Turner A1, Drinkwater J1, Woods K1

1Lions Outback Vision

Biography:

Professor Angus Turner is the founding Director of Lions Outback Vision, based at the Lions Eye Institute (LEI) in Perth, Western Australia. Lions Outback Vision provides eye health services throughout Western Australia to rural and remote areas and Indigenous communities in urban locations. He is Professor of Ophthalmology at the University of Western Australia. Recently he founded Ninox Vision to help bring AI retinal insights to primary care in Australia and beyond.

Abstract:

Background/objective: Deep learning tools may improve access to screening for diabetic retinopathy, a leading cause of vision loss. Therefore, the aim was to prospectively compare the performance of three deep learning systems (DLSs); Google ARDA, Thirona RetCAD TM ,and, EyRIS SELENA+ for detection of referable diabetic retinopathy (DR), in a real-world setting.

Methods: Participants with diabetes presented to a mobile facility for DR screening in the remote Pilbara region of Western Australia, which has a high proportion of First Nations

people. Sensitivity, specificity, and other performance indicators were calculated for each DLS, compared to grading by an ophthalmologist adjudication panel. Cochran’s Q with post-hoc Dunn test assessed differences in DLS performance.

Results: 188 colour fundus photographs were assessed; 39 images had referable DR, 135 had no referable DR and 14 images were ungradable. The sensitivity/specificity of ARDA was 100% (95% CI: 91.03-100%) / 94.81% (89.68-97.47%), RetCAD was 97.37% (86.50-99.53%) / 97.01% (92.58-98.83%) and SELENA+ was 91.67% (78.17-97.13%) / 80.80%

(73.02-86.74%). DLS performance remained high in First Nations people. ARDA and RetCAD TM results were not statistically different to the ophthalmologist grading (p≥0.415).

Conclusions: In a real-world study comprising majority First Nations people, DLSs had high sensitivity and specificity for detecting referable DR. Implementation may augment DR

screening rates, and with appropriate referral and treatment pathways may prevent vision loss and improve health equity.