Background: Most vision loss due to age-related or chronic conditions, such as diabetes, can be prevented if detected and treated in a timely manner [1]. Ocular screening using non-mydriatic retinal cameras is common in remote and rural Australia [2]. However, cost and portability barriers exist to widespread uptake.

Aim: To determine if retinal images obtained from two non-mydriatic low-cost ultra-portable retinal cameras are suitable for eye-care professionals to assess (a) ocular health including diabetic retinopathy, hypertensive retinopathy, severe glaucoma, cataracts, vascular occlusion and retinal thrombosis; and (b) retinal vessel calibres for vascular risk assessment.

Method: Images from 625 consecutive patients with and without diabetes were collected during routine care in a primary-care setting by optometrists [JJY and LB] experienced in retinal imaging with non-portable, non-mydriatic retinal cameras, such as the Diabetic Retinopathy Screening [DRS] camera [comparator]. Non-mydriatic, low-cost ultra-portable retinal imaging systems compared were the Optomed Smartscope Pro [3] and the Welchallyn iExaminer iPhone 4/4s-Keeler Panoptic ophthalmoscope combination [4].

Results: Both low-cost camera systems were useful for photo-documenting significant ocular conditions affecting the anterior eye [pterygia, allergies, trichiasis], ocular media [cataract] and optic nerve [suspect and diagnosed glaucoma]. The Smartscope was also useful for photo-documentation of identified conditions affecting the ocular fundus [sight-threatening diabetic retinopathy, age-related macular degeneration, toxoplasmosis, hypertensive retinopathy, retinal tears and branch vein occlusions]. However, neither system was capable of the image quality or imaging flexibility needed for reliable and accurate screening or diagnosis of diabetic retinopathy or for retinal vascular calibre measurements. The more expensive and less-portable DRS camera also offered a more convenient data management system and patient education and engagementopportunity.

Conclusion: Retinal images from ultra-portable, low-cost digital retinal cameras were not of comparable quality to that of retinal cameras currently used for retinopathy screening. However, the lower cost and portability of the Smartscope, with its reasonable photo-documentation capabilities, some [limited] diagnostic capability and optional otoscope and dermatoscope attachments, may be useful for health-professionals working: [a] in poorly-resourced settings, such as very remote Australia, or [b] with vulnerable and high-risk populations, such as the elderly or disabled in nursing homes or institutions.