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The early detection of glaucoma is essential in preventing visual impairment. Artificial intelligence (AI) can be used to analyze color fundus photographs (CFPs) in a cost-effective manner, making glaucoma screening more accessible. While AI models for glaucoma screening from CFPs have shown promising results in laboratory settings, their performance decreases significantly in real-world scenarios due to the presence of out-of-distribution and low-quality images. To address this issue, we propose the Artificial Intelligence for Robust Glaucoma Screening (AIROGS) challenge. This challenge includes a large dataset of around 113,000 images from about 60,000 patients and 500 different screening centers, and encourages the development of algorithms that are robust to ungradable and unexpected input data. We evaluated solutions from 14 teams in this paper and found that the best teams performed similarly to a set of 20 expert ophthalmologists and optometrists. The highest-scoring team achieved an area under the receiver operating characteristic curve of 0.99 (95% CI: 0.98-0.99) for detecting ungradable images on-the-fly. Additionally, many of the algorithms showed robust performance when tested on three other publicly available datasets. These results demonstrate the feasibility of robust AI-enabled glaucoma screening.

BackgroundEvidence on the practical application of artificial intelligence (AI)-based diabetic retinopathy (DR) screening is needed.MethodsConsented participants were screened for DR using retinal imaging with AI interpretation from March 2021 to June 2021 at four diabetes clinics in Rwanda. Additionally, images were graded by a UK National Health System-certified retinal image grader. DR grades based on the International Classification of Diabetic Retinopathy with a grade of 2.0 or higher were considered referable. The AI system was designed to detect optic nerve and macular anomalies outside of DR. A vertical cup to disc ratio of 0.7 and higher and/or macular anomalies recognised at a cut-off of 60% and higher were also considered referable by AI.ResultsAmong 827 participants (59.6% women (n=493)) screened by AI, 33.2% (n=275) were referred for follow-up. Satisfaction with AI screening was high (99.5%, n=823), and 63.7% of participants (n=527) preferred AI over human grading. Compared with human grading, the sensitivity of the AI for referable DR was 92% (95% CI 0.863%, 0.968%), with a specificity of 85% (95% CI 0.751%, 0.882%). Of the participants referred by AI: 88 (32.0%) were for DR only, 109 (39.6%) for DR and an anomaly, 65 (23.6%) for an anomaly only and 13 (4.73%) for other reasons. Adherence to referrals was highest for those referred for DR at 53.4%.ConclusionDR screening using AI led to accurate referrals from diabetes clinics in Rwanda and high rates of participant satisfaction, suggesting AI screening for DR is practical and acceptable.

Objectives: To evaluate the performance of a deep learning based Artificial Intelligence (AI) software for detection of glaucoma from stereoscopic optic disc photographs, and to compare this performance to the performance of a large cohort of ophthalmologists and optometrists. Methods: A retrospective study evaluating the diagnostic performance of an AI software (Pegasus v1.0, Visulytix Ltd., London UK) and comparing it with that of 243 European ophthalmologists and 208 British optometrists, as determined in previous studies, for the detection of glaucomatous optic neuropathy from 94 scanned stereoscopic photographic slides scanned into digital format. Results: Pegasus was able to detect glaucomatous optic neuropathy with an accuracy of 83.4% (95% CI: 77.5–89.2). This is comparable to an average ophthalmologist accuracy of 80.5% (95% CI: 67.2–93.8) and average optometrist accuracy of 80% (95% CI: 67–88) on the same images. In addition, the AI system had an intra-observer agreement (Cohen’s Kappa, ?) of 0.74 (95% CI: 0.63–0.85), compared with 0.70 (range: -0.13–1.00; 95% CI: 0.67–0.73) and 0.71 (range: 0.08–1.00) for ophthalmologists and optometrists, respectively. There was no statistically significant difference between the performance of the deep learning system and ophthalmologists or optometrists. Conclusion: The AI system obtained a diagnostic performance and repeatability comparable to that of the ophthalmologists and optometrists. We conclude that deep learning based AI systems, such as Pegasus, demonstrate significant promise in the assisted detection of glaucomatous optic neuropathy.

Adherent cell lines are widely used across all fields of biology, including drug discovery, toxicity studies, and regenerative medicine. However, adherent cell processes are often limited by a lack of advances in cell culture systems. While suspension culture processes benefit from decades of development of instrumented bioreactors, adherent cultures are typically performed in static, noninstrumented flasks and well-plates. We previously described a microfabricated bioreactor that enables a high degree of control on the microenvironment of the cells while remaining compatible with standard cell culture protocols. In this report, we describe its integration with automated image-processing capabilities, allowing the continuous monitoring of key cell culture characteristics. A machine learning–based algorithm enabled the specific detection of one cell type within a co-culture setting, such as human embryonic stem cells against the background of fibroblast cells. In addition, the algorithm did not confuse image artifacts resulting from microfabrication, such as scratches on surfaces, or dust particles, with cellular features. We demonstrate how the automation of flow control, environmental control, and image acquisition can be employed to image the whole culture area and obtain time-course data of mouse embryonic stem cell cultures, for example, for confluency.