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

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


Purpose: 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).

Design: Clinical-based, prospective, comparative instrument study.

Methods: 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.

Results: 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.

Conclusion: 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.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Cell Phone / instrumentation*
  • Diabetes Complications
  • Diabetic Retinopathy / classification*
  • Female
  • Humans
  • Macular Edema / diagnosis
  • Male
  • Middle Aged
  • Mydriatics / administration & dosage
  • Ophthalmoscopy / methods*
  • Phenylephrine / administration & dosage
  • Prospective Studies
  • Pupil / drug effects
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Slit Lamp*
  • Tropicamide / administration & dosage


  • Mydriatics
  • Phenylephrine
  • Tropicamide