Saving eye sight with a smartphone

The Eye Clinic at Bonn University Hospital in cooperation with the Sankara Eye Foundation in India has started a project to introduce a unique smartphone-based, telemedical diabetic retinopathy (DR) screening.

An accessible and cost-effective technique is tested in India

Every third person in India suffers from diabetic retinopathy (DR). The Eye Clinic at Bonn University Hospital (in German: Augenklinik - Universitätsklinikum Bonn) in cooperation with the Sankara Eye Foundation in India has started a project to introduce a unique smartphone-based, telemedical diabetic retinopathy (DR) screening.

Diabetic retinopathy (DR) is the most common cause of blindness in people within the working-age worldwide. Millions of people in developing and emerging countries are at risk of impaired sight due to a lack of early diagnosis and treatment. "So far, however, there have been rather few examinations in developing and emerging countries to diagnose diabetic retinopathy," says Dr. Maximilian Wintergerst, a physician at the Eye Clinic of the University Hospital Bonn (in German: Augenklinik - Universitätsklinikum Bonn) and project manager in Germany. "An affordable and easy-to-use screening procedure for early detection would be very helpful in improving ophthalmic care," said Prof. Robert Finger, co-director of the project. The ophthalmologists in Bonn see a possible approach in smartphone-based funduscopy.

Using the smartphone's camera to look into the eye

Two years ago, they tested this highly practical and inexpensive method of back fundus mirroring in a pilot study together with the Sankara Eye Foundation in southern India. Together with the team from Sankara Eye Hospital in Bangalore, Wintergerst examined 200 patients with diabetes.

They took pictures of the back of their eyes with retrofitted smartphones. For this purpose, an adapter focuses the beam path of the camera and the light source in such a way that the mobile phones can be used as ophthalmoscopes. The result of the study was that with all four tested smartphone-based procedures, the eye fundus examination is possible. "We thus have an easily accessible and very cost-effective process," says Dr. Wintergerst.

The aim of the two-year funding is to establish telemedical DR screening in the poorer districts of Bangalore and the rural environment. The smartphone eye mirror is quickly and easily assembled so that trained, non-physician staff can take pictures of a retina away from a medical center.

Another saving effect is that ophthalmologists can directly evaluate the images sent from the smartphone to the hospital. This allows you to immediately report back whether patients have a DR and whether treatment is necessary.

Establishing eye screening by telemedicine in India

Recently, Dr. Wintergerst was in India for one week to make first preparations at the Sankara Eye Hospital in Bangalore together with Dr. Kaushik Murali and Dr. Mahesh Shanmugam, the local collaboration partners. He also started training 20 optometrists in smartphone-based funduscopy. "What is important to us is a sustainable transfer of knowledge so that telemedical screenings can be continued in the long term after the end of the project," says Dr. Wintergerst.

In addition, six ophthalmologists and employees of the Sankara Eye Hospital Bangalore will come to the Eye Clinic of the University Hospital Bonn. At the GRADE Reading Center Bonn, local experts for systematically standardized image analysis will introduce Indian colleagues to the special requirements of evaluating images of the eye fundus taken with a smartphone. They also impart know-how for the operation of a telemedical reading center. 

In the next two years, Dr. Wintergerst will travel to South India several times to supervise the training courses at the Sankara Eye Hospital and the screening camps. In the event that everything works well, he has a great vision together with the collaboration partners from India: "An expansion of the telemedical DR screening program to other hospitals of the Sankara Eye Foundation with the telemedical Reading Center established in Bangalore as the coordinating center. This could significantly improve ophthalmic care for many people with diabetes, especially in rural areas with poor medical infrastructure." He also sees the potential that this telemedical screening concept, if successful, could be transferred to other emerging and developing countries.