title: Comparison of smartphone ophthalmoscopy with slit-lamp biomicroscopy for grading diabetic retinopathy.
abstract: OBJECTIVE
  To assess the accuracy and reliability of smartphone ophthalmoscopy, we compared the ability of a smartphone ophthalmoscope with that of a slit-lamp biomicroscope to grade diabetic retinopathy (DR) in patients with diabetes mellitus (DM).
  
  
  METHODS
  Clinical-based, prospective, comparative instrument study.
  
  
  METHODS
  This comparative clinical study was performed in 120 outpatients (240 eyes) with type 1 or type 2 DM. After pupil dilation, the patients underwent smartphone ophthalmoscopy with the D-Eye device, followed by dilated retinal slit-lamp examination, to grade DR according to a 5-step scale.
  
  
  RESULTS
  Overall exact agreement between the 2 methods was observed in 204 of 240 eyes (85%) (simple κ = 0.78; CI 0.71-0.84) and agreement within 1 step was observed in 232 eyes (96.7%). Compared to biomicroscopy, the sensitivity and specificity of smartphone ophthalmoscopy for the detection of clinically significant macular edema were 81% and 98%, respectively. Smartphone ophthalmoscopy and biomicroscopy could not be used to examine the fundus and grade DR in 9 eyes (3.75%) and 4 eyes (1.7%), respectively, because of cataract and/or small pupil diameter.
  
  
  CONCLUSIONS
  Smartphone ophthalmoscopy showed considerable agreement with dilated retinal biomicroscopy for the grading of DR. The portability, affordability, and connectivity of a smartphone ophthalmoscope make smartphone ophthalmoscopy a promising technique for community screening programs.
authors.affiliation: Eye Clinic, Department of Neurological and Vision Sciences, University of Brescia, Brescia, Italy. Electronic address: dott.andrea.russo@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Russo
authors.affiliation: Eye Clinic, Department of Neurological and Vision Sciences, University of Brescia, Brescia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Morescalchi
authors.affiliation: Eye Clinic, Department of Health Sciences, University of Molise, Campobasso, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Costagliola
authors.affiliation: Eye Clinic, Department of Neurological and Vision Sciences, University of Brescia, Brescia, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Delcassi
authors.affiliation: Eye Clinic, Department of Neurological and Vision Sciences, University of Brescia, Brescia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Semeraro
mesh_terms: D000328:Adult; D000368:Aged; D040421:Cell Phone / Q000295:instrumentation*; D048909:Diabetes Complications; D003930:Diabetic Retinopathy / Q000145:classification*; D005260:Female; D006801:Humans; D008269:Macular Edema / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009184:Mydriatics / Q000008:administration & dosage; D009887:Ophthalmoscopy / Q000379:methods*; D010656:Phenylephrine / Q000008:administration & dosage; D011446:Prospective Studies; D011680:Pupil / Q000187:drug effects; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D066167:Slit Lamp; D014331:Tropicamide / Q000008:administration & dosage
chemical_list: D009184:Mydriatics; D010656:Phenylephrine; D014331:Tropicamide