AI system screens for referrable DM-associated retinopathy

  • Natarajan S & al.
  • JAMA Ophthalmol
  • 8 Aug 2019

  • International Clinical Digest
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  • An offline artificial intelligence (AI) algorithm can detect referable diabetic retinopathy ([R]DR) images taken from a smartphone-based portable camera.

Why this matters

  • Current ophthalmology-based screening methods are costly and time-consuming and require training.

Study design

  • Prospective study of the Medios AI (Remidio) automated system.
  • System analyzes retinal images (3 fundus fields) taken with a smartphone-based nonmydriatic retinal camera.
  • A minimally trained health care worker imaged 213 patients with diabetes mellitus (DM) at clinics in Mumbai, India.
  • RDR: retinopathy more severe than mild DR, with/without macular edema.
  • Results compared with direct ophthalmologist grading.
  • Funding: Medios Technologies provided the AI software.

Key results

  • Of 187 patients diagnosed as not having RDR by ophthalmologists, AI correctly diagnosed 92%.  
  • Of 15 with ophthalmologist-diagnosed RDR, AI correctly diagnosed 100%.
  • Of 12 with ophthalmologist-diagnosed mild nonproliferative DR, AI diagnosed 67%.
  • AI sensitivity and specificity (95% CIs) were, respectively:
    • RDR: 100% (78.2%-100%) and 88.4% (83.16%-92.53%); and 
    • Any DR: 85.2% (66.3%-95.8%) and 92.0% (87.1%-95.4%).


  • Small sample size.
  • Current AI version does not allow grading according to International Clinical DR severity scale or National Health Service classification.
  • Ungradable images resulting from cataracts and small pupil size necessitated dilated retinal photography screening.
  • Local setting, generalizability uncertain.  

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