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Deep learning-based automated detection for diabetic retinopathy and diabetic macular oedema in retinal fundus photographs



To present and validate a deep ensemble algorithm to detect diabetic retinopathy (DR) and diabetic macular oedema (DMO) using retinal fundus images.


A total of 8739 retinal fundus images were collected from a retrospective cohort of 3285 patients. For detecting DR and DMO, a multiple improved Inception-v4 ensembling approach was developed. We measured the algorithm’s performance and made a comparison with that of human experts on our primary dataset, while its generalization was assessed on the publicly available Messidor-2 dataset. Also, we investigated systematically the impact of the size and number of input images used in training on model’s performance, respectively. Further, the time budget of training/inference versus model performance was analyzed.


On our primary test dataset, the model achieved an 0.992 (95% CI, 0.989–0.995) AUC corresponding to 0.925 (95% CI, 0.916-0.936) sensitivity and 0.961 (95% CI, 0.950–0.972) specificity for referable DR, while the sensitivity and specificity for ophthalmologists ranged from 0.845 to 0.936, and from 0.912 to 0.971, respectively. For referable DMO, our model generated an AUC of 0.994 (95% CI, 0.992–0.996) with a 0.930 (95% CI, 0.919–0.941) sensitivity and 0.971 (95% CI, 0.965–0.978) specificity, whereas ophthalmologists obtained sensitivities ranging between 0.852 and 0.946, and specificities ranging between 0.926 and 0.985.


This study showed that the deep ensemble model exhibited excellent performance in detecting DR and DMO, and had good robustness and generalization, which could potentially help support and expand DR/DMO screening programs.

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Fig. 1
Fig. 2: Performance of the model and ophthalmologists for classifying NRDR/RDR and NRDMO/RDMO on our primary test dataset.
Fig. 3: The impact of the input image size on model performance.


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The authors acknowledge Shanghai First People’s Hospital and Shanghai Ninth People’s Hospital for our help and support.


This work was supported by the National Natural Science Foundation of China (61905144), the National Key Research and Development Program of China (2016YFF0101400) and the National Natural Science Foundation of China (51675321).

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FL, LD and HJ have made contributions to the writing. YGW and LY implemented the deep learning algorithm. HDZ, TYX and MSJ acquired the data. XDZ and ZZW analyzed and interpreted the data. All authors were involved in the study design, and approval of the final manuscript.

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Correspondence to Minshan Jiang or Xuedian Zhang or Hong Jiang.

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Li, F., Wang, Y., Xu, T. et al. Deep learning-based automated detection for diabetic retinopathy and diabetic macular oedema in retinal fundus photographs. Eye (2021).

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