The feasibility of smartphone based retinal photography for diabetic retinopathy screening among Brazilian Xavante Indians

To evaluate the feasibility of smartphone based retinal photography for diabetic retinopathy (DR) screening among Brazilian Xavante Indians and the yield of retinal images.

A non-probabilistic cluster sample of 170 individuals with and without diabetes was enrolled for ocular examination with a portable retinal camera during DR screening at two Xavante Reservations. Due to operational conditions and to optimize the field work, only the larger Xavante villages were included. Images were obtained after pupil dilation; image analysis included assessment of quality, presence of media opacities and diabetic retinopathy grading whenever possible for individuals with diabetes.

A total of 157 individuals underwent the complete ocular imaging protocol, 95 with diabetes (60.5%). Among those with diabetes, 23 (24.2%) could not have DR graded because of media opacities. For those with gradable images, the frequency of DR was 22.2%; sight- threatening DR was present in 9.7%. The main causes for ungradable images were cataracts and asteroid hyalosis.

The presence of DR was higher than in previous studies, calling attention for its prevention in this vulnerable population. The screening model with a smartphone-based portable retinal camera is feasible and could increase screening coverage if associated with telemedicine.