The Tele-Screening Model for Diabetic Retinopathy: Evaluating the Influence of Mydriasis on the Gradability of a Single-Field 45° Digital Fundus Image
Abstract
The purpose of this article was to study the influence of pupillary dilatation on the gradability of a single-field 45 degrees digital fundus images taken in a telescreening model for diabetic retinopathy. Telescreening camps for diabetic retinopathy were organized in rural south India. Sixty-eight patients with type 2 diabetes were enrolled. Single-field 45 degrees digital fundus images were obtained before (group I) and after pupillary dilatation (group II). Digital fundus images were obtained using nonmydriatic fundus camera and transmitted in real time to the base hospital for grading by a retinal specialist. Various factors that could influence the gradability of images were studied, including patients' age and visual acuity, experience of the photographer, and interobserver variability. After pupillary dilatation, the nongradability of digital fundus images was reduced from 29.1% to 8.6%. With each line of improvement in Snellen's Visual acuity, the gradability improved by 12.1%; likewise, with each year of age, the gradability improved by 5.5% following mydriasis. Interobserver variation was excellent (k = 0.88). The learning curve of photographer had no effect on image gradability. Pupillary dilatation improves the gradability of a single-field 45 degrees digital fundus image during telescreening of diabetic retinopathy.
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Remote grading of retinal images was widely utilized, with 18 out of 30 studies relying on this approach.
“Remote grading of retinal images is widely utilized, with 18 out of 30 studies relying on this approach [10, 15, 16, 18, 21–27, 29–35, 37]”
From Diabetic retinopathy screening model in low and middle-income countries: a scoping review (2025) · cites this paper as [10]
Image acquisition was often performed by trained non-physician staff, while final grading was typically carried out by ophthalmologists or retinal specialists in 22 out of 30 studies.
“Image acquisition was often performed by trained non-physician staff (technicians, optometrists, nurses, paramedics), while final grading was typically carried out by ophthalmologists or retinal specialists (22/30 studies) [8–13, 15, 16, 18, 21, 22, 24, 26, 27, 30–37]”
From Diabetic retinopathy screening model in low and middle-income countries: a scoping review (2025) · cites this paper as [10]
Sight-threatening diabetic retinopathy is most commonly defined as severe non-proliferative DR, proliferative DR, or clinically significant macular edema.
“Sight-threatening diabetic retinopathy (STDR) is most commonly defined as severe non-proliferative DR (NPDR), proliferative DR (PDR), or clinically significant macular edema (CSME) [8, 10, 11, 13, 14, 21, 33]”
From Diabetic retinopathy screening model in low and middle-income countries: a scoping review (2025) · cites this paper as [10]
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Efficacy of a remote based computerised visual acuity measurement
Srinivasan, K., Ramesh, S. V., Babu, N., Sanker, N., Ray, A., & Karuna, S. M. (2012) · British Journal of Ophthalmology · doi:10.1136/bjophthalmol-2012-301751 · Cited by 25 · see citing works
Diabetic retinopathy screening model in low and middle-income countries: a scoping review
Lestari, Y. D., Sitompul, R., Widyahening, I. S., Tahapary, D. L., Yusuf, P. A., Sasongko, M. B., Riono, P., Nursakina, Y., & Alexandra, G. (2025) · BMC Public Health · doi:10.1186/s12889-025-25543-6 · Cited by 11 · see citing works
- Authors
- Raman, R., Rani, P. K., Mahajan, S., Paul, P., Gnanamoorthy, P., Krishna, M. S., & Sharma, T.
- Affiliations
- Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, Tamil Nadu, India.
- Venue
- Telemedicine and e-Health
- Publisher
- SAGE Publications
- Published
- 2007-10
- Volume
- 13
- Issue
- 5
- Pages
- 597-602
- ISSN
- 1530-5627 (ISSN-L)
- 1556-3669
- OpenAlex
- W2022027515
- Cited by
- 22
- References
- 0
- Citations by year
- 2025: 3 · 2024: 1 · 2022: 2 · 2021: 2 · 2020: 1 · 2018: 2 · 2017: 1 · 2016: 2 · 2015: 1 · 2012: 6
- FWCI
- 0.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Telemedicine Journal and e-Health (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Health Sciences › Medicine › Ophthalmology › Ophthalmology and Visual Health Research
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Keywords
- diabetic retinopathy, telescreening, pupil dilation, type 2 diabetes, interobserver variability, visual acuity
- MeSH terms
- Adult, Age Factors, Aged, Aged, 80 and over, Diabetes Mellitus, Type 2, Diabetic Retinopathy, Female, Fundus Oculi, Health Status Indicators, Humans, India, Male, Mass Screening, Middle Aged, Photography, Visual Acuity, Mydriasis, Models, Organizational
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