Performance Evaluation of Artificial Intelligence Assisted Diabetic Retinopathy Grading in the Leuven University Hospital: Can Technology Improve the Resident?

Diabetes mellitus is one of the major health challenges of our era. It is estimated that 642 million people will be diagnosed with this disease worldwide by 2040. Diabetes is a disease effecting the entire body and comes with many possible complications due to its' effect on the microvasculature. The most prevalent of these complications is diabetic retinopathy which is caused by both microvascular and neural damage.

According to studies in the United States by the Eye Diseases Prevalence Research group, about 40% of patients present with some degree of retinopathy. 8% of patients even have vision-threatening diabetic retinopathy.

Diabetic retinopathy is one of the main causes of blindness in our current society. However annual screening and timely referral for treatment can prevent this from occurring. The best illustration is the fact that since the implementation of a nationwide screening program, diabetes mellitus is no longer the leading cause of blindness in the UK.

Therefore, many countries have organized some sort of screening program. However, there are big organizational differences between countries. This can range from an annual dilated fundoscopy by an ophthalmologist (as is the case in Belgium) to non-mydriatic fundus photographs evaluated by a trained grader who is not a (para)medic.

Even with the most efficient screening pathway possible, the increase of patient numbers will become a problem since the human factor in the screening pathway (doctor, optometrist, trained grader,...) cannot increase its' capacity with the same speed. The current system will reach its limits at one point or another. Furthermore, it is known that a significant proportion of diabetes patients do not comply with the recommended annual screening. These problems will result in longer waiting lists, underdiagnosis because of overworked doctors, long waiting lists and possibly lack of high quality care.