Skip to main content

Diabetic Eye Screening Using a Hand-Held Non-mydriatic Digital Retinal Camera: Experience from a Lower Middle-Income Country

  • Chapter
  • First Online:
Digital Eye Care and Teleophthalmology

Abstract

Diabetes mellitus (DM) is a fast-growing epidemic in the world. Diabetic Eye Disease (DED) is a common microvascular complication of DM that could lead to sight loss if not detected and treated on time. It is a major cause of avoidable blindness and visual impairment. Barriers to implement systematic diabetic eye screening (DES) in low- and middle-income countries are mostly related to major system factors such as lack of human resources and DES infrastructure leading to unavailability of services. Digital retinal imaging is the most advanced and commonly used retinal imaging method currently in use, yet it is a costly intervention for resource poor settings. Therefore, more affordable strategies such as hand-held retinal imaging become popular in DES. Our aim in this chapter is to describe how countries with low resources can improve DES or at least case finding at the outset, by laying out the steps of development and testing of a DES model in Sri Lanka as a case study. In our feasibility study, we demonstrated that DES by physicians using a hand-held digital retinal camera at a medical clinic is one way of case finding that could contribute to systematic screening. We identified that the selection of primary graders, different screening pathways, and transferrable learning methods should be adopted according to local contextual requirements.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. IDF. International diabetes federation diabetes atlas eighth edition 2019 [Internet]. 2019. http://www.diabetesatlas.org/resources/2019-atlas.html. Accessed on 15 June 2021

  2. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pr. 2010;87(1):04–14.

    Google Scholar 

  3. Leasher JL, Bourne RRA, Flaxman SR, Jonas JB, Keeffe J, Naidoo K, et al. Global estimates on the number of people blind or visually impaired by diabetic retinopathy: a meta-analysis from 1990 to 2010. Diabetes Care [Internet]. 2016;39(9):1643–9. http://www.ncbi.nlm.nih.gov/pubmed/27555623.

  4. Scanlon PH. The English national screening programme for diabetic retinopathy 2003–2016. Acta Diabetol. 2017;54(6):515–25.

    Google Scholar 

  5. Diabetic Retinopathy Screening: A short Guide - WHO Regional Office for Europe [Internet]. 2020. https://apps.who.int/iris/bitstream/handle/10665/336660/9789289055321-eng.pdf. Accessed on 15 June 2021.

  6. Piyasena MMPN, Murthy G, Yip J, Gilbert C, Zuurmond M, Peto T, et al. Systematic review on barriers and enablers for access to diabetic retinopathy screening services in different income settings. PLoS ONE. 2019;14(4):e0198979.

    Google Scholar 

  7. Lanzetta P, Sarao V, Scanlon P, Barratt J, Porta M, Bandello F, et al. Fundamental principles of an effective diabetic retinopathy screening program. Acta Diabetol. 2020;57:785–98.

    Google Scholar 

  8. Piyasena MMPN, Zuurmond M, Yip J, Murthy G. Process of adaptation, development and assessment of acceptability of a health educational intervention to improve referral uptake by people with diabetes in Sri Lanka. BMC Public Health. 2019;19(614).

    Google Scholar 

  9. Andermann A, Blancquaet I, Beauchamp S, Dery V. Revisiting Wilson and Jungner in the genomic age: a review of screening criteria over the past 40 years. Bull World Heal Orgn. 2008;86(4):317–9.

    Google Scholar 

  10. Screening programmes: a short guide. World Health Organization Regional Office for Europe. [Internet]. 2020. Available from: https://apps.who.int/iris/bitstream/handle/10665/330829/9789289054782-eng.pdf. Accessed on 15 June 2021.

  11. Piyasena MMPN. A Feasibility study to develop an integrated diabetic retinopathy screening programme in the western province of Sri Lanka [Internet]. PhD Thesis (Research Paper Style), London School of Hygiene & Tropical Medicine; 2019. https://doi.org/10.17037/PUBS.04654682. Accessed on 15 June 2021.

  12. Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. The effects of integrated care: a systematic review of UK and international evidence. BMC Health Serv Res. 2018;18(1):1–13.

    Google Scholar 

  13. Tsiachristas A, Stein KV, Evers S, Mölken MR. Performing economic evaluation of integrated care: highway to hell or stairway to heaven? Int J Integr Care. 2016;16(4):1–12. https://doi.org/10.5334/ijic.2472.

  14. Piyasena MMPN, Murthy GVS. A situation analysis of diabetic eye care service delivery in health care institutions of the Western Province of Sri Lanka. Ceylon Med J [Internet]. 2017;62(September 2016):205–6. https://doi.org/10.4038/cmj.v62i3.8527.

  15. Piyasena MMPN, Murthy G. Availability of eye care infrastructure and human resources for managing diabetic retinopathy in the Western province of Sri Lanka. Indian J Ophthalmol. 2020;68(5):841–6.

    Google Scholar 

  16. Piyasena MMPN. A situational analysis and mapping of availability of services for diabetic retinopathy in health care instituions in Western Province Sri Lanka [Internet]. London School of Hygiene & Tropical Medicine; 2014. https://discover.lshtm.ac.uk/discovery/search?query=any,contains,msc,public,health,for,eye,care&tab=Everything&search_scope=MyInstitution&vid=44HYG_INST:44HYG_VU1&facet=rtype,include,mscproject&facet=searchcreationdate,include,2014%7C,%7C2014&offset=0. Accessed on 15 June 2021.

  17. Katulanda P, Rathnapala DAV, Sheriff R, Mathews DR. Province and ethnic specific prevalence of diabetes among Sri Lakan adults. Sri Lanka J Diabetes Endocrinol Metab. 2011;1:2–7.

    Google Scholar 

  18. Piyasena MMPN, Yip JLY, Macleod D, Kim M, Gudlavalleti VSM. Diagnostic test accuracy of diabetic retinopathy screening by physician graders using a hand-held non-mydriatic retinal camera at a tertiary level medical clinic. BMC Ophthalmol. 2019;19(1):89. https://doi.org/10.1186/s12886-019-1092-3.2019;1-13.

  19. Piyasena MMPN, Murthy GVS, Yip JLY, Gilbert C, Peto T, et al. Systematic review and meta-analysis of diagnostic accuracy of detection of any level of diabetic retinopathy using digital retinal imaging. Syst Rev. 2018;7(1):182. https://doi.org/10.1186/s13643-018-0846-y.2018;1-18.

  20. Carmichael TR, Carp GI, Welsh ND, Kalk WJ. Effective and accurate screening for diabetic retinopathy using a 60 degree mydriatic fundus camera. South African Med J. 2005;95(1):57–61.

    Google Scholar 

  21. Bhargava M, Cheung CYL, Sabanayagam C, Kawasaki R, Harper CA, Lamoureux EL, et al. Accuracy of diabetic retinopathy screening by trained non-physician graders using non-mydriatic fundus camera. Singapore Med J. 2012;53(11):715–9.

    Google Scholar 

  22. De Silva D. How many doctors should we train for Sri Lanka ? System dynamics modelling of training needs. Ceylon Med J. 2017;62:233–7. https://doi.org/10.4038/cmj.v62i4.8573.

  23. Kang J, Goh H, Cheung CY, Sim SS, Tan PC, Siew G, et al. Retinal imaging techniques for diabetic retinopathy screening. J Diabetes Sci Technol. 2016;10(2):282–94. https://doi.org/10.1177/1932296816629491.

  24. Tran K, Mendel TA, Holbrook KL, Yates PA. Construction of an inexpensive, hand-held fundus camera through modification of a consumer “point-and-shoot” camera. Investig Ophthalmol Vis Sci. 2012;53(12):7600–7.

    Google Scholar 

  25. Xiao B, Liao Q, Li Y, Weng F, Lin L, Wang Y, et al. Validation of handheld fundus camera with mydriasis for retinal imaging of diabetic retinopathy screening in China: a prospective comparison study. Diabetes Endocrinol. 2020;10(10):e040196.

    Google Scholar 

  26. Tan C, Kyaw B, Smith H, Tan C, Car L. Use of smartphone to detect diabetic retinopathy: scoping review and meta-analysis of diagnostic test accuracy studies. J Med Internet Res. 2020;22(5):e16658.

    Google Scholar 

  27. Cuadros J, Bresnick G. Can commercially available handheld retinal cameras effectively screen diabetic retinopathy? J Diabetes Sci Technol. 2017;11(1):135–7. https://doi.org/10.1177/1932296816682033.

  28. Gruppen L, Mangrulkar R, Kolars J. The promise of competency-based education in the health professions for improving global health. Hum Resour Health. 2012;10(43):1–7.

    Google Scholar 

  29. International Council for Ophthalmology Guidelines for Diabetic Eye Care. 2014(February) (updated 2017). http://www.icoph.org/downloads/ICOGuidelinesforDiabeticEyeCare.pdf. Accessed on 15 June 2021.

  30. Piyasena MMPN, Murthy G, Gilbert C, Yip J, Peto T. Development and validation of a diabetic retinopathy screening modality using a hand-held nonmydriatic digital retinal camera by physician graders at a tertiary level medical clinic: protocol for a validation study. JMIR Res Protoc. 2018;7(12):e10900.

    Google Scholar 

  31. Scottish Diabetic Retinopathy Grading Scheme 2007 - Version 1. https://www.ndrs.scot.nhs.uk/wp-content/uploads/2013/04/Grading-Scheme-2007-v1.1.pdf. Accessed on 15 June 2021.

  32. Manyazewal T. Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities. Arch Public Health. 2017;75:50. https://doi.org/10.1186/s13690-017-0221-9. eCollection 2017.

  33. Taylor DJ, Goatman KA, Gregory A, Histed M, Martin CN, Warburton TJ, et al. Image-quality standardization for diabetic retinopathy screening. Expert Rev Ophthalmol. 2009;4(5):469–76.

    Google Scholar 

Download references

Acknowledgements

Prof. G.V.S. Murthy - Professor of Public Health for Eye Care and Disability (Main Supervisor) and Dr. Jennifer Yip - Associate Professor in Ophthalmology (Co-Supervisor) for supervising the research degree student (first author) at the London School of Hygiene and Tropical Medicine, United Kingdom and Dr. Charith Fonseka - Senior Consultant Ophthalmologist (Co-Principal Investigator of the project) National Eye Hospital of Sri Lanka.

Funding

This project was funded by a Ph.D. student grant received by the first author from Queen Elizabeth Diamond Jubilee Trust (QEDJT) coordinated through the Commonwealth Eye Health Consortium, UK.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Prabhath Piyasena .

Editor information

Editors and Affiliations

Ethics declarations

Prof. Congdon declares that he works as Director of Research for Orbis International, an organization working on global eye health and supported by the Ulverscroft Foundation, United Kingdom.

Permission Requests No other party’s permission is required for the material used in this book chapter. The first author holds the copyright of all photos, retinal images, and figures used.

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Piyasena, P., Peto, T., Congdon, N. (2023). Diabetic Eye Screening Using a Hand-Held Non-mydriatic Digital Retinal Camera: Experience from a Lower Middle-Income Country. In: Yogesan, K., Goldschmidt, L., Cuadros, J., Ricur, G. (eds) Digital Eye Care and Teleophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-031-24052-2_25

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-24052-2_25

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-24051-5

  • Online ISBN: 978-3-031-24052-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics