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Dow ER, Chen KM, Zhao CS, Knapp AN, Phadke A, Weng K, Do DV, Mahajan VB, Mruthyunjaya P, Leng T, Myung D. Artificial Intelligence Improves Patient Follow-Up in a Diabetic Retinopathy Screening Program. Clin Ophthalmol 2023; 17:3323-3330. [PMID: 38026608 PMCID: PMC10665027 DOI: 10.2147/opth.s422513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/30/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose We examine the rate of and reasons for follow-up in an Artificial Intelligence (AI)-based workflow for diabetic retinopathy (DR) screening relative to two human-based workflows. Patients and Methods A DR screening program initiated September 2019 between one institution and its affiliated primary care and endocrinology clinics screened 2243 adult patients with type 1 or 2 diabetes without a diagnosis of DR in the previous year in the San Francisco Bay Area. For patients who screened positive for more-than-mild-DR (MTMDR), rates of follow-up were calculated under a store-and-forward human-based DR workflow ("Human Workflow"), an AI-based workflow involving IDx-DR ("AI Workflow"), and a two-step hybrid workflow ("AI-Human Hybrid Workflow"). The AI Workflow provided results within 48 hours, whereas the other workflows took up to 7 days. Patients were surveyed by phone about follow-up decisions. Results Under the AI Workflow, 279 patients screened positive for MTMDR. Of these, 69.2% followed up with an ophthalmologist within 90 days. Altogether 70.5% (N=48) of patients who followed up chose their location based on primary care referral. Among the subset of patients that were seen in person at the university eye institute under the Human Workflow and AI-Human Hybrid Workflow, 12.0% (N=14/117) and 11.7% (N=12/103) of patients with a referrable screening result followed up compared to 35.5% of patients under the AI Workflow (N=99/279; χ2df=2 = 36.70, p < 0.00000001). Conclusion Ophthalmology follow-up after a positive DR screening result is approximately three-fold higher under the AI Workflow than either the Human Workflow or AI-Human Hybrid Workflow. Improved follow-up behavior may be due to the decreased time to screening result.
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Grants
- P30 EY026877 NEI NIH HHS
- Research to Prevent Blindness
- Roche/Genentech, Protagonist Therapeutics, Alcon, Regeneron, Graybug, Boehringer Ingelheim, Kanaph
- Nanoscope Therapeutics, Apellis, Astellas
- Regeneron, Kriya, Boerhinger Ingelheim
- Genentech, Regeneron, Kodiak Sciences, Apellis, Iveric Bio
- Stanford Diabetes Research Center (SDRC)
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Affiliation(s)
- Eliot R Dow
- Department of Ophthalmology, Byers Eye Institute at Stanford, Palo Alto, CA, USA
- Department of Ophthalmology, Duke Eye Center, Durham, NC, USA
| | - Karen M Chen
- Department of Ophthalmology, Byers Eye Institute at Stanford, Palo Alto, CA, USA
| | - Cindy S Zhao
- Department of Ophthalmology, Byers Eye Institute at Stanford, Palo Alto, CA, USA
| | - Austen N Knapp
- Department of Ophthalmology, Byers Eye Institute at Stanford, Palo Alto, CA, USA
| | - Anuradha Phadke
- Department of Internal Medicine, Stanford Health Care, Palo Alto, CA, USA
| | - Kirsti Weng
- Department of Internal Medicine, Stanford Health Care, Palo Alto, CA, USA
| | - Diana V Do
- Department of Ophthalmology, Byers Eye Institute at Stanford, Palo Alto, CA, USA
| | - Vinit B Mahajan
- Department of Ophthalmology, Byers Eye Institute at Stanford, Palo Alto, CA, USA
| | - Prithvi Mruthyunjaya
- Department of Ophthalmology, Byers Eye Institute at Stanford, Palo Alto, CA, USA
| | - Theodore Leng
- Department of Ophthalmology, Byers Eye Institute at Stanford, Palo Alto, CA, USA
| | - David Myung
- Department of Ophthalmology, Byers Eye Institute at Stanford, Palo Alto, CA, USA
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