Impact of an Artificial Intelligence Algorithm on Diabetic Retinopathy Grading by Ophthalmology Residents

PurposeTo determine whether AI significantly affects the performance of diabetic retinopathy (DR) grading by ophthalmology residents. Secondary objectives included evaluation of AIs effects on intergrader variability, self-reported confidence, and decision making. MethodsFour ophthalmology residents at a single academic medical center across all years of training (PGY-2 to PGY-4) analyzed 265 retinal fundus photographs for diabetic retinopathy from a publicly available dataset without and with the assistance of an AI algorithm, separated by a 3-week washout period ResultsOverall, there was no significant difference without versus with AI in five-class grading, as measured by QWK, with differences ranging from +0.010-0.017, p=0.09-0.32. No significant difference without and with AI was observed for binary classification of referable DR, except for the specificity of the PGY-3 resident (71.8% to 80%, p=0.019). Intergrader agreement among residents significantly increased with AI (FK +0.072, p=0.0003). Self-reported confidence also significantly increased for 3 out of 4 residents. ConclusionThe use of an AI algorithm did not significantly affect the DR grading performance of ophthalmology residents but did increase intergrader agreement and self-reported confidence. Introducing AI into the ophthalmology residency curriculum may be beneficial as the technology becomes more prevalent. Summary StatementA cross-sectional study that evaluated the performance of ophthalmology residents grading diabetic retinopathy fundus photographs with and without the assistance of an artificial intelligence algorithm.