The diabetic retinopathy screening workflow: potential for smartphone imaging

Complications of diabetes mellitus, namely diabetic retinopathy and diabetic maculopathy, are the leading cause of blindness in working aged people. Sufferers can avoid blindness if identified early via retinal imaging. Systematic screening of the diabetic population has been shown to greatly reduce prevalence and incidence of blindness within the population. Many national screening programmes have digital fundus photography as their basis. In the past five years several techniques and adapters have been developed that allow digital fundus photography to be performed using smartphones. We review recent progress in smartphone - based fundus imaging and discuss its potential for integration into national systematic DR screening programmes. Some systems have produced promising initial results with respect to their agreement with reference standards. However further multi-site trialling of such systems’ use withi n implementable screening workflows is required if an evidence base strong enough to affect policy change is to be established. If this were to occur national diabetic retinopathy screening would, for the first time, become possible in low-and middle-income settings where cost and availability of trained eye-care personnel are currently key barriers to implementation. As diabetes prevalence and incidence is increasing sharply in these settings, the impact on global blindness could be profound.