In some parts of India, around one in ten people is diabetic. Damage to the retina due to diabetes is now considered the most common cause of blindness in working-age adults. This makes early detection of so-called diabetic retinopathy (DR) all the more important.
But for diabetics living in rural India or in poorer areas of the cities, there is a lack of adequate ophthalmological care. Therefore, the Eye Clinic at the University Hospital Bonn (UKB) has launched a low-cost smartphone-based telemedicine DR screening programme together with the Sankara Eye Foundation in India.
Smartphone-based, telemedical DR-Screening Programme in India: Trained ophthalmic assistants use an adapted smartphone for retinal imaging.
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To continue the collaboration, the project partners have now received funding over 50,000 euros from the German Federal Ministry for Economic Cooperation and Development (BMZ) and the Else Kröner-Fresenius Foundation. In addition, Novartis is supporting the project with a further 50,000 euros as part of the eXcellence in Ophthalmology and Vision Awards (XOVA).
Millions of people in low- and middle-income countries are at risk of vision loss or even blindness due to DR because there is a lack of ophthalmological care. "However, if such retinopathy is detected and treated in time, vision loss can often be prevented," emphasizes Dr. Maximilian Wintergerst, doctor at the University Eye Hospital Bonn and project leader in Germany. "We therefore wanted to remedy the situation and introduce retinal screening of diabetics in poorer areas." Prof. Dr. Robert Finger, co-leader of the project, adds: "An affordable and easy-to-perform screening procedure for early detection is very helpful to improve ophthalmological care." "Our endeavour at Sankara Eye Foundation India has been to ensure world class eye care with a social impact. We realise that technology can bridge the lack of access to millions needing care for diabetic eye disease", shared Dr. Mahesh P Shanmugam, Head Vitreoretina & Ocular Oncology Sankara Eye Foundation India.
The UKB ophthalmologists first tested a smartphone-based examination of the back of the eye about four years ago as part of a pilot study together with the Sankara Eye Foundation in southern India. There, Wintergerst with the team from the Sankara Eye Hospital in Bangalore examined 200 patients with diabetes. "We used the camera of the smartphone to look into the eye," Wintergerst explains. To do this, they took pictures of the background of the eye with adapted smartphones. An adapter focuses the beam path of the camera and the illumination source so that the mobile phones can be used as ophthalmoscopes.
The easily accessible and very inexpensive procedure was then also the basis for establishing telemedical DR screening in the poorer districts of Bangalore and the surrounding rural areas. This is because the smartphone eye mirror is quick and easy to assemble, allowing trained, non-medical staff to take images of the retina far away from a medical centre. A further savings effect arises from the fact that an ophthalmologist can directly evaluate the images sent to him by the smartphone via the Internet. This way, it is reported back immediately or after a short waiting time whether the patient has DR and whether treatment is necessary.
Wintergerst has already been to India several times to establish the smartphone-based tele-ophthalmology unit at the Sankara Eye Hospital in Bangalore together with the local collaboration partners. "It is important for us to have a sustainable knowledge transfer so that the telemedical screenings can be continued in the long term," says Wintergerst. To this end, he trained ophthalmic assistants in digital retinal imaging with the smartphone and ophthalmologists in the standardized and systematic classification of DR on retinal images
In addition, Wintergerst and colleagues at the Sankara Eye Hospital, in collaboration with local computer scientists in Bangalore, developed a stand-alone app that enables an even more efficient smartphone-based telemedical DR screening.
The collaboration has now come a step closer to its vision of expanding the telemedical DR screening program with the telemedical reading centre established at Sankara Eye Hospital Bangalore as the coordinating centre to as many hospitals of the Sankara Eye Foundation as possible. Towards this, the project is now being extended to a total of 24 Vision Centres of the Sankara Eye Foundation spread all over India. In addition, the scientists in Bonn and Bangalore, in collaboration with computer scientists, have developed deep learning algorithms to automatically analyze smartphone-based images for DR and plan to integrate them into their app in the future. "This can improve eye care for many people with diabetes, especially in rural areas with poor medical infrastructure", adds Prof. Dr. Frank Holz, director of the University Eye Hospital, Bonn. "There is also the potential for this telemedicine screening concept to be transferred to other low-and middle-income countries."