AI-Driven Diabetic Retinopathy Screening: Multicentric Validation of AIDRSS in India

Purpose: Diabetic retinopathy (DR) is a major cause of vision loss, particularly in India, where access to retina specialists is limited in rural areas. This study aims to evaluate the Artificial Intelligence-based Diabetic Retinopathy Screening System (AIDRSS) for DR detection and prevalence assessment, addressing the growing need for scalable, automated screening solutions in resource-limited settings. Approach: A multicentric, cross-sectional study was conducted in Kolkata, India, involving 5,029 participants and 10,058 macula-centric retinal fundus images. The AIDRSS employed a deep learning algorithm with 50 million trainable parameters, integrated with Contrast Limited Adaptive Histogram Equalization (CLAHE) preprocessing for enhanced image quality. DR was graded using the International Clinical Diabetic Retinopathy (ICDR) Scale, categorizing disease into five stages (DR0 to DR4). Statistical metrics including sensitivity, specificity, and prevalence rates were evaluated against expert retina specialist assessments. Results: The prevalence of DR in the general population was 13.7%, rising to 38.2% among individuals with elevated random blood glucose levels. The AIDRSS achieved an overall sensitivity of 92%, specificity of 88%, and 100% sensitivity for detecting referable DR (DR3 and DR4). These results demonstrate the system's robust performance in accurately identifying and grading DR in a diverse population. Conclusions: AIDRSS provides a reliable, scalable solution for early DR detection in resource-constrained environments. Its integration of advanced AI techniques ensures high diagnostic accuracy, with potential to significantly reduce the burden of diabetes-related vision loss in underserved regions.