According to a recent article in the Indian National Medical Journal, India is the diabetic capital of the world, and diabetes mellitus is an enormous burden on healthcare resources there. Diabetic retinopathy (DR) is a serious complication of the disease and the leading cause of blindness in the global working age population. Every person living with diabetes should go for a regular eye screening as DR can be prevented in 95% of the cases with early detection and timely treatment.
The currently available methods of screening for DR depend on the availability of healthcare professionals and technology. The high prevalence of diabetes in India, and the need to repeatedly screen such patients for DR and treat them, presents an enormous economic and logistical burden.
But all is not gloom. There are promising trends in imaging for DR screening and emerging technologies that show potential for improving upon current screening approaches. While most screening programs employ mydriatic or non-mydriatic color fundus photography and trained image graders to identify referable DR, new imaging modalities offer significant improvements in diagnostic accuracy, throughput, and affordability. As we covered in a previous blog, smartphone-based fundus photography, macular optical coherence tomography, ultrawide-field imaging, and artificial intelligence-based image reading will come into play as DR becomes more prevalent.
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India is setting the stage for even more progress in this field. The Sharma Lotus Eye Hospital and Institute in Tamilnadu has led in the development of an inexpensive smartphone-based fundus camera device (MII Ret Cam) for screening for DR. It’s a device that has slots to fit a smartphone (built-in camera and flash) and a 20-D lens. With the help of the device and an innovative imaging technique, high-quality fundus images have been captured. The MII Ret Cam overcomes multiple shortcomings of existing fundus cameras, including the possibility to image the peripheral retina, reducing cost and increasing portability.
Few months ago, the Indian National Medical Journal reported on the concept of screening for DR with ‘selfie retinal imaging’ where three patients captured retinal images themselves and transferred to a grading centre for further deliberation. A ́selfie of the retina´ could in the future obviate the need for trained healthcare professionals in screening for DR as images could be captured by the patients, stored and transferred to a grading facility for interpretation and treatment advice. Follow-ups could be scheduled without expensive travel and emergencies could be dealt with in a timely manner. With the ever increasing penetration of smartphones worldwide and rapid evolution in smartphone technology, photography and app-based platforms, it is likely that ́selfies of the retina´ can be hugely beneficial in preventing loss of vision due to diabetes.