Development and Validation of a Deep Learning Algorithm for Detection of Diabetic Retinopathy in Retinal Fundus Photographs

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Abstract
Among individuals with diabetes, the prevalence of diabetic retinopathy is approximately 28.5% in the United States1 and 18% in India.2 Most guidelines recommend annual screening for those with no retinopathy or mild diabetic retinopathy, repeat examination in 6 months for moderate diabetic retinopathy, and an ophthalmologist referral for treatment evaluation within a few weeks to months for severe or worse diabetic retinopathy or the presence of referable diabetic macular edema, known as clinically significant macular edema.3 Referable diabetic retinopathy has been defined as moderate or worse diabetic retinopathy or referable diabetic macular edema,4 given that recommended management changes from yearly screening to closer follow-up at moderate disease severity.3 Retinal photography with manual interpretation is a widely accepted screening tool for diabetic retinopathy, with performance that can exceed that of in-person dilated eye examinations.3