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Med."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Artificial intelligence (AI) is an accurate screening tool for diabetic retinopathy (DR), the leading cause of blindness among working-aged adults. However, its impact on referral uptake is uncertain. We searched Embase, MEDLINE, Scopus, Web of Science and Cochrane Library databases from year 2000 to February 17, 2025. Randomised and non-randomised studies comparing referral uptake after AI-assisted DR screening versus standard of care were included. 2644 articles were identified, and six included for analysis. The relative risk of DR referral uptake with AI-assisted screening compared with the status quo was 1.89 (95% CI, 1.18, 3.03,\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>\n                      <jats:italic>2<\/jats:italic>\n                    <\/jats:sup>\n                    \u2009=\u200991.9%). Settings which underwent referral pathway transformation from routine to targeted referrals for DR demonstrated the greatest effect size. Most (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20094) studies also utilised behavioural change interventions enabled by immediate results acquisition of AI to enhance health-seeking behaviour. Our findings suggest the effectiveness of DR screening is derived not only from diagnostic technology, but from AI-enabled care pathway redesign encompassing both health system transformation and coordinated patient-facing interventions which improve referral uptake.\n                  <\/jats:p>","DOI":"10.1038\/s41746-026-02616-3","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T10:15:03Z","timestamp":1776420903000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Referral uptake after diabetic retinopathy screening with artificial intelligence-assisted care pathways: a systematic review and meta-analysis"],"prefix":"10.1038","volume":"9","author":[{"given":"James A.","family":"Leigh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Sherrington","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angus R. J.","family":"Barber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angus W.","family":"Turner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Kidd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Powell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Pope","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"2616_CR1","doi-asserted-by":"publisher","first-page":"e489","DOI":"10.1016\/S2214-109X(20)30488-5","volume":"9","author":"MJ Burton","year":"2021","unstructured":"Burton, M. J. et al. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob. 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J.P. receives funding for part of his salary from the NIHR Applied Research Collaboration Oxford and Thames Valley at Oxford NHS Foundation Trust. A.T. is Director of Lions Outback Vision and Ninox Vision in Australia, a social enterprise pioneering telehealth and diabetic retinal screening. The following competing non-financial interests are declared: C.P. is Chair of the NIHR Senior Investigator Award Panel and holds membership with NIHR study steering and advisory groups not related to this study. C.P. holds unpaid positions as Trustee\/Treasurer, Foundation for the Sociology of Health & Illness (since Sept. 2024); Member of Governing Body, Green Templeton College, University of Oxford (since Oct. 2024); and Trustee & Publications Director, BSA (until Jul. 2024). AT holds a directorship with organisations involved in telehealth-based diabetic retinal screening in Australia. All other authors declare no competing financial or non-financial interests. No author is associated as an editor with this journal or collection.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"468"}}