  Diabetic eye disease is one of the fastest growing causes of preventable
blindness. With the advent of anti-VEGF (vascular endothelial growth factor)
therapies, it has become increasingly important to detect center-involved
diabetic macular edema (ci-DME). However, center-involved diabetic macular
edema is diagnosed using optical coherence tomography (OCT), which is not
generally available at screening sites because of cost and workflow
constraints. Instead, screening programs rely on the detection of hard exudates
in color fundus photographs as a proxy for DME, often resulting in high false
positive or false negative calls. To improve the accuracy of DME screening, we
trained a deep learning model to use color fundus photographs to predict
ci-DME. Our model had an ROC-AUC of 0.89 (95% CI: 0.87-0.91), which corresponds
to a sensitivity of 85% at a specificity of 80%. In comparison, three retinal
specialists had similar sensitivities (82-85%), but only half the specificity
(45-50%, p<0.001 for each comparison with model). The positive predictive value
(PPV) of the model was 61% (95% CI: 56-66%), approximately double the 36-38% by
the retinal specialists. In addition to predicting ci-DME, our model was able
to detect the presence of intraretinal fluid with an AUC of 0.81 (95% CI:
0.81-0.86) and subretinal fluid with an AUC of 0.88 (95% CI: 0.85-0.91). The
ability of deep learning algorithms to make clinically relevant predictions
that generally require sophisticated 3D-imaging equipment from simple 2D images
has broad relevance to many other applications in medical imaging.
