Revolutionizing Diabetic Retinopathy Screening: Integrating AI-Based Retinal Imaging in Primary Care

Diabetic retinopathy (DR) is a public health issue affecting millions in the United States and Europe. However, despite strong recommendations for screening at regular intervals by many professional societies, including the American Diabetes Association and the American Academy of Ophthalmology, screening rates remain suboptimal, with only 50-70% of patients with diabetes adhering to recommended annual eye exams. Barriers to screening include lack of awareness, socioeconomic factors, health care system fragmentation, and workforce shortages, among others. Artificial intelligence (AI)-based retinal screening tools offer promising solutions to improve DR detection in primary care settings. We describe a quality improvement and continuing medical education programme, starting in 2020, which has so far deployed 198 AI-equipped cameras in 5 health systems, covering approximately 151,000 patients with diabetes. To date, over 20,000 screenings were completed, with more than mild DR detected in more than 3,450 people, leading to specialist referrals for follow-up care. Notably, negative screenings potentially represent deferred specialist care. While AI adoption in healthcare presents challenges, its potential benefits in improving patient care and optimising resources are significant. Integrating AI-based DR screening with a comprehensive education and process improvement initiative in primary care practices warrants serious consideration, promising to enhance patient outcomes.