Artificial intelligence-enabled screening for diabetic retinopathy: a real-world, multicenter and prospective study

作者：Yifei Zhang, Juan Shi, Ying Peng, Zhiyun Zhao, Qidong Zheng, Zilong Wang, Kun Liu, Shengyin Jiao, Kexin Qiu, Ziheng Zhou, Yan Li, Dong Zhao, Hongwei� Jiang, Yuancheng Dai, Benli Su, Pei Gu, Heng Su, Qin Wan, Yongde Peng, Jianjun Liu, Ling Hu, Tingyu Ke, Lei Chen, Fengmei Xu, Qijuan Dong, Demetri Terzopoulos, Guang Ning, Xun Xu, Xiaowei Ding, Weiqing Wang · 发表于：BMJ Open Diabetes Research & Care · 年份：2020 · DOI：10.1136/bmjdrc-2020-001596 · 被引用次数：110 · 研究领域：Retinal Imaging and Analysis、Retinal Diseases and Treatments、Retinal and Optic Conditions

INTRODUCTION: Early screening for diabetic retinopathy (DR) with an efficient and scalable method is highly needed to reduce blindness, due to the growing epidemic of diabetes. The aim of the study was to validate an artificial intelligence-enabled DR screening and to investigate the prevalence of DR in adult patients with diabetes in China. RESEARCH DESIGN AND METHODS: The study was prospectively conducted at 155 diabetes centers in China. A non-mydriatic, macula-centered fundus photograph per eye was collected and graded through a deep learning (DL)-based, five-stage DR classification. Images from a randomly selected one-third of participants were used for the DL algorithm validation. RESULTS: In total, 47 269 patients (mean (SD) age, 54.29 (11.60) years) were enrolled. 15 805 randomly selected participants were reviewed by a panel of specialists for DL algorithm validation. The DR grading algorithms had a 83.3% (95% CI: 81.9% to 84.6%) sensitivity and a 92.5% (95% CI: 92.1% to 92.9%) specificity to detect referable DR. The five-stage DR classification performance (concordance: 83.0%) is comparable to the interobserver variability of specialists (concordance: 84.3%). The estimated prevalence in patients with diabetes detected by DL algorithm for any DR, referable DR and vision-threatening DR were 28.8% (95% CI: 28.4% to 29.3%), 24.4% (95% CI: 24.0% to 24.8%) and 10.8% (95% CI: 10.5% to 11.1%), respectively. The prevalence was higher in female, elderly, longer diabetes durat...