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BMJ Open. 2019 Dec 8;9(12):e028811. doi: 10.1136/bmjopen-2018-028811.

Use of smartphones for detecting diabetic retinopathy: a protocol for a scoping review of diagnostic test accuracy studies.

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Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore.
Brighton and Sussex Medical School, Brighton, Brighton and Hove, UK.
Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.
Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore.
Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore



Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus and the leading cause of impaired vision in adults worldwide. Early detection and treatment for DR could improve patient outcomes. Traditional methods of detecting DR include the gold standard Early Treatment Diabetic Retinopathy Study seven standard fields fundus photography, ophthalmoscopy and slit-lamp biomicroscopy. These modalities can be expensive, difficult to access and require involvement of specialised healthcare professionals. With the development of mobile phone technology, there is a growing interest in their use for DR identification as this approach is potentially more affordable, accessible and easier to use. Smartphones can be employed in a variety of ways for ophthalmoscopy including the use of smartphone camera, various attachments and artificial intelligence for obtaining and grading of retinal images. The aim of this scoping review is to determine the diagnostic test accuracy of various smartphone ophthalmoscopy approaches for detecting DR in diabetic patients.


We will perform an electronic search of MEDLINE, Embase and Cochrane Library for literature published from 2000 onwards. Two reviewers will independently analyse studies for eligibility and assess study quality using the QUADAS-2 tool. Data for a 2⨉2 contingency table will be extracted. If possible, we will pool sensitivity and specificity data using the random-effects model and construct a summary receiver operating characteristic curve. In case of high heterogeneity, we will present the findings narratively. Subgroup analysis and sensitivity analysis will be performed where appropriate.


This scoping review aims to provide an overview of smartphone ophthalmoscopy in DR identification. It will present findings on the accuracy of smartphone ophthalmoscopy in detecting DR, identify gaps in the literature and provide recommendations for future research. This review does not require ethical approval as we will not collect primary data.


diabetic retinopathy; ophthalmology; telemedicine

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