SMARTPHONE-BASED eye imaging could enable community health workers to screen people for cataracts in remote and underserved areas, according to research presented at the 44th Congress of the European Society of Cataract and Refractive Surgeons (ESCRS).
Remote ophthalmologists reviewing smartphone images agreed with in-person clinicians on hospital referral decisions in 96% of cases, suggesting the technology could support wider access to eye screening.
Researchers developed a portable imaging attachment that clips onto an Android smartphone.
The device incorporates a magnifying lens, two white LEDs, and a silicone scope designed to maintain a consistent distance from the eye and block ambient light.
Costing less than £150 including the smartphone, the system is paired with a mobile telemedicine app capable of operating in low-bandwidth environments.
Community health workers received three hours of training before using the system to screen 1,093 patients attending 19 rural eye camps near Pondicherry, India.
Images were assessed remotely by ophthalmologists, whose diagnoses and referral decisions were compared with those made by ophthalmologists examining patients in person at the camps.
Remote and in-person ophthalmologists agreed on whether patients required hospital referral in 96% of cases. Agreement was also high for several individual diagnoses.
Clinicians agreed on the presence of any cataract in 89% of cases, mature cataract in 96%, immature cataract in 85%, a clear crystalline lens in 89%, and pseudophakia in 97%.
Community health workers were able to screen each eye in less than 2.5 minutes, with diagnostic agreement improving as image quality increased.
The researchers suggest the system could enable trained community workers to capture images locally while ophthalmologists provide diagnostic expertise remotely.
Such an approach could be particularly valuable in rural areas where travelling to an ophthalmologist is difficult and specialist availability is limited.
However, the technology should not be considered a replacement for comprehensive ophthalmological examination.
The study did not compare remote assessment directly with a masked gold-standard slit-lamp examination, and performance was weaker for some non-lens conditions. Images were also sometimes captured before pupil dilation while in-person examinations occurred afterwards.
Researchers plan to investigate additional imaging capabilities, including slit-beam and blue-light imaging, alongside artificial intelligence-assisted cataract grading.
Further studies in other geographical and cultural settings will also be required to establish whether the findings can be generalised beyond rural South India.
Reference
Ravilla PK et al. Decentralizing cataract screening: validation of a novel smartphone-based anterior segment imaging system for remote diagnosis of anterior segment eye disease. Presented at: 44th Congress of the European Society of Cataract and Refractive Surgeons; 13 September 2026.
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