title: SMARTPHONE-BASED DILATED FUNDUS PHOTOGRAPHY AND NEAR VISUAL ACUITY TESTING AS INEXPENSIVE SCREENING TOOLS TO DETECT REFERRAL WARRANTED DIABETIC EYE DISEASE.
abstract: OBJECTIVE
  To compare clinical assessment of diabetic eye disease by standard dilated examination with data gathered using a smartphone-based store-and-forward teleophthalmology platform.
  
  
  METHODS
  100 eyes of 50 adult patients with diabetes from a health care safety-net ophthalmology clinic. All patients underwent comprehensive ophthalmic examination. Concurrently, a smartphone was used to estimate near visual acuity and capture anterior and dilated posterior segment photographs, which underwent masked, standardized review. Quantitative comparison of clinic and smartphone-based data using descriptive, kappa, Bland-Altman, and receiver operating characteristic analyses was performed.
  
  
  RESULTS
  Smartphone visual acuity was successfully measured in all eyes. Anterior and posterior segment photography was of sufficient quality to grade in 96 and 98 eyes, respectively. There was good correlation between clinical Snellen and smartphone visual acuity measurements (rho = 0.91). Smartphone-acquired fundus photographs demonstrated 91% sensitivity and 99% specificity to detect moderate nonproliferative and worse diabetic retinopathy, with good agreement between clinic and photograph grades (kappa = 0.91 ± 0.1, P < 0.001; AUROC = 0.97, 95% confidence interval, 0.93-1).
  
  
  CONCLUSIONS
  The authors report a smartphone-based telemedicine system that demonstrated sensitivity and specificity to detect referral-warranted diabetic eye disease as a proof-of-concept. Additional studies are warranted to evaluate this approach to expanding screening for diabetic retinopathy.
authors.affiliation: *Byers Eye Institute, Stanford University School of Medicine, Department of Ophthalmology, Palo Alto, California; †Department of Ophthalmology, Santa Clara Valley Medical Center, San Jose, California; and ‡DigiSight Technologies, Inc., San Francisco, California.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Toy
authors.forename: David J
authors.initials: DJ
authors.lastname: Myung
authors.forename: Lingmin
authors.initials: L
authors.lastname: He
authors.forename: Carolyn K
authors.initials: CK
authors.lastname: Pan
authors.forename: Robert T
authors.initials: RT
authors.lastname: Chang
authors.forename: Alison
authors.initials: A
authors.lastname: Polkinhorne
authors.forename: Douglas
authors.initials: D
authors.lastname: Merrell
authors.forename: Doug
authors.initials: D
authors.lastname: Foster
authors.forename: Mark S
authors.initials: MS
authors.lastname: Blumenkranz
mesh_terms: D000368:Aged; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000503:physiopathology; 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; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D000068997:Smartphone; D017216:Telemedicine; D015351:Vision Screening / Q000295:instrumentation; D014792:Visual Acuity / Q000502:physiology*
chemical_list: D009184:Mydriatics