Use of artificial intelligence with retinal imaging in screening for diabetes-associated complications: systematic review
Open accessAbstract
Background: Artificial Intelligence (AI) has been used to automate detection of retinal diseases from retinal images with great success, in particular for screening for diabetic retinopathy, a major complication of diabetes. Since persons with diabetes routinely receive retinal imaging to evaluate their diabetic retinopathy status, AI-based retinal imaging may have potential to be used as an opportunistic comprehensive screening for multiple systemic micro- and macro-vascular complications of diabetes. Methods: We conducted a qualitative systematic review on published literature using AI on retina images to detect systemic diabetes complications. We searched three main databases: PubMed, Google Scholar, and Web of Science (January 1, 2000, to October 1, 2024). Research that used AI to evaluate the associations between retinal images and diabetes-associated complications, or research involving diabetes patients with retinal imaging and AI systems were included. Our primary focus was on articles related to AI, retinal images, and diabetes-associated complications. We evaluated each study for the robustness of the studies by development of the AI algorithm, size and quality of the training dataset, internal validation and external testing, and the performance. Quality assessments were employed to ensure the inclusion of high-quality studies, and data extraction was conducted systematically to gather pertinent information for analysis. This study has been registered on PROSPERO under the registration ID CRD42023493512. Findings: From a total of 337 abstracts, 38 studies were included. These studies covered a range of topics related to prediction of diabetes from pre-diabetes or non-diabeticindividuals (n = 4), diabetes related systemic risk factors (n = 10), detection of microvascular complications (n = 8) and detection of macrovascular complications (n = 17). Most studies (n = 32) utilized color fundus photographs (CFP) as retinal image modality, while others employed optical coherence tomography (OCT) (n = 6). The performance of the AI systems varied, with an AUC ranging from 0.676 to 0.971 in prediction or identification of different complications. Study designs included cross-sectional and cohort studies with sample sizes ranging from 100 to over 100,000 participants. Risk of bias was evaluated by using the Newcastle-Ottawa Scale and AXIS, with most studies scoring as low to moderate risk. Interpretation: Our review highlights the potential for the use of AI algorithms applied to retina images, particularly CFP, to screen, predict, or diagnose the various microvascular and macrovascular complications of diabetes. However, we identified few studies with longitudinal data and a paucity of randomized control trials, reflecting a gap between the development of AI algorithms and real-world implementation and translational studies. Funding: Dr. Gavin Siew Wei TAN is supported by: 1. DYNAMO: Diabetes studY on Nephropathy And other Microvascular cOmplications II supported by National Medical Research Council (MOH-001327-03): data collection, analysis, trial design 2. Prognositc significance of novel multimodal imaging markers for diabetic retinopathy: towards improving the staging for diabetic retinopathy supported by NMRC Clinician Scientist Award (CSA)-Investigator (INV) (MOH-001047-00).
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Models constructed with clinical data such as electronic health records, laboratory tests, and imaging are the most widely used due to their high accessibility.
“At the feature level, models constructed with clinical data such as EHR [148, 149], laboratory tests [150, 151], and imaging [152, 153] are the most widely used due to their high accessibility.”
From Artificial intelligence-powered prediction of diabetic complications: from clinical data to molecular omics (2026) · cites this paper as [153]
The Introduction (page unavailable) describes retinal-imaging AI models and says retinal images can be obtained during routine examinations, making their use easy to scale. This supports the imaging example and its accessibility, but the paper does not establish that imaging-based models are among the most widely used model types. The EHR and laboratory-test examples have separate citations and are not attributed to this source. (LLM, conf=0.84)
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Mueller, S., Wintergerst, M. W. M., Falahat, P., Holz, F. G., Schaefer, C. A., Schahab, N., Finger, R. P., & Schultz, T. (2022) · Scientific Reports · doi:10.1038/s41598-022-05169-z · Cited by 35 · see citing works
Benhamza, M., Dahlui, M., & Said, M. A. (2024) · BMC Ophthalmology · doi:10.1186/s12886-024-03665-6 · Cited by 32 · see citing works
Khan, N. C., Perera, C. M., Dow, E. R., Chen, K., Mahajan, V. B., Mruthyunjaya, P., Diana, V., Leng, T., & Myung, D. J. (2022) · Diagnostics · doi:10.3390/diagnostics12071714 · Cited by 32 · see citing works
A deep learning model for screening type 2 diabetes from retinal photographs
Yun, J., Kim, J., Jung, S., Cha, S., Ko, S., Ahn, Y., Won, H., Sohn, K.-A., & Kim, D. (2022) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2022.01.010 · Cited by 31 · see citing works
Oculomics: A Crusade Against the Four Horsemen of Chronic Disease
Patterson, E. J., Bounds, A. D., Wagner, S. K., Kadri-Langford, R., Taylor, R., & Daly, D. S. (2024) · Ophthalmology and Therapy · doi:10.1007/s40123-024-00942-x · Cited by 31 · see citing works
Santos, A. R., Mendes, L. G. A., Madeira, M. H., Marques, I. P., Tavares, D., Figueira, J., Lobo, C. L., & Cunha-Vaz, J. G. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10102142 · Cited by 25 · see citing works
Mellor, J., Jiang, W., Fleming, A., McGurnaghan, S. J., Blackbourn, L. A. K., Styles, C., Storkey, A., McKeigue, P., & Colhoun, H. M. (2023) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2023.105072 · Cited by 25 · see citing works
Zee, B. C.-Y., Wong, Y. W. Y., Lee, J., Fan, Y., Zeng, J., Lam, B. Y. K., Wong, A., Shi, L., Lee, A. T. C., Kwok, C., et al. (2021) · Brain Communications · doi:10.1093/braincomms/fcab124 · Cited by 24 · see citing works
Self-citationBarriada, R. G., Simó‐Servat, O., Planas, A., Hernández, C., Simó, R., & Masip, D. (2022) · Applied Sciences · doi:10.3390/app12031401 · Cited by 22 · see citing works
Telemedicine for Diabetic Retinopathy Screening
Ting, D. S. W., & Tan, G. S. W. (2017) · JAMA Ophthalmology · doi:10.1001/jamaophthalmol.2017.1257 · Cited by 20 · see citing works
Self-citationWhite, T., Selvarajah, V., Sand, F. W., Svangård, N., Mohankumar, G., Fenici, P., Rough, K., Onyango, N. O., Lyons, K., Mack, C. D., et al. (2024) · Diabetes Obesity and Metabolism · doi:10.1111/dom.15587 · Cited by 19 · see citing works
Exploratory Study on Direct Prediction of Diabetes Using Deep Residual Networks
Abbasi-Sureshjani, S., Dashtbozorg, B., Romeny, B. M. T. H., & Fleuret, F. (2017) · Lecture notes in computational vision and biomechanics · doi:10.1007/978-3-319-68195-5_86 · Cited by 18 · see citing works
Identifying Peripheral Neuropathy in Colour Fundus Photographs Based on Deep Learning
Cervera, D. R., Smith, L., Díaz-Santana, L., Kumar, M., Raman, R., & Sivaprasad, S. (2021) · Diagnostics · doi:10.3390/diagnostics11111943 · Cited by 16 · see citing works
Nabrdalik, K., Irlik, K., Meng, Y., Kwiendacz, H., Piaśnik, J., Hendel, M., Ignacy, P., Kulpa, J., Kegler, K., Herba, M., et al. (2024) · Cardiovascular Diabetology · doi:10.1186/s12933-024-02367-z · Cited by 16 · see citing works
Tomić, M., Vrabec, R., Hendelja, Đ., Kolarić, V., Bulum, T., & Rahelić, D. (2023) · Biomedicines · doi:10.3390/biomedicines12010034 · Cited by 14 · see citing works
DeBuc, D. C. (2023) · The Lancet Digital Health · doi:10.1016/s2589-7500(23)00047-x · Cited by 12 · see citing works
Evaluation of a self-imaging OCT for remote diagnosis and monitoring of retinal diseases
Liu, Z., Huang, W., Wang, Z., Jin, L., Congdon, N. G., Zheng, Y., Chen, S., & Liu, Y. (2023) · British Journal of Ophthalmology · doi:10.1136/bjo-2023-324012 · Cited by 10 · see citing works
Carrillo-Larco, R. M., Bravo-Rocca, G., Castillo‐Cara, M., Xu, X., & Bernabé‐Ortiz, A. (2024) · Primary care diabetes · doi:10.1016/j.pcd.2024.04.002 · Cited by 9 · see citing works
Tan, R., Teo, K. Y. C., Husain, R., Tan, N. C., Lee, Q. X., Hamzah, H., Wong, T. T. L., Aung, T., Cheng, C., Lamoureux, E. L., et al. (2023) · British Journal of Ophthalmology · doi:10.1136/bjo-2023-323339 · Cited by 8 · see citing works
Self-citationWei, J., Xu, Y., Wang, H., Niu, T., Jiang, Y. C., Shen, Y., Li, S., Dou, T., Peng, Y., Bi, L., et al. (2024) · Computer Methods and Programs in Biomedicine · doi:10.1016/j.cmpb.2024.108382 · Cited by 8 · see citing works
Morpho-mechanistic screening criteria for the echocardiographic detection of rheumatic heart disease
Hunter, L. D., Doubell, A. F., Pecoraro, A. J. K., Monaghan, M. J., Lloyd, G., Lombard, C. J., & Herbst, P. G. (2023) · Heart · doi:10.1136/heartjnl-2022-322192 · Cited by 6 · see citing works
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4 of the 98 references couldn’t be matched to a known paper.
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Oculomics: Current concepts and evidence
Zhu, Z., Wang, Y., Qi, Z., Hu, W., Zhang, X., Wagner, S. K., Wang, Y., Ran, A. R., Ong, J., Waisberg, E., et al. (2025) · Progress in Retinal and Eye Research · doi:10.1016/j.preteyeres.2025.101350 · Cited by 94 · see citing works
Self-citationSacchini, F., Mancin, S., Cangelosi, G., Palomares, S. M., Caggianelli, G., Gravante, F., & Petrelli, F. (2025) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2025.109139 · Cited by 17 · see citing works
Cangelosi, G., Conti, A., Caggianelli, G., Panella, M., Petrelli, F., Mancin, S., Ratti, M., & Masini, A. (2025) · Medicina · doi:10.3390/medicina61081403 · Cited by 14 · see citing works
Artificial Intelligence in Ocular Drug Delivery: Precision Drug Delivery's New Horizon
Srivastava, V., Yadav, P., Yadav, A., & Parashar, P. (2025) · AAPS PharmSciTech · doi:10.1208/s12249-025-03271-9 · Cited by 9 · see citing works
Retinal microvascular biomarkers for cardiovascular risk stratification: Insights from OCTA and AI
Wang, T., Li, H., Wang, C., Li, X., Deng, A., & Jiao, X. (2025) · Experimental Eye Research · doi:10.1016/j.exer.2025.110815 · Cited by 6 · see citing works
Self-citationGhamdi, M. A., & Alyahyan, S. Y. (2026) · Applied Sciences · doi:10.3390/app16063024 · Cited by 6 · see citing works
Agrawal, L., Agrawal, P. K., Agrawal, S. S., Sonune, M. S., Kadu, R. K., Kulkarni, M. B., & Bhaiyya, M. L. (2026) · Graefe s Archive for Clinical and Experimental Ophthalmology · doi:10.1007/s00417-026-07273-6 · Cited by 6 · see citing works
Chen, Q., Chen, Y., Mou, K., & Zhang, M. (2025) · Biomedicines · doi:10.3390/biomedicines13061306 · Cited by 6 · see citing works
Lim, S. K., Nam, G. E., & Sharma, A. M. (2025) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2025.0278 · Cited by 5 · see citing works
Xie, X., Wu, C., Huang, Z., Zhou, Y., Huang, J., Dao, F., Yan, D., Deng, K., Lyu, H., Ma, C., et al. (2026) · Briefings in Bioinformatics · doi:10.1093/bib/bbag083 · Cited by 4 · see citing works
Liu, C., Duan, Y., Wu, H., & Duan, J. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1724001 · Cited by 4 · see citing works
The Danish Ophthalmological Society guidelines for screening of diabetic retinopathy
Grauslund, J., Andersen, N., Andresen, J. L., Bek, T., Knudsen, S. T., & Subhi, Y. (2025) · AJO International · doi:10.1016/j.ajoint.2025.100141 · Cited by 4 · see citing works
Sheng, Q., Dong, Q., Wu, S., & Liang, W. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2026.1923216 · Cited by 3 · see citing works
Role of retinal biomarkers in diabetes detection and risk prediction: A systematic scoping review
Kaup, S., Bhat, S., Reardon, E. E., Prathiba, V., Rajalakshmi, R., Carrillo-Larco, R. M., Jagannathan, R., Anjana, R. M., Ali, M. K., Mohan, V., et al. (2026) · Diabetes & Metabolic Syndrome Clinical Research & Reviews · doi:10.1016/j.dsx.2026.103405 · Cited by 2 · see citing works
Singh, A. K., Pandey, G., Kolipaka, T., & Srivastava, S. (2026) · BioNanoScience · doi:10.1007/s12668-026-02733-z · Cited by 2 · see citing works
Artificial Intelligence and Machine Learning Approaches in Radiology for Medical Imaging Diagnostics
Gomase, V. S., & Ghatule, A. P. (2025) · Recent Advances in Electrical & Electronic Engineering (Formerly Recent Patents on Electrical & Electronic Engineering) · doi:10.2174/0123520965407792250811093550 · Cited by 1 · see citing works
Miller, M. N., Hsu, D., Tailor, P. D., & Starr, M. R. (2026) · Current Opinion in Ophthalmology · doi:10.1097/icu.0000000000001225 · Cited by 1 · see citing works
Du, K., Zheng, Y., & Wang, Z. (2026) · Frontiers in Neurology · doi:10.3389/fneur.2026.1885303 · Cited by 1 · see citing works
Treatment Options for Diabetic Neuropathy: Insights from the Romanian Neuropathy Guidelines
Nica, A. E., Parliteanu, O. A., Claudia, S., Dobjanschi, C. G., Rusu, E., & Radulian, G. (2025) · IntechOpen eBooks · doi:10.5772/intechopen.1009813 · Cited by 1 · see citing works
Kar, S., Akib, A. S. M. A. S., Hasib, A., Yaser, S., & Azim, A. B. (2026) · Communications in computer and information science · doi:10.1007/978-981-95-7292-2_21 · Cited by 1 · see citing works
Das Potenzial von künstlicher Intelligenz in der Diabetologie
Tan, S., Lee-Barkey, Y. H., Kulzer, B., Hermanns, N., & Ehrmann, D. (2025) · Die Diabetologie · doi:10.1007/s11428-025-01362-6
Modern Machine Learning Approaches for Predicting Type 2 Diabetes Mellitus
Butkova, T. V., Kulikova, L. I., Malsagova, K. A., Petrovskiy, D. V., Rudnev, V. R., Анатольевна, Р. Е., Kulikov, A. V., & Kaysheva, A. L. (2025) · Mathematical Biology and Bioinformatics · doi:10.17537/2025.20.301
Esserkassi, B., Boujelb, Z., Eddarouich, S., & Bourouhou, A. (2025) · Data & Metadata · doi:10.56294/dm20251220
Applications of Artificial Intelligence in Peripheral Neuropathy: A Systematic Review
Sutha, A. A. N. A. B., Sharon, Rahman, D. N., Amanah, S. R., Wicaksono, T. B., Sofiana, D., & Hermawan, G. M. (2023) · Medicinus · doi:10.19166/med.v13i1.10778
A Multimodal Deep Learning Based System for Diabetics and Retinal Complication Detection
Jobin, T., & Jacob, P. M. (2025) · International Conference on Advances in Computation, Communication and Information Technology (ICAICCIT) · doi:10.1109/icaiccit68829.2025.11434427
Use of Artificial Intelligence in Biomedical Imaging Systems
Pandey, S., Shekher, S., Das, S., & Kothari, A. (2026) · IGI Global eBooks · doi:10.4018/979-8-3373-7183-2.ch001
A Deep Learning Prognostic Model for Diabetes Patients Using Bilateral Fundus Imaging
Lai, Y.-M., Chung, I.-F., Huang, S.-H., Sheu, W. H., Liang, K.-H., & Chen, H.-S. (2026) · Journal of Diabetes Science and Technology · doi:10.1177/19322968261434035
The Potential of AI in Reducing Human Error and Enhancing Safety in the Nigerian Aviation Sector
Uhuegho, K. O., Anas, M. M., Gwems, J., Na'Allah, A., & Fadele, A. A. (2026) · Advances in Multidisciplinary & Scientific Research Journal Publication · doi:10.22624/aims/bhi/v12n1p3
A Deep Dive into Healthcare Related Vision AI Applications
Chu, N. N., & Dhankar, S. (2026) · International Conference on Artificial Intelligence, Computer, Data Sciences and Applications (ACDSA) · doi:10.1109/acdsa67686.2026.11467888
Huang, L., Lu, H., Yang, M., Liu, Y., Wang, H., & Zhang, K. C. (2026) · Frontiers in Digital Health · doi:10.3389/fdgth.2026.1768780
Noman, A. A., Debi, C. R., Haque, M. A., Mukta, A. A., Rahman, F., & Khaliluzzaman, M. (2025) · IEEE International Conference on Biomedical Engineering, Computer and Information Technology for Health (BECITHCON) · doi:10.1109/becithcon69222.2025.11504152
DRFEC-Net: A Framework for Accurate Diabetic Retinopathy Classification
Basreddy, V., & Veerashetty, S. S. (2026) · IEEE International Conference for Convergence in Computing Technology (I3CTCON) · doi:10.1109/i3ctcon68242.2026.11507608
Jayaswal, R. P., CHANU, T. Z., Kapani, V., Pankaj, P. P., & Kant, R. (2026) · International Journal of Diabetes in Developing Countries · doi:10.1007/s13410-026-01690-3
Effect of RAS inhibitors on retinal microvasculature in DKD using AI-based ultra-wide-field images
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范泽月, Qin, Y., Chen, L., Yuan, J., Xiong, Z., Chen, X., Lai, S., Tham, Y. C., Sheng, B., Wang, X., et al. (2026) · PLOS Digital Health · doi:10.1371/journal.pdig.0001347
Self-citationThe Retina as a Window to Metal-Induced Neurotoxicity
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AI-Based Diagnosis of Diabetic Retinopathy Using Fundus Images
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USO DA INTELIGÊNCIA ARTIFICIAL NO DIAGNÓSTICO E ACOMPANHAMENTO DAS DOENÇAS DA RETINA
RIBEIRO, B. V. L., de Mello, E. M. F., Souza, Â. G. M., Coelho, C. C. S., Garrote, G. B., Scatolin, J. F. N., Pretti, P. U., Takahashi, J. N., Lopes, I. P., PEREIRA, Y. C. D. F., et al. (2026) · Editora Pasteur eBooks · doi:10.59290/4199320006
- Authors
- Yang, Q., Bee, Y. M., Lim, C. C., Sabanayagam, C., Yim-Lui Cheung, C., Wong, T. Y., Ting, D. S. W., Lim, L.-L., Li, H., He, M., Lee, A. Y., Shaw, A. J., Keong, Y. K., & Wei Tan, G. S.
- Affiliations
- Singapore National Eye Center (SG)
- Singapore General Hospital (SG)
- Tianjin Medical University Eye Hospital (CN)
- University of Malaya (MY)
- Shanghai Jiao Tong University (CN)
- Hong Kong Polytechnic University (HK)
- University of Washington (US)
- Duke University (US)
- National Heart Centre Singapore (SG)
- ORCID
- Venue
- eClinicalMedicine
- Publisher
- Elsevier BV
- Published
- 2025-03
- Volume
- 81
- Pages
- 103089
- ISSN
- 2589-5370 (ISSN-L)
- PMC
- PMC11883405
- OpenAlex
- W4407698494
- Cited by
- 38
- References
- 98
- Citations by year
- 2026: 23 · 2025: 15
- FWCI
- 6.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- EClinicalMedicine (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PolyU Institutional Research Archive (Hong Kong Polytechnic University) (publishedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Medical Research Council (OFLCG/001/2017, MOH-CSAINV21jun-005, MOHOFLCG22may-0003)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Health Sciences › Health Professions › Health Information Management › Artificial Intelligence in Healthcare
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Keywords
- artificial intelligence, retinal imaging, diabetic retinopathy, diabetes complications, diabetic microvascular complications, diabetic macrovascular complications, color fundus images, optical coherence tomography, opportunistic screening, diabetes prediction, retinal biomarkers, deep learning, risk of bias, external validation, training data quality, algorithm interpretability, explainable AI, clinical implementation barriers, health equity
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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