title: Comparison Among Methods of Retinopathy Assessment (CAMRA) Study: Smartphone, Nonmydriatic, and Mydriatic Photography.
abstract: OBJECTIVE
  We compared smartphone fundus photography, nonmydriatic fundus photography, and 7-field mydriatic fundus photography for their abilities to detect and grade diabetic retinopathy (DR).
  
  
  METHODS
  This was a prospective, comparative study of 3 photography modalities.
  
  
  METHODS
  Diabetic patients (n = 300) were recruited at the ophthalmology clinic of a tertiary diabetes care center in Chennai, India.
  
  
  METHODS
  Patients underwent photography by all 3 modalities, and photographs were evaluated by 2 retina specialists.
  
  
  METHODS
  The sensitivity and specificity in the detection of DR for both smartphone and nonmydriatic photography were determined by comparison with the standard method, 7-field mydriatic fundus photography.
  
  
  RESULTS
  The sensitivity and specificity of smartphone fundus photography, compared with 7-field mydriatic fundus photography, for the detection of any DR were 50% (95% confidence interval [CI], 43-56) and 94% (95% CI, 92-97), respectively, and of nonmydriatic fundus photography were 81% (95% CI, 75-86) and 94% (95% CI, 92-96%), respectively. The sensitivity and specificity of smartphone fundus photography for the detection of vision-threatening DR were 59% (95% CI, 46-72) and 100% (95% CI, 99-100), respectively, and of nonmydriatic fundus photography were 54% (95% CI, 40-67) and 99% (95% CI, 98-100), respectively.
  
  
  CONCLUSIONS
  Smartphone and nonmydriatic fundus photography are each able to detect DR and sight-threatening disease. However, the nonmydriatic camera is more sensitive at detecting DR than the smartphone. At this time, the benefits of the smartphone (connectivity, portability, and reduced cost) are not offset by the lack of sufficient sensitivity for detection of DR in most clinical circumstances.
authors.affiliation: Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Martha E
authors.initials: ME
authors.lastname: Ryan
authors.affiliation: Dr. Mohan's Diabetes Specialities Centre, Chennai, India.
authors.forename: Ramachandran
authors.initials: R
authors.lastname: Rajalakshmi
authors.affiliation: Dr. Mohan's Diabetes Specialities Centre, Chennai, India.
authors.forename: Vijayaraghavan
authors.initials: V
authors.lastname: Prathiba
authors.affiliation: Dr. Mohan's Diabetes Specialities Centre, Chennai, India.
authors.forename: Ranjit Mohan
authors.initials: RM
authors.lastname: Anjana
authors.affiliation: Dr. Mohan's Diabetes Specialities Centre, Chennai, India.
authors.forename: Harish
authors.initials: H
authors.lastname: Ranjani
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: K M Venkat
authors.initials: KM
authors.lastname: Narayan
authors.affiliation: Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Olsen
authors.affiliation: Dr. Mohan's Diabetes Specialities Centre, Chennai, India.
authors.forename: Viswanathan
authors.initials: V
authors.lastname: Mohan
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Ward
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lynn
authors.affiliation: Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia. Electronic address: ahendrick@emory.edu.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Hendrick
mesh_terms: D000328:Adult; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009184:Mydriatics / Q000008:administration & dosage*; D010781:Photography / Q000379:methods*; D011446:Prospective Studies; D011680:Pupil / Q000187:drug effects*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D000068997:Smartphone
chemical_list: D009184:Mydriatics