Send to

Choose Destination
Am J Ophthalmol. 2015 Feb;159(2):360-4.e1. doi: 10.1016/j.ajo.2014.11.008. Epub 2014 Nov 7.

Comparison of smartphone ophthalmoscopy with slit-lamp biomicroscopy for grading diabetic retinopathy.

Author information

Eye Clinic, Department of Neurological and Vision Sciences, University of Brescia, Brescia, Italy. Electronic address:
Eye Clinic, Department of Neurological and Vision Sciences, University of Brescia, Brescia, Italy.
Eye Clinic, Department of Health Sciences, University of Molise, Campobasso, Italy.



To assess the accuracy and reliability of smartphone ophthalmoscopy, we compared the ability of a smartphone ophthalmoscope with that of a slit-lamp biomicroscope to grade diabetic retinopathy (DR) in patients with diabetes mellitus (DM).


Clinical-based, prospective, comparative instrument study.


This comparative clinical study was performed in 120 outpatients (240 eyes) with type 1 or type 2 DM. After pupil dilation, the patients underwent smartphone ophthalmoscopy with the D-Eye device, followed by dilated retinal slit-lamp examination, to grade DR according to a 5-step scale.


Overall exact agreement between the 2 methods was observed in 204 of 240 eyes (85%) (simple κ = 0.78; CI 0.71-0.84) and agreement within 1 step was observed in 232 eyes (96.7%). Compared to biomicroscopy, the sensitivity and specificity of smartphone ophthalmoscopy for the detection of clinically significant macular edema were 81% and 98%, respectively. Smartphone ophthalmoscopy and biomicroscopy could not be used to examine the fundus and grade DR in 9 eyes (3.75%) and 4 eyes (1.7%), respectively, because of cataract and/or small pupil diameter.


Smartphone ophthalmoscopy showed considerable agreement with dilated retinal biomicroscopy for the grading of DR. The portability, affordability, and connectivity of a smartphone ophthalmoscope make smartphone ophthalmoscopy a promising technique for community screening programs.

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center