AIMS: To evaluate diabetic retinopathy (DR) screening with a portable handheld smartphone-based retinal camera and telemedicine in an urban primary healthcare setting and to evaluate the learning curve for image acquisition, performed by healthcare personnel without previous experience in retinal imaging .
METHODS: This was a prospective study that enrolled patients with type 2 diabetes mellitus (T2DM) followed at a primary healthcare unit in São Paulo, Brazil . After a brief training in image acquisition, there was further continuous feedback given by a retina specialist during the remote image reading process . Each patient underwent two fundus and one anterior ocular segment images per eye, after mydriasis . Patients were classified according to the need of referral .
RESULTS: A total of 627 adult individuals with T2DM underwent retinal evaluation . The population was composed by 63.2% female individuals, age median of 66 years, diabetes duration 10.7 ± 8.2 years and HbA1c 7.7 ± 1.9% (61 + 20.8 mmol/mol). The most prevalent associated comorbidities were arterial hypertension (80.3 %) and dyslipidemia (50.2 %). Referral decision was possible in 81.2% patients . Most patients had absent or non-referable DR; the main ocular media opacity detected was cataract . After the 7th day of image acquisition, the daily rate of patients whose images allowed clinical decision was maintained above 80% . A higher HbA1c was associated with referable DR .
CONCLUSIONS: A low-cost DR screening strategy with a handheld device and telemedicine is feasible and has the potential to increase coverage of DR screening in underserved areas; the possibility of mobile units is relevant for DR screening in the context of COVID-19 pandemic . Daily rate of patients whose examinations allowed clinical decision . X-axis: day of examination; Y-axis: rate (%) of patients whose examinations allowed a clinical decision.