Diabetic retinopathy screening using MII Ret Cam assisted smartphone-based fundus imaging

Diabetes Mellitus is a tremendous health implication and it has originated as seventh leading cause of death in 2030 as proposed by WHO. Diabetic Retinopathy is one of the top complication of diabetes leading to preventable blindness. This investigation highlights the importance of timely screening and counselling using MIIRetcam assisted smartphone-based fundus imaging. Our study is a boon for bed-ridden and seriously ill patients who cannot be evaluated on fundus camera. This is an observational prospective study conducted at Ophthalmology unit, wards and intensive care unit (ICU) of a single tertiary teaching hospital between 1 May to 31 November 2022. A total of 268 subjects with diabetes were included. The fundus of all diabetic patients during the study period were examined by a single-trained ophthalmologist. Those diagnosed with diabetic retinopathy were taken for acquisition of fundus picture with MIIRetcam. Images were captured using 5 S iphone and 20D fixed in MII Ret Cam. Out of 268 subjects (536 eyes) screened during the study period. 86 patients (154 eyes) were found to have diabetic retinopathy (DR). Male: Female ratio was 1.4:1. The mean age was 56.37 ± 15.26 in years and the mean duration of diabetes was 10.60 ± 6.97 years. Grading of DR revealed proliferative diabetic retinopathy to be the topmost (n=84 eyes, 54.5%), followed by mild NPDR in 26 eyes (16%) and moderate NPDR in 24 eyes (15%) while severe NPDR was seen in 10 eyes (6.5%) and very severe NPDR was found in 8 eyes (5.2%) and diabetic papillopathy in 2 eyes. Grading of vitreous hemorrhage revealed Grade 1 in one eye (1.8%); Grade 2 in 19 eyes (34.54%); Grade 3 in 33 eyes (60%) and Grade 4 in 2 eyes (3.63%). Grading of macular edema according to the distribution of hard exudates as Grade 1(No Clinically significant macular edema) in 33 eyes (34.37%) and Grade 2 (Clinically significant macular edema) in 63 eyes (65.62%). The duration of diabetes had direct association with occurrence of DR,13patients (151%) had duration of diabetes less than five years;31patients(36%) had duration of diabetes between 6 years to 10 years;28 patients (32%) had duration between 11 years to 20 years.14 patients (16.3%) had duration more than twenty years. The Mean duration of diabetes in Group 1 was 11.40+/- 7.09 years and was 9.10+/- 6.48 in Group II. The mean HBA1c in group 1 is 7.44+/- 1.24 in group I and 6.54 +/- 1.09 in Group II.Mean fasting blood sugar in Group I is 130.87 +/- 29.57 and 106.62+/- 29.85 in Group II. Mean of random blood sugar was 202.15 +/- 60.84 in group I and 155.13 +/- 55.95 in Group II. Results are suggestive of association of DR occurrence with fasting,random blood sugar, duration of diabetes and HbA1c. Diabetic Retinopathy Screening using MIIRetcam assisted Smartphone -based fundus imaging may be a useful device to screen for referable and vision threatening diabetic retinopathy. MIIRetcam is easily accessible and portable equipment to counsel the patients in resource-limited countries.