It would be great if we had an inexpensive and fast way to diagnose diabetic retinopathy. A team of researchers in Germany and India now say that they just might have found it.
Diabetic retinopathy is a condition in which excessive blood sugar damages the blood vessels that feed the retina at the back of the eye, causing the retina to deteriorate. It’s a major cause of blindness around the world, but it can be especially devastating in underdeveloped countries, where existing health systems might not have the resources to deal with it. It’s estimated that 80% of diabetes patients worldwide live in emerging countries, where systematic retinal screening is difficult, if not impossible.
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But diabetic retinopathy can be averted. According to Maximilian Wintergerst, MD, of the Department of Ophthalmology at the University Hospital Bonn, “If such a retinopathy is recognized and treated in time, vision loss can often be prevented. An important aspect of therapy is better control of the diabetes; in addition, it is also possible to treat the undersupplied retina with laser light before further problems occur.”
For that reason, Wintergerst and a team of researchers from University Hospital Bonn joined forces with researchers at the Sankara Eye Hospital in Bangalore, India, to investigate the possibility of creating a simpler, less-costly way to screen diabetes patients for diabetic retinopathy. They came up with the idea of using a technology created for much different reasons—smartphones, which are more and more common around the world. The scientists took advantage of the excellent cameras that are now pretty much standard equipment on modern smartphones. They found out that these cameras can be really good at diagnosing retinal problems and called their approach smartphone-based fundus imaging, or SBFI. Joining forces with researchers from the Sankara Eye Hospital in Bangalore, the researchers supervised smartphone eye examinations on 193 patients with diabetes and determined the examiners required only about one to two minutes for each eye examination.
The researchers considered four possible ways of examining the interior of the eye with a regular smartphone and learned that, as Wintergerst put it, “The best result in our test was achieved by an adapter with an additional lens that is attached to the smartphone…. It allowed almost 80% of eyes with any retinal changes to be detected, even in the early stages. Advanced damage could even be diagnosed 100% of the time.” Study co-author Robert Finger, MD, pointed out that the smartphone method is especially attractive because an onsite ophthalmologist isn’t needed: “The examination can also be enabled by trained laypersons…. The images are then sent via the Internet to the ophthalmologist for diagnosis.” Mahesh P. Shanmugam, PhD, of the Sankara Eye Foundation pointed out another advantage of the smartphone technology: “COVID-19 has further necessitated the need for us to explore methods of reducing patients visiting hospital. This modality is promising in increasing efficiency of screening for retinal changes in diabetics.”
The study authors are now seeking to develop an app that will encrypt an electronic patient file on the smartphones used for the eye examinations. The file will store not only the images taken by the smartphone cameras but also the comments of the doctor who reviews them. Beyond that, they are looking at ways to use artificial intelligence to automatically evaluate the images in advance of the physician’s assessment.