{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T10:13:15Z","timestamp":1792059195020,"version":"4.4.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Ophthalmol."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate real-world agreement between a CE-marked OCT-based AI decision-support system and routine retreatment decisions for neovascular AMD within a teleophthalmology workflow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Retrospective clinical study including 429 OCT examinations from 247 patients (306 treated eyes) with neovascular AMD. Retinal specialists made routine retreatment decisions (\u201cinject\u201d vs \u201cwatch-and-wait\u201d) using full clinical context. Independently, the AI system (deepeye\n                      <jats:sup>\u00ae<\/jats:sup>\n                      TPS, version 1.2) analyzed the current OCT volume only (no prior OCT, visual acuity, treatment interval, or clinical notes) and generated a Disease Activity Score (DAS; 0\u2013100) used to derive an \u201cinject\u201d vs \u201cwatch-and-wait\u201d recommendation. Discrepant cases were re-evaluated by senior graders to establish a double-senior-graded (DSG) reference standard. Implementation analyses assessed a deferral (\u201csafety zone\u201d) strategy. Main outcome measures included agreement\/accuracy, sensitivity, and specificity versus real-world decisions and the double-senior-graded (DSG) reference standard, as well as decision coverage under deferral.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Agreement between real-world decisions and AI recommendations was 83.2% (sensitivity 74.7%, specificity 88.0%). Against the double-senior-graded reference standard (DSG), accuracy in the full analysis set (FAS), analyzed at the examination level, was 85.5% (sensitivity 77.2%, specificity 90.4%). Using an empirically optimized DAS threshold, accuracy increased to 88.6% (sensitivity 78.5%, specificity 94.9%) in the eligible retreatment-decision set (ERDS). Application of a deferral policy (\u201csafety zone\u201d, DAS 33\u201364) resulted in automated recommendations for 78.4% of eligible examinations, while 21.6% were deferred due to intermediate DAS values; among examinations with an automated recommendation, accuracy was 92.3% (sensitivity 83.2%, specificity 97.5%). Most misclassifications involved subtle IRF\/SRF and SHRM as identified by the reading center and tended to be underestimated by the AI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The evaluated OCT-only AI decision-support output showed substantial agreement with routine retinal-specialist retreatment decisions in a real-world teleophthalmology workflow, particularly when intermediate Disease Activity Scores were deferred to human review. However, false-negative cases and context-dependent discrepancies highlight that the system should support, not replace, clinician judgement. Prospective multicenter validation using longitudinal and multimodal input data is required before broader workflow integration can be recommended.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fopht.2026.1870572","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T05:42:38Z","timestamp":1782884558000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Real-world evaluation of an OCT-based AI decision-support system for neovascular AMD activity triage in teleophthalmology"],"prefix":"10.3389","volume":"6","author":[{"given":"Kai","family":"Rothaus","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, St. Franziskus Hospital","place":["M\u00fcnster, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Gr\u00fcn","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, St. Franziskus 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