Toward Personalized Diabetic Retinopathy Screening: Deep Learning Fundus Image Analysis and Clinical Risk Factors

Diabetic retinopathy (DR) screening commonly relies on fixed follow-up intervals, although progression risk differs across patients. We developed a preliminary image-clinical framework to support personalized follow-up recommendations from retinal fundus images and systemic risk factors. Public DR datasets were harmonized into a binary task distinguishing absence of DR from DR of any grade. An ImageNet-pretrained ResNet50 and a foundation model-based feature extraction pipeline were compared. The selected image model was integrated with literature-derived severe retinopathy progression curves and clinical risk modifiers to estimate personalized cumulative risk and assign follow-up intervals using a predefined acceptable risk threshold. The ResNet50-based model was selected for subsequent analyses. In the target cohort, the integrated model assigned 90.0\% of patients to follow-up within 12 months. Clinical adjustment substantially modified image-only recommendations, generally shifting patients toward shorter intervals. These preliminary findings support the feasibility of combining image-derived estimates of baseline DR status with clinical modifiers to inform personalized screening intervals. Larger longitudinal studies are needed to validate calibration, clinical utility, and safety before real-world implementation.