A deep learning system for predicting time to progression of diabetic retinopathy.

Journal: Nature medicine
PMID: 38177850

Abstract

Diabetic retinopathy (DR) is the leading cause of preventable blindness worldwide. The risk of DR progression is highly variable among different individuals, making it difficult to predict risk and personalize screening intervals. We developed and validated a deep learning system (DeepDR Plus) to predict time to DR progression within 5 years solely from fundus images. First, we used 717,308 fundus images from 179,327 participants with diabetes to pretrain the system. Subsequently, we trained and validated the system with a multiethnic dataset comprising 118,868 images from 29,868 participants with diabetes. For predicting time to DR progression, the system achieved concordance indexes of 0.754-0.846 and integrated Brier scores of 0.153-0.241 for all times up to 5 years. Furthermore, we validated the system in real-world cohorts of participants with diabetes. The integration with clinical workflow could potentially extend the mean screening interval from 12 months to 31.97 months, and the percentage of participants recommended to be screened at 1-5 years was 30.62%, 20.00%, 19.63%, 11.85% and 17.89%, respectively, while delayed detection of progression to vision-threatening DR was 0.18%. Altogether, the DeepDR Plus system could predict individualized risk and time to DR progression over 5 years, potentially allowing personalized screening intervals.

Authors

  • Ling Dai
    Department of Computer Science and Engineering, Shanghai Jiao Tong University, China; MoE Key Lab of Artificial Intelligence, AI Institute, Shanghai Jiao Tong University, China.
  • Bin Sheng
    MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China.
  • Tingli Chen
    Department of Ophthalmology, Huadong Sanatorium, Wuxi, China.
  • Qiang Wu
    Department of Radiotherapy, West China Hospital, Sichuan University, Chengdu, PR China; Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, PR China.
  • Ruhan Liu
    Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.
  • Chun Cai
    Guangdong Provincial Engineering Research Center of Intelligent Low-carbon Pollution Prevention and Digital Technology & Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, School of Environment, South China Normal University, Guangzhou 510006, P. R. China.
  • Liang Wu
    Clinical and Research Center of AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
  • Dawei Yang
    Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China.
  • Haslina Hamzah
    Singapore Eye Research Institute, Singapore National Eye Center, Singapore.
  • Yuexing Liu
    Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, 200233, China.
  • Xiangning Wang
    Department of Ophthalmology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
  • Zhouyu Guan
    Shanghai International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China.
  • Shujie Yu
    Shanghai International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China.
  • Tingyao Li
    Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China.
  • Ziqi Tang
    Department of Pharmaceutical Chemistry, Department of Bioengineering and Therapeutic Sciences, Institute for Neurodegenerative Diseases, and Bakar Computational Health Sciences Institute, University of California, San Francisco, 675 Nelson Rising Ln Box 0518, San Francisco, CA, 94143, USA.
  • Anran Ran
    Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR.
  • Haoxuan Che
    Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong, China.
  • Hao Chen
    The First School of Medicine, Wenzhou Medical University, Wenzhou, China.
  • Yingfeng Zheng
    State Key Laboratory of Ophthalmology, Clinical Research Center for Ocular Disease, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China.
  • Jia Shu
    College of Life Science, Northwest A&F University, 712100, Shaanxi, Yangling, China.
  • Shan Huang
    Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, 300211 Tianjin, China.
  • Chan Wu
    Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
  • Shiqun Lin
    Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
  • Dan Liu
    Department of Bioengineering, Temple University, Philadelphia, PA, United States.
  • Jiajia Li
    Shanghai Artificial Intelligence Research Institute Co., Ltd, Shanghai, China.
  • Zheyuan Wang
    Shanghai International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China; MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China.
  • Ziyao Meng
    Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China.
  • Jie Shen
    Anhui Provincial Center for Drug Clinical Evaluation, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui 241001, China; Pharmacy School, Wannan Medical College, Wuhu, Anhui 241002, China; Department of Clinical Pharmacy, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui 241001, China; Anhui Provincial Engineering Research Center for Polysaccharides Drugs, Wannan Medical College, Wuhu, Anhui 241001, China.
  • Xuhong Hou
    Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, 200233, China.
  • Chenxin Deng
    Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
  • Lei Ruan
    Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
  • Feng Lu
    National Engineering Research Center for Big Data Technology and System, Services Computing Technology and System Lab, Cluster and Grid Computing Lab, School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, China.
  • Miaoli Chee
    Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
  • Ten Cheer Quek
    Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
  • Ramyaa Srinivasan
    Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India.
  • Rajiv Raman
    Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.
  • Xiaodong Sun
    Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai JiaoTong University, 200080 Shanghai, China.
  • Ya Xing Wang
    Beijing Visual Science and Translational Eye Research Institute (BERI), Eye Center of Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China.
  • Jiarui Wu
    The First School of Clinical Medicine, Guangdong Medical University, Zhanjiang, China.
  • Hai Jin
    National Engineering Research Center for Big Data Technology and System, Services Computing Technology and System Lab, Cluster and Grid Computing Lab, School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, China.
  • Rongping Dai
    Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China.
  • Dinggang Shen
    School of Biomedical Engineering, ShanghaiTech University, Shanghai, China.
  • Xiaokang Yang
  • Minyi Guo
  • Cuntai Zhang
    Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
  • Carol Y Cheung
    Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China. Electronic address: carolcheung@cuhk.edu.hk.
  • Gavin Siew Wei Tan
    Singapore Eye Research Institute, Singapore National Eye Center, Singapore.
  • Yih-Chung Tham
    Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore.
  • Ching-Yu Cheng
    Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore.
  • Huating Li
    Shanghai Jiao Tong University Affiliated Sixth People's Hospital, China. Electronic address: huarting99@sjtu.edu.cn.
  • Tien Yin Wong
    Singapore National Eye Center, Duke-National University of Singapore Medical School, Singapore 168751, Singapore; National Institutes of Health Research Biomedical Research Centre Biomedical Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
  • Weiping Jia
    Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Diabetes Institute Shanghai 200233, China.

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