Remote screening of retinal and optic disc diseases using handheld nonmydriatic cameras in programmed routine occupational health checkups onsite at work centers

Abstract

Purpose: To evaluate the first year outcomes of a remote screening program for detection of retinal diseases using handheld nonmydriatic cameras in occupational routine checkups performed onsite at work centers.

Methods: Cross-sectional, first year screening program outcomes audit. Participants were volunteers recruited from staff within work centers. Retinal fundus images were captured by technicians, and images and data were anonymized and sent securely to a remote server. A team of ophthalmologists, all retinal specialists, remotely read the images using a custom-made software and sent telematic reports of findings within 24-48 h. The main items evaluated were the detection of retinal abnormalities and the relationship between retinal findings and demographic data such as age and sex.

Results: A total of 19,881 workers were evaluated in 52 centers. Mean age was 41.1 years old, 43.9% men and 56.1% women. Mean duration of the test was around 2 min. Of the workers, 7.8% presented abnormalities in retinal fundus images, being the main findings choroidal nevus (2.4%), macular pigment abnormalities (1.5%), glaucomatous optic disc (1.2%), and macular signs of high myopia (1.1%). The presence of abnormalities was associated with greater age, being 5%, 7.9%, 12.6%, and 19.7% in workers less than 40 years, from 40 to 49, 50-59, and ≥ 60 years (p < 0.05), respectively. Men had more abnormalities in retinal fundus images than women (8.6 vs. 7.2; p < 0.05 RR: 1.2; CI 1092-1322).

Conclusions: Mass screening of retinal and optic disc abnormalities during occupational health routine checkups is a feasible, quick, and efficient tool for early detection of potential vision-threatening disease markers.

Keywords: Occupational health; Optic nerve diseases; Retinal diseases; Screening; Telemedicine.

Fig. 1

Example of fundus photographs with different models of handheld cameras. Images performed with Smartscope PRO: (A1) peripapillar choroidal nevus and (A2) myopic fundus with atrophy and Fuchs’ spot. Images capted with Visuscout 100: (B1) macular pigmented abnormalities and (B2) diabetic retinopathy. Images from Aurora: (C1) Retinal scars and (C2) tessellated fundus

Fig. 2

Demonstration of retinal fundus imaging, using handheld camera, and preregistration with QR codes

Fig. 3

Representation of the main abnormalities found in the retinographies and their absolute numbers of the total series. GON, glaucomatous optic neuropathy: AMD, age-related macular degeneration; ERM, epiretinal membrane; CSC, central serous chorioretinopathy; DRP, diabetic retinopathy

Fig. 4

Distribution of retinal fundus abnormalities depending on age groups