The availability of portable hand-held non-nonmydriatic fundus cameras (which can capture retinal images without the need to apply medication to enlarge the pupils) is another advancement that may improve the uptake of screening, particularly in primary care setting. Non-nonmydriatic imaging is quick and causes less discomfort and therefore may be more readily accepted by the patients and more convenient to the health care provider. Several studies, conducted in high-resource countries, have reported that non-mydriatic cameras provide an effective and cost-effective approach for DR screening. [26, 27]
Another emerging technology is the use of smartphones for screening of DR. Smartphones are an attractive option for the capture, interpretation and transmission of retinal images due to their widespread accessibility, portability and relatively low cost. [25, 28] Preliminary studies evaluating the use of smartphone technology for DR screening have shown encouraging results, but further work is needed to improve image quality and validate their use by non-ophthalmology personnel.
The use of automated grading software to evaluate digital retinal photographs is another approach that may help reduce the costs of DR screening, by removing the requirement for manual (human) grading by specialist readers. A pilot study conducted in Scotland that evaluated an automated system designed to assess image quality, and detect the presence of quality, showed that automated grading displayed similar effectiveness to manual grading, but was less costly.  The use of automated grading systems for the assessment and detection of DR has since been evaluated in several other countries, and is likely to play a major role in DR screening in the future.[31, 32]