7-field mydriatic fundus photography.

Results: The sensitivity and specificity of smartphone fundus photography, compared with 7-field mydriatic fundus photography, for the detection of any DR were 50% (95% confidence interval [CI], 43-56) and 94% (95% CI, 92-97), respectively, and of nonmydriatic fundus photography were 81% (95% CI, 75-86) and 94% (95% CI, 92-96%), respectively. The sensitivity and specificity of smartphone fundus photography for the detection of vision-threatening DR were 59% (95% CI, 46-72) and 100% (95% CI, 99-100), respectively, and of nonmydriatic fundus photography were 54% (95% CI, 40-67) and 99% (95% CI, 98-100), respectively.

Conclusions: Smartphone and nonmydriatic fundus photography are each able to detect DR and sight-threatening disease. However, the nonmydriatic camera is more sensitive at detecting DR than the smartphone. At this time, the benefits of the smartphone (connectivity, portability, and reduced cost) are not offset by the lack of sufficient sensitivity for detection of DR in most clinical circumstances.

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Figures

Figure 1
Figure 1
Representative photographs from each image modality. Top: Series taken from the same eye demonstrates no background retinopathy. Bottom: Images demonstrate diabetic macular edema in the same eye with each modality.
See this image and copyright information in PMC

References

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