A male patient is screened for diabetic retinopathy using AI in an eye clinic in Rwanda

Research: Two original Orbis studies show benefits of AI for rural eye care

Two peer-reviewed Orbis studies in the British Journal of Ophthalmology and Opthalmology Science show the potential for artificial intelligence (AI) to transform eye care in hard-to-reach communities.

We're delighted to share the results of two studies showing patient satisfaction and uptake of eye care services rose when patients were screened for diabetic retinopathy using AI.

The most recent study published in the British Journal of Ophthalmology, conducted in Rwanda in partnership with the Rwanda International Institute of Ophthalmology, looked at the satisfaction levels of patients screened for diabetic retinopathy and other eye conditions using Orbis’s Cybersight AI tool.

The research found that patient satisfaction with AI screening was high, at over 99%, and more than 63% of the study participants preferred AI over human graders.

The screenings were conducted during routine appointments at four diabetes clinics in and near Kigali, Rwanda, in 2021. This is one of the first clinical studies on the practical applications of AI in diabetic retinopathy screening in Africa.

Another Orbis study from 2022 published in Ophthalmology Science showed that diabetic retinopathy screenings supported by AI-enhanced patients’ speed and uptake of referral services, which can help reduce vision loss due to diabetes in the region.

Speaking about the latest study, Dr. Ciku Mathenge, Medical Advisor for Orbis International and the study’s principal investigator, says: “This study has the potential to make a big impact for patients with diabetes in Africa. In the study, we found that most patients had not had a recent full eye exam despite worrying about their vision and knowing their risks for developing diabetic retinopathy. Our research findings show that access to easy-to-use and conveniently located screening technologies allows patients to get the care they need and to prevent vision loss or blindness from diabetic retinopathy. The key now will be to ensure that such technologies become affordable and accessible to all.

A doctor screens her patient for diabetic retinopathy using AI-led technology in an eye care center in Rwanda

The study's principal investigator Dr. Ciku Mathenge screens a patient for diabetic retinopathy using AI.

Factors that may have contributed to high participant satisfaction in the latest study include:

  • Receiving the exam during their diabetes appointment, as opposed to scheduling a separate appointment with an eye clinic, saved time and the cost of travel, an important barrier for rural patients, who composed nearly half the participants.
  • The AI screening model was integrated into the existing workflow at the four diabetes clinics where the study took place.
  • Most patients were not required to have their pupils dilated to undergo AI screening, which reduces time commitment and avoids temporarily blurred vision.
  • Printed reports, available immediately during the screening, provided an opportunity for patients to learn about the condition and their risks while at their appointment, as opposed to waiting for delayed reporting from human grading.
  • The study showed Cybersight AI performed well and led to accurate referrals from diabetes clinics.

Tackling Diabetic Retinopathy with AI

Diabetes is on the rise globally, and diabetic retinopathy is the leading cause of vision loss among working-age people around the world. Anyone with diabetes is at risk of developing the condition, which can lead to irreversible blindness. Recent reports show the prevalence of diabetic retinopathy is increasing in sub-Saharan Africa, more than in any other region.

Access to diabetic retinopathy screening is critical to preventing visual impairment as most patients with diabetes do not realize they have the disease until their vision is already affected irreversibly. Low-resource settings, such as Rwanda, lack the infrastructure and trained personnel to implement the screenings effectively.

There is an extremely low number of eye doctors in sub-Saharan Africa, averaging 3.7 ophthalmologists per 1 million people. Training other medical personnel to conduct diabetic retinopathy screenings is an alternative and effective model in low- and middle-income countries that also preserves ophthalmologists’ time for care only they can manage. AI makes the screening process accessible for medical personnel and patients alike in non-ophthalmic settings.

A eye health professional screens a patient for eye disease diabetic retinopathy using AI-led technology

Etienne Uwingabire, Senior Nurse and Director of the Rwanda Diabetes Association, describes the technology as "like a miracle."

The critical insights we get from our research inform our evidence-based approach to tackling global vision loss. If you are interested in funding Orbis research, or our efforts to use technology to revolutionize eye care in low- and middle-income countries, please contact [email protected]

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