Journal Article

Universal artificial intelligence platform for collaborative management of cataracts

Xu, Guihua, Xu, Fan, Chen, Lijian, Chen, Yanyi, Lin, Haotian, Ge, Zongyuan, Wu, Dongxuan, Xiang, Yifan, Wu, Jianghao, Liu, Yizhi, Yu, Tongyong, Huang, Yelin, Wu, Xiaohang, Chen, Chuan, Guo, Chong, Lai, Weiyi, Lin, Duoru, Lv, Jian, Liu, Congxin, Zhu, Yi, Wang, Ruixin, Du, Shaolin, Li, Cong, Zou, Minjie, Nie, Danyao, Wang, Dingding, Zhang, Kai, Chen, Kexin, Yang, Yahan, Jiang, Jiewei, Liu, Zhenzhen, Xiao, Chi, Chen, Weirong, Zhang, Xiayin, Zhu, Ke, Long, Erping, Xiong, Jianhao

2019

Overview

PurposeTo establish and validate a universal artificial intelligence (AI) platform for collaborative management of cataracts involving multilevel clinical scenarios and explored an AI-based medical referral pattern to improve collaborative efficiency and resource coverage.MethodsThe training and validation datasets were derived from the Chinese Medical Alliance for Artificial Intelligence, covering multilevel healthcare facilities and capture modes. The datasets were labelled using a three-step strategy: (1) capture mode recognition; (2) cataract diagnosis as a normal lens, cataract or a postoperative eye and (3) detection of referable cataracts with respect to aetiology and severity. Moreover, we integrated the cataract AI agent with a real-world multilevel referral pattern involving self-monitoring at home, primary healthcare and specialised hospital services.ResultsThe universal AI platform and multilevel collaborative pattern showed robust diagnostic performance in three-step tasks: (1) capture mode recognition (area under the curve (AUC) 99.28%–99.71%), (2) cataract diagnosis (normal lens, cataract or postoperative eye with AUCs of 99.82%, 99.96% and 99.93% for mydriatic-slit lamp mode and AUCs >99% for other capture modes) and (3) detection of referable cataracts (AUCs >91% in all tests). In the real-world tertiary referral pattern, the agent suggested 30.3% of people be ‘referred’, substantially increasing the ophthalmologist-to-population service ratio by 10.2-fold compared with the traditional pattern.ConclusionsThe universal AI platform and multilevel collaborative pattern showed robust diagnostic performance and effective service for cataracts. The context of our AI-based medical referral pattern will be extended to other common disease conditions and resource-intensive situations.

• Publisher: BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adolescent / Adult / Aged / Aged, 80 and over / Area Under Curve / Artificial Intelligence / Cataract - classification / Cataract - diagnosis / Cataract - epidemiology / Cataract Extraction / Cataracts / Clinical Science / Collaboration / Datasets / Female / Humans / Intersectoral Collaboration / Male / Mass Screening / Medical diagnosis / Medical referrals / Middle Aged / Public health / ROC Curve / Slit Lamp Microscopy / Vision Disorders - rehabilitation