Diabetic retinopathy screening using digital non-mydriatic fundus photography and automated image analysis

Acta Ophthalmol Scand. 2004 Dec;82(6):666-72. doi: 10.1111/j.1600-0420.2004.00350.x.


Purpose: To investigate the use of automated image analysis for the detection of diabetic retinopathy (DR) in fundus photographs captured with and without pharmacological pupil dilation using a digital non-mydriatic camera.

Methods: A total of 83 patients (165 eyes) with type 1 or type 2 diabetes, representing the full spectrum of DR, were photographed with and without pharmacological pupil dilation using a digital non-mydriatic camera. Two sets of five overlapping, non-stereoscopic, 45-degree field images of each eye were obtained. All images were graded in a masked fashion by two readers according to ETDRS standards and disagreements were settled by an independent adjudicator. Automated detection of red lesions as well as image quality control was made: detection of a single red lesion or insufficient image quality was categorized as possible DR.

Results: At patient level, the automated red lesion detection and image quality control combined demonstrated a sensitivity of 89.9% and specificity of 85.7% in detecting DR when used on images captured without pupil dilation, and a sensitivity of 97.0% and specificity of 75.0% when used on images captured with pupil dilation. For moderate non-proliferative or more severe DR the sensitivity was 100% for images captured both with and without pupil dilation.

Conclusion: Our results demonstrate that the described automated image analysis system, which detects the presence or absence of DR, can be used as a first-step screening tool in DR screening with considerable effectiveness.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Area Under Curve
  • Diabetic Retinopathy / diagnosis*
  • Diagnostic Techniques, Ophthalmological*
  • False Positive Reactions
  • Fundus Oculi
  • Humans
  • Image Processing, Computer-Assisted / methods*
  • Mydriatics / administration & dosage
  • Photography / methods*
  • Pupil / drug effects
  • Reproducibility of Results
  • Sensitivity and Specificity


  • Mydriatics