title: Suitability of a Low-Cost, Handheld, Nonmydriatic Retinograph for Diabetic Retinopathy Diagnosis.
abstract: OBJECTIVE
  We assessed the suitability of a low-cost, handheld, nonmydriatic retinograph, namely the Horus DEC 200, for diabetic retinopathy (DR) diagnosis. Two factors were considered: ease of image acquisition and image quality.
  
  
  METHODS
  One operator acquired fundus photographs from 54 patients using the Horus and AFC-330, a more expensive, nonportable retinograph. Satisfaction surveys were filled out by patients. Then, two retinologists subjectively assessed image quality and graded DR severity in one eye of each patient. Objective image quality indices also were computed.
  
  
  RESULTS
  During image acquisitions, patients had difficulty locating the fixation target inside the Horus: by default, 53.7% of them had to fixate external points with the contralateral eye, as opposed to none of them using the AFC-330 (P< 0.0001). This issue impacted the duration of image acquisitions. Images obtained by the Horus were of significantly lower quality according to the experts (P= 0.0002 andP= 0.0004) and to the objective criterion (P< 0.0001). As a result, up to 20.4% of eyes were inadequate for interpretation, as opposed to 9.3% using the AFC-330. However, no significant difference was found in terms of DR severity according to both experts (P= 0.557 andP= 0.156).
  
  
  CONCLUSIONS
  The Horus can be used to screen DR, but at the cost of longer examination times and higher proportions of patients referred to an ophthalmologist due to inadequate image quality.
  
  
  CONCLUSIONS
  The Horus is adequate to screen DR, for instance in primary care centers or in mobile imaging units.
authors.affiliation: Inserm, UMR 1101, Brest, F-29200 France.
authors.forename: Gwenolé
authors.initials: G
authors.lastname: Quellec
authors.affiliation: Service d'Ophthalmologie, CHRU Brest, Brest, F-29200 France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Bazin
authors.affiliation: Inserm, UMR 1101, Brest, F-29200 France ; Institut Mines-Telecom, Telecom Bretagne, UEB, Dpt ITI, Brest, F-29200 France.
authors.forename: Guy
authors.initials: G
authors.lastname: Cazuguel
authors.affiliation: Service d'Ophthalmologie, CHRU Brest, Brest, F-29200 France.
authors.forename: Ivan
authors.initials: I
authors.lastname: Delafoy
authors.affiliation: Inserm, UMR 1101, Brest, F-29200 France ; Service d'Ophthalmologie, CHRU Brest, Brest, F-29200 France ; Univ Bretagne Occidentale, Brest, F-29200 France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Cochener
authors.affiliation: Inserm, UMR 1101, Brest, F-29200 France ; Univ Bretagne Occidentale, Brest, F-29200 France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Lamard
keywords: diabetic retinopathy diagnosis; fundus photography; image quality; inter-observer variability; low-cost, handheld, nonmydriatic retinograph