Smartphone-based fundus photography for screening of plus-disease retinopathy of prematurity

  • Tapan P. Patel
  • Michael T. Aaberg
  • Yannis M. Paulus
  • Philip Lieu
  • Vaidehi S. Dedania
  • Cynthia X. Qian
  • Cagri G. Besirli
  • Todd Margolis
  • Daniel A. Fletcher
  • Tyson N. KimEmail author



Inadequate screening of treatment-warranted retinopathy of prematurity (ROP) can lead to devastating visual outcomes. Especially in resource-poor communities, the use of an affordable, portable, and easy to use smartphone-based non-contact fundus photography device may prove useful for screening for high-risk ROP. This study evaluates the feasibility of screening for high-risk ROP using a novel smartphone-based fundus photography device, RetinaScope.


Retinal images were obtained using RetinaScope on a cohort of prematurely born infants during routine examinations for ROP. Images were reviewed by two masked graders who determined the image quality, the presence or absence of plus disease, and whether there was retinopathy that met predefined criteria for referral. The agreement between image-based assessments was compared to the gold standard indirect ophthalmoscopic assessment.


Fifty-four eyes of 27 infants were included. A wide-field fundus photograph was obtained using RetinaScope. Image quality was acceptable or excellent in 98% and 95% of cases. There was substantial agreement between the gold standard and photographic assessment of presence or absence of plus disease (Cohen’s κ = 0.85). Intergrader agreement on the presence of any retinopathy in photographs was also high (κ = 0.92).


RetinaScope can capture digital retinal photographs of prematurely born infants with good image quality for grading of plus disease.


Retinopathy of prematurity Telemedicine Fundus photography Smartphone Plus disease 



We thank Sparrow Hospital (Lansing, MI) for participating in this study and allowing the authors to recruit patients.

Financial support

This work was supported by the Knights Templar Eye Foundation Career-Starter Research Grant (TPP, TNK, YMP), 1K08EY027458 (YMP), the University of Michigan Translational Research and Commercialization for Life Sciences (TNK, YMP), the University of Michigan Center for Entrepreneurship Dean’s Engineering Translational Prototype Research Fund (TNK, YMP), the QB3 Bridging the Gap Award from the Rogers Family Foundation (DAF), the Bakar Fellows Award (DAF), the Chan-Zuckerberg Biohub Investigator award (DAF), the National Eye Institute grant 4K12EY022299 (YMP), the University of Michigan Department of Ophthalmology and Visual Sciences, and unrestricted departmental support from Research to Prevent Blindness. The funding agency was not involved in the study design, collection, analysis, interpretation of data, or writing of the text.

Compliance with ethical standards

This study was approved by the Institutional Review Board at the University of Michigan and Sparrow Hospital, Michigan State University. All research was conducted in compliance with human subjects regulations and adhered to the tenets of the Declaration of Helsinki. This study was registered on, identifier NCT03076697.

Conflict of interest

DAF is a co-founder of CellScope, Inc., a company commercializing a cellphone-based otoscope, and holds shares in CellScope, Inc. DAF and TNK are inventors on US patents and related applications pertaining to a “Retinal CellScope Apparatus.”


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Tapan P. Patel
    • 1
  • Michael T. Aaberg
    • 1
  • Yannis M. Paulus
    • 1
    • 2
  • Philip Lieu
    • 1
  • Vaidehi S. Dedania
    • 3
  • Cynthia X. Qian
    • 4
  • Cagri G. Besirli
    • 1
  • Todd Margolis
    • 5
  • Daniel A. Fletcher
    • 6
    • 7
  • Tyson N. Kim
    • 1
    • 8
    Email author
  1. 1.Department of Ophthalmology and Visual Sciences, Kellogg Eye CenterUniversity of MichiganAnn ArborUSA
  2. 2.Department of Biomedical EngineeringUniversity of MichiganAnn ArborUSA
  3. 3.Department of OphthalmologyNew York University School of MedicineNew YorkUSA
  4. 4.Department of OphthalmologyUniversity of MontrealMontrealCanada
  5. 5.Department of Ophthalmology and Visual SciencesWashington University School of Medicine in St. LouisSt. LouisUSA
  6. 6.Department of Bioengineering and Biophysics ProgramUniversity of CaliforniaBerkeleyUSA
  7. 7.Chan-Zuckerberg BiohubSan FranciscoUSA
  8. 8.Department of OphthalmologyUniversity of California, San FranciscoSan FranciscoUSA

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