Integration of Teleretinal and AI-based Screening in Diabetic Retinopathy Management

Authors

• Darrin Cottle, University of LynchburgFollow

Specialty

Primary Care, Family Medicine

Advisor

Debra Munsell, DHSc PA-C DFAAPA

Abstract

ABSTRACT

Diabetic retinopathy remains a primary cause of preventable blindness among working-age adults in the United States, yet significant quality gaps in screening compliance persist.

This review examines how the integration of teleretinal and artificial intelligence (AI) based screening into primary care addresses barriers to access, promotes health equity, and enhances clinical follow-up, while identifying the critical need for longitudinal data linking these technologies to long-term vision preservation.  A comprehensive synthesis of clinical trials, systematic reviews, and meta-analyses published through 2025 was conducted in PubMed. Current evidence indicates these digital modalities achieve high diagnostic precision; AI-based screening, in particular, demonstrates 94% sensitivity and 94% specificity, frequently outperforming manual screening in undilated eyes. Point-of-care AI screening nearly doubles the likelihood of ophthalmologic evaluation (OR = 1.89) and substantially increases follow-up rates, from 22% to 64%. Furthermore, large-scale implementation proves to be a powerful tool for health equity, notably narrowing the screening adherence gap between Black and Asian American patients from 15.6% to 3.5%.  From a systemic perspective, these programs optimize specialist resources by filtering for referrable disease, proving cost-effective for both patients and health systems.  Despite marked improvements in access, early detection, and satisfaction, a critical data gap remains.  Future research must pivot from measuring process-oriented metrics, such as screening completion, to evaluating longitudinal, patient-centered outcomes, specifically the prevention of legal blindness and long-term vision loss.

Key Words: diabetic retinopathy; artificial intelligence; teleretinal screening; primary care

Recommended Citation

Cottle D. Integration of Teleretinal and AI-based Screening in Diabetic Retinopathy Management. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).