{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:15:03Z","timestamp":1790658903910,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["493623784"],"award-info":[{"award-number":["493623784"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Diabetic retinopathy (DR) is a leading cause of vision loss in middle\u2010aged adults globally. Although artificial intelligence (AI)\u2010based screening tools like IDx\u2010DR (classification) and Thirona RetCAD (regression) have shown high sensitivity in controlled settings, real\u2010world screening faces challenges due to missing or low\u2010quality images and inadequate adaptation to local healthcare needs. The objective was to compare the performance of two AI\u2010based DR screening algorithms (IDx\u2010DR and RetCAD) that analyse non\u2010mydriatic images, against ophthalmologists' mydriatic fundoscopy with image analysis and the impact of customized referral threshold modification (\u2018Greifswald modification\u2019) on screening outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This one\u2010centre observational study included 1716 patients with diabetes mellitus (Clinical Trials Register: DRKS00035967). Sensitivity, specificity, the proportion of ungradable images and the reduction in ophthalmologic evaluations were assessed. Customized referral threshold modification was conducted using the Youden Index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 98 patients (5.7%), no images could be acquired, and 35 patients (2.1%) had incomplete image sets for IDx\u2010DR. IDx\u2010DR rejected 438 patients (25.5%) due to image quality, while RetCAD flagged 134 eyes from 120 patients (6.9%) but provided output for all. Among analysable images, sensitivities ranged from 70.4% (RetCAD) to 93.6% (RetCAD with Greifswald modification). Including all patients reduced sensitivity from 52.7% (IDx\u2010DR) to 79.9% (RetCAD with Greifswald modification). AI screening reduced ophthalmologic exam needs by 47.5% to 78.5%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Real\u2010world DR screening performance of AI algorithms, when including non\u2010analysable patients, can be substantially lower than in controlled studies. The use of regression algorithms enabled the customization of referral thresholds, improving screening accuracy and reducing the clinical burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aos.17591","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T11:15:07Z","timestamp":1757589307000},"page":"323-332","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Customizing\n                    <scp>AI<\/scp>\n                    \u2010based screening with real\u2010world data: Practical insights from diabetic retinopathy"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2393-0369","authenticated-orcid":false,"given":"Broder","family":"Poschkamp","sequence":"first","affiliation":[{"name":"Department of Ophthalmology University Medicine Greifswald  Greifswald Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8595-4126","authenticated-orcid":false,"given":"Liane","family":"Kantz","sequence":"additional","affiliation":[{"name":"Department of Diabetology Heart\u2010 and Diabetes Centre Karlsburg  Karlsburg Germany"},{"name":"Leibniz Institute for Plasma Science and Technology  Greifswald Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"Augstein","sequence":"additional","affiliation":[{"name":"Department of Diabetology Heart\u2010 and Diabetes Centre Karlsburg  Karlsburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allam","family":"Tayar","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University Medicine Greifswald  Greifswald Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Kaderali","sequence":"additional","affiliation":[{"name":"Leibniz Institute for Plasma Science and Technology  Greifswald Germany"},{"name":"Institute of Bioinformatics, University Medicine Greifswald  Greifswald Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6259-3946","authenticated-orcid":false,"given":"Martin","family":"Busch","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University Medicine Greifswald  Greifswald Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beathe","family":"Bohl","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University Medicine Greifswald  Greifswald Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Paul","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University Medicine Greifswald  Greifswald 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