University of Oulu

Kubin, A.-M., Wirkkala, J., Keskitalo, A., Ohtonen, P. and Hautala, N. (2021), Handheld fundus camera performance, image quality and outcomes of diabetic retinopathy grading in a pilot screening study. Acta Ophthalmol, 99: e1415-e1420.

Handheld fundus camera performance, image quality and outcomes of diabetic retinopathy grading in a pilot screening study

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Author: Kubin, Anna-Maria1,2,3; Wirkkala, Joonas1,2,3; Keskitalo, Antti2,3;
Organizations: 1Department of Ophthalmology, PEDEGO Research Unit and Medical Research Center, Oulu University, Oulu, Finland
2Oulu University Hospital, Oulu, Finland
3Division of Operative Care, Oulu University Hospital, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
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Language: English
Published: John Wiley & Sons, 2021
Publish Date: 2021-12-08


Purpose: To compare the performance and image quality of the handheld fundus camera to standard table-top fundus cameras in diabetic retinopathy (DR) screening. The reliability and diagnostic accuracy of DR grading performed by an ophthalmologist and a photographer reader were evaluated.

Materials and methods: 157 patients with diabetes, attending screening or follow-up of DR, were evaluated by fundus photographs taken in mydriasis by Optomed Aurora and Canon or Zeiss Visucam fundus cameras. The image quality and the severity of DR were evaluated independently by an ophthalmologist and experienced photographer. The sensitivity, specificity and reliability of the assessments were determined.

Results: 1884 fundus images from 314 eyes were analysed. In 53% of all eyes, DR was not present. 10% had mild non-proliferative diabetic retinopathy (NPDR), 16% moderate NPDR, 6% severe NPDR and 16% proliferative diabetic retinopathy (PDR). The DR grading outcomes by Aurora highly equalled to those of Canon or Zeiss (κ = 0.93, 95% CI 0.91 to 0.94), and there was almost perfect agreement in grading between the ophthalmologist and photographer (κ = 0.96, 95% CI 0.95 to 0.97). The image quality of Aurora was sufficient for reliable assessment according to both graders in 84-88% of the cases.

Conclusion: The Optomed Aurora fundus camera seems appropriate for DR screening. The sufficient image quality and high diagnostic accuracy for DR grading are supportive for a less expensive and easily transportable screening system for DR. Immediate image grading carried out by a photographer would further improve and speed up the screening process in all settings.

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Series: Acta ophthalmologica
ISSN: 1755-375X
ISSN-E: 1755-3776
ISSN-L: 1755-375X
Volume: 99
Issue: 8
Pages: E1415 - E1420
DOI: 10.1111/aos.14850
Type of Publication: A1 Journal article – refereed
Field of Science: 3125 Otorhinolaryngology, ophthalmology
Copyright information: © 2021 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.