Feasibility of screening for diabetic retinopathy using artificial intelligence, Brazil

PROBLEM: There is currently no national strategy or standardized approach to diabetic retinopathy screening in the Brazilian public health system, and multiple socioeconomic barriers prevent access to eye examination in Brazil’s poorest regions. APPROACH: From September 2021 to March 2022 we carried out a pilot project with an artificial intelligence system for diabetic retinopathy screening, embedded in a portable retinal camera. Patients with a diagnosis of diabetes according to the municipality registry were invited to attend nearby clinics for screening on designated days. Trained health-care technicians acquired images which were automatically evaluated by the system, with instant remote evaluation by retinal specialists in selected cases. LOCAL SETTING: Our study was based in Sergipe State, located at a region with high illiteracy rates and no local availability of specialized retina care. The average number of laser treatments performed annually in the last 5 years is 126, for a total State population of 2.3 million. RELEVANT CHANGES: Even though screening was performed free of charge in a convenient location for patients, from a total 2052 eligible individuals, only 1083 attended for screening. LESSONS LEARNT: Efforts to raise awareness on the condition screened and to provide health education for patients and local health-care personnel are fundamental for increased attendance. Tailoring screening systems to the local setting, such as determining the trade-off between sensitivity and specificity, is challenging in regions with no current benchmarks. Standards for retinopathy screening based on the strategies adopted by high-income countries may not be realistic in low- and middle-income countries.