Smartphones Provide Cost-Effective Telemedical Eye Screening in India

The Eye Clinic at the University Hospital Bonn and the Sankara Eye Foundation in India are collaborating to introduce smartphone-based telemedical diabetic retinopathy (DR) screening for people with diabetes living in rural India or in poorer areas of the cities.

Ophthalmologists in Bonn first tested smartphone-based funduscopy in a pilot study with the Sankara Eye Foundation in southern India in 2017, examining 200 patients with diabetes and taking pictures of the patients’ eyegrounds with retrofitted smartphones. The phones were retrofitted for funduscopy by using an adapter to focus the beam path of the camera and the light source in such a way that the mobile phone could be used as an ophthalmoscope. Results of the study showed that ocular fundus examination was possible with four tested smartphone-based procedures.

The smartphone ophthalmoscope can be quickly and easily assembled so that trained, nonphysician staff members can take pictures of a retina even when they are not in a medical center. An ophthalmologist can directly evaluate the images sent from the smartphone to the hospital via the internet and immediately report back whether the patient has DR and treatment is necessary.

At Sankara Eye Hospital in Bangalore, Dr. Maximilian Wintergerst trains medical assistants in smartphone-based funduscopy. Courtesy of Augenklinik/UK Bonn.

Dr. Maximilian Wintergerst, physician at the Eye Clinic of the University Hospital Bonn and director of the project in Germany, said, “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 [two-year] project.” Six ophthalmologists and employees of the Sankara Eye Hospital Bangalore will travel to the Eye Clinic in Bonn, where they will learn how to evaluate images of the fundus taken with a smartphone and how a telemedical reading center operates.

Wintergerst will travel to South India several times over the next two years to supervise the training at the Sankara Eye Hospital and the screening camps. He hopes to see the telemedical DR screening program extended to other hospitals, with the telemedical reading center established in Bangalore as the coordinating center. He believes that this telemedical screening concept, if successful, could be transferred to other emerging and developing countries.