Automated diabetic retinopathy screening for primary care settings using deep learning

Abstract Diabetic Retinopathy (DR) is one of the leading causes of blindness in the United States and other high-income countries. Early detection is key to prevention, which could be achieved effectively with a fully automated screening tool performing well on clinically relevant measures in primary care settings. We have built an artificial intelligence-based tool on a cloud-based platform for large-scale screening of DR as referable or non-referable. In this paper, we aim to validate this tool built using deep learning based techniques. The cloud-based screening model was developed and tested using deep learning techniques with 88702 images from the Kaggle dataset and externally validated using 1748 high-resolution images of the retina (or fundus images) from the Messidor-2 dataset. For validation in the primary care settings, 264 images were taken prospectively from two diabetes clinics in Queens, New York. The images were uploaded to the cloud-based software for testing the automated system as compared to expert ophthalmologists' evaluations of referable DR. Measures used were area under the curve (AUC), sensitivity, and specificity of the screening model with respect to professional graders. The screening system achieved a high sensitivity of 99.21% and a specificity of 97.59% on the Kaggle test dataset with an AUC of 0.9992. The system was also externally validated in Messidor-2, where it achieved a sensitivity of 97.63% and a specificity of 99.49% (AUC, 0.9985). On primary care data, the sensitivity was 92.3% overall (12/13 referable images are correctly identified), and overall specificity was 94.8% (233/251 non-referable images). The proposed DR screening tool achieves state-of-the-art performance among the publicly available datasets: Kaggle and Messidor-2 to the best of our knowledge. The performance on various clinically relevant measures demonstrates that the tool is suitable for screening and early diagnosis of DR in primary care settings.