Grading Vertical Cup-to-Disc Ratio Using The Smartphone Based D-EYE Retinal Imaging System in Comparison to Slit Lamp Bio-Microscopy

Visual loss from Glaucoma is caused by gradual deterioration of the optic nerve leading to the progressive loss of the field of vision. Millions of people around the globe suffer from Glaucoma and go blind. Startling, it is also the leading cause for preventable blindness. Most people who go blind have no reason to believe they are going blind until the later stages of the disease. Often, we here from senior adults; “I just thought I was getting old and my eyesight was failing”. Unlike most eye diseases, most types of Glaucoma are chronic lifelong disorders that can be managed if diagnosed and treated in early progressive stages of the disease.

What is lacking is a regimented foundation for continuous eye examinations. The D-EYE Retinal Imaging System brings a simple and quick exam process that can be recorded, shared for consultation and saved to a comparative patient record over time.

In order to bring consideration for the use of D-EYE to screen and monitor Glaucoma, Founder and inventor of the D-EYE retinal imaging lens, Dr. Andrea Russo and colleagues from several institutions in Italy conducted a study of 110 patients comparing gold standard slit-lamp bio-microscopy and the D-EYE smartphone based system in 2016.

The study was published in the Wolters Kluwer Health Journal of Glaucoma in September of 2016. The published study can be found here:

Grading Vertical Cup-to-Disc Ratio Using The Smartphone Based D-EYE Retinal Imaging System

The purpose of the study was to determine the agreement between smartphone ophthalmoscopy and slit-lamp indirect bio microscopy when assessing vertical cup-to-disc ratios (VCDRs).

The format was a prospective, comparative instrument study performed in 110 patients with ocular hypertension (OH) or primary open angle glaucoma (POAG). Patients underwent estimation of VCDR by undilated smartphone ophthalmoscopy and slit-lamp bio-microscopy by 2 masked glaucoma specialists.

The differences between the mean VCDR estimations obtained by each technique were not statistically significant. Overall exact agreement between the 2 modalities was found in 21 of 29 eyes (72.4%; simple ╬║=0.63, confidence interval, 0.52-0.73, P<0.001) in POAG patients and in 52 of 78 eyes (66.7%) in OH patients. The optic nerve head was not gradable with smartphone ophthalmoscopy in 1 eye with POAG and in 2 eyes with OH because of media opacities and/or small pupil diameter.

The results showed smartphone ophthalmoscopy performed  substantial agreement with slit-lamp examination for the estimation of vertical cup-to-disc ratio (VCDR). The ubiquitous diffusion of the smartphones, together with their connectivity and portability features, enables an extensive benefit for this technology to be used in glaucoma screening, especially in low-resource settings.

We invite researchers and practitioners to contact the team at D-EYE about the above results and possible further studies on the use of D-EYE in the field. With over 60 million people affected by Glaucoma worldwide, many in rural areas, remote screening performed by trained health professionals and transmitted for further assessment by experienced readers can make a significant difference in people’s lives.

D-EYE can also be used to screen for mid-to -later stage Diabetic Retinopathy, hypertensive and other significant pathologies.

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FIGURE 1. Representative retinal images of ONH taken with smartphone ophthalmoscopy. A, ONH of a 43-year-old woman graded as 0.6. B, ONH of a 29-year-old man graded as 0.1. C, ONH of a 54-year-old woman graded as 0.6. D, ONH of a 74-year-old man graded as 0.8. E, Depiction of the D-Eye adapter attached to the smartphone used in the study. ONH indicates optic nerve head.

FIGURE 2. Cross-polarization inside the D-EYE adapter increased nerve fiber layer definition (A) and wedge-shaped defects (B). White arrows indicate the nerve fiber layer visualization

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