Prayogo Mohammad Eko, Zaharo Alfia Fatma, Damayanti Novandriati Nur Rizky, Widyaputri Felicia, Thobari Jarir At, Susanti Vina Yanti, Sasongko Muhammad Bayu
Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada - Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta, Indonesia.
Department of Ophthalmology, Universitas Gadjah Mada Academic Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Clin Ophthalmol. 2023 Aug 18;17:2459-2470. doi: 10.2147/OPTH.S416422. eCollection 2023.
Diabetic retinopathy (DR) is a leading cause of blindness. Early DR screening is essential, but the infrastructure can be less affordable in low resource countries. This study aims to review the accuracy of low-cost smartphone-based fundus cameras for DR screening in adult patients with diabetes.
We performed a systematic literature search to find studies that reported the sensitivity and specificity of low-cost smartphone-based devices for fundus photography in adult patients with diabetes. We searched three databases (MEDLINE, Google Scholar, Scopus) and one register (Cochrane CENTRAL). We presented the accuracy values by grouping the diagnosis into three: any DR, referrable DR, and diabetic macular oedema (DMO). Risk of bias and applicability of the studies were assessed using QUADAS-2.
Five out of 294 retrieved records were included with a total of six smartphone-based devices reviewed. All of the reference diagnostic methods used in the included studies were either indirect ophthalmoscopy or slit-lamp examinations and all smartphone-based devices' imaging protocols used mydriatic drops. The reported sensitivity and specificity for any DR were 52-92.2% and 73.3-99%; for referral DR were 21-91.4% and 64.9-100%; and for DMO were 29.4-81% and 95-100%, respectively.
Sensitivity available low-cost smartphone-based devices for DR screening were acceptable and their specificity particularly for detecting referrable DR and DMO were considerably good. These findings support their potential utilization for DR screening in a low resources setting.
糖尿病视网膜病变（DR）是导致失明的主要原因。早期DR筛查至关重要，但在资源匮乏的国家，相关基础设施的成本可能较高。本研究旨在评估基于低成本智能手机的眼底相机对成年糖尿病患者进行DR筛查的准确性。
我们进行了系统的文献检索，以查找报告基于低成本智能手机的设备对成年糖尿病患者进行眼底摄影的敏感性和特异性的研究。我们检索了三个数据库（MEDLINE、谷歌学术、Scopus）和一个登记处（Cochrane CENTRAL）。我们将诊断分为三类：任何DR、可转诊的DR和糖尿病性黄斑水肿（DMO），并给出了准确性值。使用QUADAS-2评估研究的偏倚风险和适用性。
在检索到的294条记录中，纳入了5条，共评估了6种基于智能手机的设备。纳入研究中使用的所有参考诊断方法均为间接检眼镜检查或裂隙灯检查，所有基于智能手机的设备的成像方案均使用散瞳滴眼液。报告的任何DR的敏感性和特异性分别为52-92.2%和73.3-99%；可转诊DR的敏感性和特异性分别为21-91.4%和64.9-100%；DMO的敏感性和特异性分别为29.4-81%和95-100%。
基于低成本智能手机的现有DR筛查设备的敏感性是可以接受的，其特异性，特别是在检测可转诊DR和DMO方面相当不错。这些发现支持了它们在低资源环境中用于DR筛查的潜在用途。
