Observational studyActa ophthalmologica2026
Customizing AI-based screening with real-world data: Practical insights from diabetic retinopathy.
Observational study in Acta ophthalmologica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed.
- Rerouting Eye Care: How AI and Telemedicine Are Reshaping Ophthalmology Patient Journeys in the United Kingdom and Germany.Journal of medical Internet research · 2026Article
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Authors and funding
18 authors.
Funding
Abstract
purposeDiabetic retinopathy (DR) is a leading cause of vision loss in middle-aged adults globally. Although artificial intelligence (AI)-based screening tools like IDx-DR (classification) and Thirona RetCAD (regression) have shown high sensitivity in controlled settings, real-world screening faces challenges due to missing or low-quality images and inadequate adaptation to local healthcare needs. The objective was to compare the performance of two AI-based DR screening algorithms (IDx-DR and RetCAD) that analyse non-mydriatic images, against ophthalmologists' mydriatic fundoscopy with image analysis and the impact of customized referral threshold modification ('Greifswald modification') on screening outcomes.
methodsThis one-centre observational study included 1716 patients with diabetes mellitus (Clinical Trials Register: DRKS00035967). Sensitivity, specificity, the proportion of ungradable images and the reduction in ophthalmologic evaluations were assessed. Customized referral threshold modification was conducted using the Youden Index.
resultsIn 98 patients (5.7%), no images could be acquired, and 35 patients (2.1%) had incomplete image sets for IDx-DR. IDx-DR rejected 438 patients (25.5%) due to image quality, while RetCAD flagged 134 eyes from 120 patients (6.9%) but provided output for all. Among analysable images, sensitivities ranged from 70.4% (RetCAD) to 93.6% (RetCAD with Greifswald modification). Including all patients reduced sensitivity from 52.7% (IDx-DR) to 79.9% (RetCAD with Greifswald modification). AI screening reduced ophthalmologic exam needs by 47.5% to 78.5%.
conclusionsReal-world DR screening performance of AI algorithms, when including non-analysable patients, can be substantially lower than in controlled studies. The use of regression algorithms enabled the customization of referral thresholds, improving screening accuracy and reducing the clinical burden.
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