Autonomous AI-driven point-of-care screening for diabetic retinopathy compared to reading center multi-expert clinical review: results from three prospective controlled pivotal validation studies with AEYE-DS in over 1,200 patients

Abstract

Purpose Diabetic retinopathy (DR) remains the leading cause of blindness among working-age adults and requires regular screening to detect progression among the growing global diabetic population. This study evaluated the performance of AEYE-DS, an autonomous artificial intelligence (AI) system designed for high-throughput, point-of-care analysis of retinal images, in detecting more-than-mild diabetic retinopathy (mtmDR) during routine screening of patients with diabetes who had not previously been diagnosed with DR. Principal results AEYE-DS was tested across three prospective clinical studies using two FDA-cleared non-mydriatic retinal cameras: the handheld Aurora and the desktop Topcon NW400. The algorithm autonomously analyzed retinal images and determined mtmDR presence. Diagnostic outcomes were compared to a reference standard based on the Early Treatment for Diabetic Retinopathy Study (ETDRS) severity grading performed by multi-expert review at an independent reading center. Sensitivity and specificity were 93% and 91% in AEYE-1 (95% CI: 83%–97% and 88%–94%), 92% and 94% in AEYE-2 (95% CI: 79%–97% and 90%–96%), and 93% and 89% in AEYE-3 (95% CI: 80%–97% and 85%–92%). Imageability was >99% in all studies. Intra-operator repeatability exceeded 99% for both devices. Between-operator reproducibility was 98% for the desktop camera and 95% for the handheld device, while between-device reproducibility reached 99% and 97%, respectively. Conclusions AEYE-DS demonstrated high diagnostic accuracy, imageability, reliability, and reproducibility across different operators and devices in non-mydriatic settings. Findings support autonomous AI system use for scalable, point-of-care DR screening, potentially expanding access, streamlining workflows, and reducing the global burden of diabetic eye disease.