Diabetic Retinopathy Screening Using a Portable Retinal Camera in Vanuatu

Abstract

Background and Objective

Proof-of-concept study to test the feasibility of using an all-in-one portable retinal camera for the screening of diabetic retinopathy in the Pacific Island of Vanuatu, which has a high rate of diabetes and its associated complications and a dearth of ophthalmologists.

Study Design/Materials and methods

From February 10, 2020, through February 28, 2020, 49 patients with diabetes mellitus from three islands in Vanuatu were recruited to participate in the study. Demographics, basic health data and retinal photography were obtained. A non-mydriatic, handheld camera was used (Volk Pictor Plus).

Results

Eleven participants (24%) had referral-warranted diabetic retinopathy. There was moderately high inter-rater reliability for our dependent variables: referral status (κ = 0.62, 95% CI 0.42–0.83), retinopathy severity (κ = 0.76, 95% CI 0.55–0.96), and clinically significant macular edema (κ = 0.50, 95% CI 0.25–0.74).

Conclusion

Our study confirms that portable handheld cameras can be used to obtain retinal images of sufficient quality for diabetic retinopathy screening even in resource limited environments like Vanuatu. Among this cohort, a relatively high (24%) prevalence of referral-warranted diabetic retinopathy was found in Vanuatu.

Keywords:

• diabetic retinopathy
• retinal screening
• Vanuatu
• portable retinal camera
• Pictor

Data Access

Data cannot be shared publicly due to HIPAA privacy laws. Data is available from the University of Michigan Institutional Data Access/ Ethics Committee for researchers who meet the criteria to access confidential de-identified data.

Acknowledgments

Juan Caceres and Yibing Zhang are co-first authors for this study. This work was sponsored by a grant from the National Eye Institute (1K08EY027458, PI YMP), Alcon Research Institute Young Investigator Grant (PI YMP), unrestricted departmental support from Research to Prevent Blindness, generous support of the Helmut F. Stern Career Development Professorship in Ophthalmology and Visual Sciences (YMP), and the University of Michigan Department of Ophthalmology and Visual Sciences. We would like to thank the physicians, nurses, and staff at Godden Memorial Hospital, Northern Provincial Hospital, and Vila Central Hospital for all the support. We would also like to thank Alexis Cullen for helping us with the conception, design, and logistics of the trip. We finally thank Dr. David Musch for statistical guidance for the project.

Author Contributions

All authors made a significant contribution to the work reported, whether that was in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas. All authors revised the work and approved the final submitted version. All authors also have agreed both to be personally accountable for the author’s own contributions and ensure that any questions related to the accuracy or integrity of the work are appropriately addressed.

Disclosure

None of the authors has a conflict of interest relevant to this paper.