Accuracy of Autonomous Artificial Intelligence-Based Diabetic Retinopathy Screening in Real-Life Clinical Practice

Background: In diabetic retinopathy, early detection and intervention are crucial in preventing vision loss and improving patient outcomes. In the era of artificial intelligence (AI) and machine learning, new promising diagnostic tools have emerged. The IDX-DR machine (Digital Diagnostics, Coralville, IA, USA) represents a diagnostic tool that combines advanced imaging techniques, AI algorithms, and deep learning methodologies to identify and classify diabetic retinopathy. Methods: All patients that participated in our AI-based DR screening were considered for this study. For this study, all retinal images were additionally reviewed retrospectively by two experienced retinal specialists. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for the IDX-DR machine compared to the graders' responses. Results: We included a total of 2282 images from 1141 patients who were screened between January 2021 and January 2023 at the Jules Gonin Eye Hospital in Lausanne, Switzerland. Sensitivity was calculated to be 100% for 'no DR', 'mild DR', and 'moderate DR'. Specificity for no DR', 'mild DR', 'moderate DR', and 'severe DR' was calculated to be, respectively, 78.4%, 81.2%, 93.4%, and 97.6%. PPV was calculated to be, respectively, 36.7%, 24.6%, 1.4%, and 0%. NPV was calculated to be 100% for each category. Accuracy was calculated to be higher than 80% for 'no DR', 'mild DR', and 'moderate DR'. Conclusions: In this study, based in Jules Gonin Eye Hospital in Lausanne, we compared the autonomous diagnostic AI system of the IDX-DR machine detecting diabetic retinopathy to human gradings established by two experienced retinal specialists. Our results showed that the ID-x DR machine constantly overestimates the DR stages, thus permitting the clinicians to fully trust negative results delivered by the screening software. Nevertheless, all fundus images classified as 'mild DR' or greater should always be controlled by a specialist in order to assert whether the predicted stage is truly present.