{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T19:05:03Z","timestamp":1784574303826,"version":"3.55.0"},"reference-count":29,"publisher":"American Diabetes Association","issue":"8","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/501100000367","name":"British Council for the Prevention of Blindness","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000367","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000862","name":"Sir Halley Stewart Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000862","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["207472\/Z\/17\/Z"],"award-info":[{"award-number":["207472\/Z\/17\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Comparative evaluations of commercially available artificial intelligence (AI) systems for use in diabetic retinopathy (DR) screening, particularly studies that identify systems by name, are limited, constraining procurement and implementation. This study aimed to identify commercially available AI systems potentially suitable for DR screening in a low-resource Tanzanian setting and compare their accuracy in detecting referable DR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>Through a scoping review and expert consultation, we identified AI systems potentially suitable for implementation. Systems confirmed as suitable, and whose developers agreed to participate, were evaluated. Performance was assessed on a data set of retinal images collected from a Tanzanian DR screening program. The primary outcomes were sensitivity and specificity in detecting referable DR. Additional implementation data, including regulatory approval, referral thresholds, and additional product features, were also collected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Four commercially available AI systems (Medios AI\/Remidio, MONA, Ophtai, and SELENA+) were evaluated. Among 689 people included in the test data set, 379 (55.0%) had referable DR and 93 (13.5%) had proliferative DR. Sensitivity in detecting referable DR ranged from 83.9% to 93.7%, with lower specificity ranging from 70.3% to 79.0%. Sensitivity in detecting proliferative DR exceeded 98% in all four AI systems. All the evaluated AI systems were Conformit\u00e9 Europ\u00e9enne\u2013marked medical devices; one system (Medios AI\/Remidio) functions offline as standard.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Several commercially available AI systems demonstrated high sensitivity in detecting referable and proliferative DR, supporting their potential implementation. Consensus on minimum performance thresholds and consideration of implementation factors such as regulatory approval and offline functionality are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc26-0572","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T13:55:51Z","timestamp":1781099751000},"page":"1451-1457","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":0,"title":["Head-to-Head Comparative Evaluation of Four Commercially Available Artificial Intelligence Systems for Detecting Referable Diabetic Retinopathy in a Tanzanian Population"],"prefix":"10.2337","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2761-8092","authenticated-orcid":false,"given":"Charles R.","family":"Cleland","sequence":"first","affiliation":[{"name":"International Centre for Eye Health, London School of Hygiene and Tropical Medicine 1 , London, U.K."},{"name":"Eye Department, Kilimanjaro Christian Medical Centre 2 , Moshi, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Covadonga","family":"Bascaran","sequence":"additional","affiliation":[{"name":"International Centre for Eye Health, London School of Hygiene and Tropical Medicine 1 , London, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William U.","family":"Makupa","sequence":"additional","affiliation":[{"name":"Eye Department, Kilimanjaro Christian Medical Centre 2 , Moshi, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernadetha","family":"Shilio","sequence":"additional","affiliation":[{"name":"Ministry of Health 3 , Dodoma, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Tufail","sequence":"additional","affiliation":[{"name":"National Institute for Health and Care Research Biomedical Research Centre for Ophthalmology, Moorfields Hospital London NHS Foundation Trust and University College London Institute of Ophthalmology 4 , London, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Egan","sequence":"additional","affiliation":[{"name":"National Institute for Health and Care Research Biomedical Research Centre for Ophthalmology, Moorfields Hospital London NHS Foundation Trust and University College London Institute of Ophthalmology 4 , London, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiri","family":"Fajtl","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, City St. George\u2019s University of London 5 , London, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abraham","family":"Olvera-Barrios","sequence":"additional","affiliation":[{"name":"National Institute for Health and Care Research Biomedical Research Centre for Ophthalmology, Moorfields Hospital London NHS Foundation Trust and University College London Institute of Ophthalmology 4 , London, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicja R.","family":"Rudnicka","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, City St. George\u2019s University of London 5 , London, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher G.","family":"Owen","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, City St. George\u2019s University of London 5 , London, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Wallis","sequence":"additional","affiliation":[{"name":"Dorset Diabetic Eye Screening Programme 6 , Bournemouth, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edyta","family":"Cartwright","sequence":"additional","affiliation":[{"name":"University Hospitals Sussex NHS Foundation Trust 7 , Worthing, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Bastawrous","sequence":"additional","affiliation":[{"name":"International Centre for Eye Health, London School of Hygiene and Tropical Medicine 1 , London, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Macleod","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine 8 , London, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Burton","sequence":"additional","affiliation":[{"name":"International Centre for Eye Health, London School of Hygiene and Tropical Medicine 1 , London, U.K."},{"name":"National Institute for Health and Care Research Biomedical Research Centre for Ophthalmology, Moorfields Hospital London NHS Foundation Trust and University College London Institute of Ophthalmology 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England","volume":"7","author":"Rudnicka","year":"2025","journal-title":"Lancet Digit Health"},{"key":"2026072014522814000_B7","doi-asserted-by":"crossref","first-page":"146","DOI":"10.3390\/diabetology6120146","article-title":"A real-world comparison of three deep learning systems for diabetic retinopathy in remote Australia","volume":"6","author":"Drinkwater","year":"2025","journal-title":"Diabetology (Basel)"},{"key":"2026072014522814000_B8","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.2337\/dc20-1877","article-title":"Multicenter, head-to-head, real-world validation study of seven automated artificial intelligence diabetic retinopathy screening systems","volume":"44","author":"Lee","year":"2021","journal-title":"Diabetes Care"},{"key":"2026072014522814000_B9","doi-asserted-by":"crossref","first-page":"2352018","DOI":"10.1080\/07853890.2024.2352018","article-title":"Comparison of 21 artificial intelligence algorithms in automated diabetic retinopathy screening using handheld fundus camera","volume":"56","author":"Kubin","year":"2024","journal-title":"Ann Med"},{"key":"2026072014522814000_B10","doi-asserted-by":"crossref","first-page":"100915","DOI":"10.1016\/j.landig.2025.100915","article-title":"Independent and openly reported head-to-head comparative validation studies of AI medical devices: a necessary step towards safe and responsible clinical AI deployment","volume":"7","author":"Cleland","year":"2025","journal-title":"Lancet Digit Health"},{"key":"2026072014522814000_B11","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1111\/tmi.12652","article-title":"Diabetic retinopathy in Tanzania: prevalence and risk factors at entry into a regional screening programme","volume":"21","author":"Cleland","year":"2016","journal-title":"Trop Med Int Health"},{"key":"2026072014522814000_B12","article-title":"The Management of Grading Quality: Good Practice in the Quality Assurance of Grading\u2014Version 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(Lausanne)"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/49\/8\/1451\/885349\/dc260572.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/49\/8\/1451\/885349\/dc260572.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T18:52:38Z","timestamp":1784573558000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/49\/8\/1451\/171992\/Head-to-Head-Comparative-Evaluation-of-Four"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,10]]},"references-count":29,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,6,10]]},"published-print":{"date-parts":[[2026,8,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc26-0572","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,10]]}}}