Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jun:6:12.
doi: 10.21037/aes-20-114. Epub 2021 Jun 15.

Combined automated screening for age-related macular degeneration and diabetic retinopathy in primary care settings

Alauddin Bhuiyan  1   2 , Arun Govindaiah  1 , Sharmina Alauddin  2 , Oscar Otero-Marquez  2 , R Theodore Smith  2
Affiliations

Combined automated screening for age-related macular degeneration and diabetic retinopathy in primary care settings

Alauddin Bhuiyan et al. Ann Eye Sci. 2021 Jun.

Abstract

Background: Age-related macular degeneration (AMD) and diabetic retinopathy (DR) are among the leading causes of blindness in the United States and other developed countries. Early detection is the key to prevention and effective treatment. We have built an artificial intelligence-based screening system which utilizes a cloud-based platform for combined large scale screening through primary care settings for early diagnosis of these diseases.

Methods: iHealthScreen Inc., an independent medical software company, has developed automated AMD and DR screening systems utilizing a telemedicine platform based on deep machine learning techniques. For both diseases, we prospectively imaged both eyes of 340 unselected non-dilated subjects over 50 years of age. For DR specifically, 152 diabetic patients at New York Eye and Ear faculty retina practices, ophthalmic and primary care clinics in New York city with color fundus cameras. Following the initial review of the images, 308 images with other confounding conditions like high myopia and vascular occlusion, and poor quality were excluded, leaving 676 eligible images for AMD and DR evaluation. Three ophthalmologists evaluated each of the images, and after adjudication, the patients were determined referrable or non-referable for AMD DR. Concerning AMD, 172 were labeled referable (intermediate or late), and 504 were non-referable (no or early). Concurrently, regarding DR, 33 were referable (moderate or worse), and 643 were non-referable (none or mild). All images were uploaded to iHealthScreen's telemedicine platform and analyzed by the automated systems for both diseases. The system performances are tested on per eye basis with sensitivity, specificity, accuracy, and kappa scores with respect to the professional graders.

Results: In identifying referable DR, the system achieved a sensitivity of 97.0% and a specificity of 96.3%, and a kappa score of 0.70 on this prospective dataset. For AMD, the sensitivity was 86.6%, the specificity of 92.1%, and a kappa score of 0.76.

Conclusions: The AMD and DR screening tools achieved excellent performance operating together to identify two retinal diseases prospectively in mixed datasets, demonstrating the feasibility of such tools in the early diagnosis of eye diseases. These early screening tools will help create an even more comprehensive system capable of being trained on other retinal pathologies, a goal within reach for public health deployment.

Keywords: Diabetic retinopathy; age-related macular degeneration; primary care.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/aes-20-114). The series “Retinal Imaging and Diagnostics” was commissioned by the editorial office without any funding or sponsorship. RTS served as the unpaid Guest Editor of the series, and serves as an unpaid editorial board member of Annals of Eye Science from May 2019 to Apr 2021. AB reports grants from iHealthScreen Inc., during the conduct of the study; other from iHealthScreen Inc., outside the submitted work. AG reports grants from NIH SBIR, during the conduct of the study; other from iHealthscreen Inc, outside the submitted work. RTS reports a patent issued: the multi excitation image analysis technique for hyperspectral AF imaging. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Normal vision (A), DR patient vision (B), and vision with AMD (C).
Figure 2
Figure 2
Original RGB fundus image (A), preprocessed image (B), with brightness gradient correction.
Figure 3
Figure 3
The screening system workflow showing image acquisition, gradability testing, image analysis, referral to an ophthalmologist, and the upload of results to the telemedicine application.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. AMD-Defined. Age-Related Macular Degeneration (AMD). Projections for AMD (2010-2030-2050), National Eye Institute (NEI), last accessed on August 3, 2020.
    1. Age-Related-Eye-Disease-Study-Research-Group. The Age-Related Eye Disease Study (AREDS): design implications. AREDS report no 1. Control Clin Trials 1999;20(6):573–600. - PMC - PubMed
    1. Bartlett H, Eperjesi F. Use of Fundus Imaging in Quantification of Age-related Macular Change. Surv. Ophthalmol 2007;52:655–71. - PubMed
    1. American Academy of Ophthalmology. Diabetic Retinopathy PPP — 2014. Available online: http://one.aao.org/preferred-practice-pattern/diabetic-retinopathy-ppp--..., last accessed on October 1, 2020.
    1. Schmier JK, Jones ML, Halpern MT. The burden of age-related macular degeneration. Pharmacoeconomics 2006;24:319–34. - PubMed

LinkOut - more resources