Date of Award


Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Nicola L. Hawley


IMPORTANCE Novel methods of detecting eye disease are needed due to the challenges associated with service delivery in resource-limited settings.

BACKGROUND The objective of this study is to determine whether clinically gradable fundus images can be obtained using a low-cost, handheld non-mydriatic fundus camera by a non-ophthalmic provider in a remote setting.

DESIGN Cross-sectional study

PARTICIPANTS Two-hundred and six individuals (412 eyes) in the Pacific Island nation of Samoa with pre-diabetes and diabetes (HbA1c ≥5.7% or FBG ≥110 mg/dl).

METHODS Participants underwent non-mydriatic fundus photography with the PanOptic iExaminer System, along with an assessment of near vision, medical, and ophthalmic histories. Images were remotely graded by an ophthalmologist and optometrist, who were blinded to participants’ demographic and biometric data.

MAIN OUTCOME MEASURES The percentage of clinically gradable images, positive findings, and degree of inter-rater reliability and agreeability among graders were measured.

RESULTS Clinically gradable images were obtained from 337 eyes (81.8%). Positive findings were identified in 29.1% of participants: 7 participants (3.4%) had non-proliferative diabetic retinopathy, 19 participants (9.2%) had evidence of background retinopathy, 33 participants (16.0%) had features of glaucoma, and 10 participants (4.9%) had other lesions, tumors, or structural abnormalities. Those with positive findings were referred for expedited review by a local ophthalmologist.

CONCLUSION AND RELEVANCE Positive ophthalmic findings, including features of diabetic retinopathy and glaucoma, were readily identified in individuals at risk for undiagnosed eye disease screened with the PanOptic iExaminer. Use of smartphone-based remote screening holds promise as a cost-effective public health intervention in resource-constrained settings.

Open Access

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