Validity of smartphone fundus photography in diagnosing diabetic retinopathy at Mbarara Regional Referral Hospital, South Western, Uganda

Abstract

Objective: To determine the sensitivity and specificity of smartphone funduscopy in diagnosing and stagingDiabetic Retinopathy (DR) in diabetics attending Mbarara Regional Referral Hospital (MRRH).Design: Analytical, hospital based cross sectional study.Setting: Diabetic clinic of MRRH, Mbarara.Participants: Diabetic patients (n=207) ≥ 18 years were recruited from the diabetic clinic of MRRH.Measures: Sensitivity and specificity of smartphone photographs was analysed using indirect ophthalmoscopy as the gold standard.Results: Sensitivity of smartphone in diagnosing DR was 70% and specificity 94%. The sensitivity and specificity of the smartphone in grading proliferative diabetic retinopathy was 100% and 99.4%. For macular edema, sensitivity was 38.5% and specificity 97.9%. Kappa agreement was 0.86 in diagnosing DR and 0.84 in grading diabetic retinopathy. The prevalence of DR was 13.5%.Conclusion: The study found that the sensitivity of the smartphone in diagnosing diabetic retinopathy was only 70%. Hence we do not recommend this device to be used in the screening of patients with diabetes.