Artificial intelligence-supported diabetic retinopathy screening in Tanzania: a randomised controlled trial.

Published in The Lancet. Global health. Abstract: Non-attendance after referral from screening is one of the major challenges for diabetic retinopathy screening programmes in Africa. Artificial intelligence (AI) systems for the identification of diabetic retinopathy can provide point-of-screening results and therefore enable immediate counselling. We aimed to investigate whether AI-supported diabetic retinopathy screening, with a point-of-screening result and face-to-face counselling, increased the proportion of people with true referable diabetic retinopathy who attended the central ophthalmology referral clinic when compared with standard diabetic retinopathy screening with deferred human grading and telephone counselling. This two-arm, parallel-group, individually randomised controlled trial was conducted at non-communicable disease or diabetic clinics in 24 hospitals in the Kilimanjaro and Arusha regions of Tanzania. Eligible participants (aged ≥18 years) had diabetes and attended diabetic retinopathy screening. Participants were randomly assigned (1:1) to receive either AI-supported diabetic retinopathy screening with a point-of-screening result and face-to-face counselling (the AI-intervention group) or standard-of-care diabetic retinopathy screening with deferred human retinal image assessment and telephone counselling (the standard-of-care group). Participants had retinal photographs taken of both eyes. Images from the AI-intervention group were submitted to the AI software, and these participants were given their sc...