Smartphone-Assisted Glaucoma Screening in Patients With Type ۲ Diabetes: a Pilot Study

Abstract We aimed to determine true and false positives of glaucoma screening, relying solely on photos of the retina, taken with a smartphone. We performed a descriptive and analytical study on patients with type ۲ diabetes at the National Obesity Centre, Yaounde, Cameroon. Participating patients had retinal photography sessions using an iPhone ۵s (iOS ۱۰.۳.۳; Apple, Cupertino, CA) coupled to the Make in India Retinal Camera (MIIRetCam; MIIRetCam Inc., Coimbatore, TN, India). Obtained pictures of the retina were stored and transferred via the internet to an ophthalmologist to assess glaucoma. Selected patients were then invited to undergo a conventional ophthalmological examination to confirm the diagnosis. A total of ۳۹۵ patients were screened, ۳۹ (including ۲۰ women) were diagnosed with suspicion of glaucoma based on retinal photos, a prevalence rate of ۹.۸۷%. The following signs were found; C/D equal or more than ۰.۵ in ۶۴.۱% (۲۵/۳۹), asymmetric C/D >۰.۲ in ۳۵.۹% (۱۴/۳۹), papillary haemorrhage in ۱۰.۲% (۴/۳۹) and retinal nerve fibre deficiency in ۲.۵% (۱/۳۹). Only ۱۴ of ۳۹ patients with suspicion of glaucoma were examined, giving a lost-to-follow-up rate of ۶۴.۱%. Chronic open-angle glaucoma was confirmed in ۸ patients (true positives) and absent in ۶ patients (false positives). The prevalence of smartphone-detected glaucoma and lost-to-follow-up rates were high. So we need to improve this type of screening, with additional tests like transpalpebral applanation tonometer and the smartphone Frequency Doubling Technique visual field combined with better education of patients to increase their adherence to follow-up.