Presented in NIH's CME on 25 May 2023. Recording is available on Podcast and YouTube at https://www.podpage.com/clinical-updates-in-covid-19/use-of-artificial-intelligence-drmata-system-for-the-detection-and-intervention-of-diabetic-retinopathy/ https://www.youtube.com/live/pvhV_UBeBQA?feature=share

1. Datuk Dr. Nor Fariza Ngah
Pakar Perunding Kanan Oftalmologi, Hospital Shah Alam
CRC Shah Alam, ICR-NIH
USE OF ARTIFICIAL INTELLIGENCE (DR.MATA SYSTEM)
FOR THE DETECTION AND INTERVENTION OF
DIABETIC RETINOPATHY
NMRR-19-2260-50173
MOH MRG

2. Diabetic Retinopathy Inference with
Multi Artificial Neural Network Technology Automation

4. DIABETES MELLITUS – Local and Global Issue

5. COMPLICATION OF DIABETES MELLITUS –
Systemic and Ocular

6. SYMPTOMS OF DIABETIC RETINOPATHY

7. SCREENING FOR DIABETIC RETINOPATHY

8. CURRENT CHALLENGES IN DR SCREENING

9. DEVELOPMENT OF AI FOR DR SCREENING –
DR.MATA SYSTEM

10. CONCLUSION / TAKE HOME MESSAGE

13. More than 130 million people suffer some sort of eye damage

14. Diabetes in Malaysia

16. The costs of lost productivity and of rehabilitation and education
of the blind constitute a significant economic burden for the
individual, the family and society.
The economic effects of visual impairment can be divided into:
• Direct costs: medical and allied health services, pharmaceuticals
• Indirect costs: lost taxation revenue and the pain, suffering and
premature death that can result from visual impairment.
Blindness has profound human and socioeconomic
consequences in all societies.

17. Diabetes and Eye Complications
Diabetes
can affect
the whole
ocular
structure
From adnexa/
anterior segment/
posterior segment
as well as the Optic
nerve
Ocular effects include:
• Changing vision
• Dryness
• Diabetic retinopathy
• Diabetic macular edema
• Cataracts
• Glaucoma
Simple dry eyes- if
not treated
properly can lead
to cornea ulcer
blindness

18. Diabetic Retinopathy
• Diabetic retinopathy (DR) is a disease of the
retina caused by diabetes that involves
damage to tiny blood vessels in the back of
the eye.
• DR is a major cause of blindness globally
after cataract.
• Diagnosis and treatment of DR focus on
vascular abnormalities that appear at later
stages of the disease

19. Diabetic
Retinopathy
in Malaysia
In Malaysia, diabetic
eye disease is the
commonest cause of
visual loss among
adults of working age.
At diagnosis, less than
5% will have
retinopathy while the
prevalence rises to 40 -
50% after 10 years.
Almost all patients with
type 1 diabetes mellitus
(T1DM) and more than
60% patients with type 2
diabetes mellitus (T2DM)
have some degree of
retinopathy after 20 years
of the disease.
Prevalence of Diabetic
Retinopathy (DR) is
closely linked to the
duration of Diabetes
Mellitus (DM).

20. What are the symptoms of DR?
• No symptoms in
majority of cases
• Blurring of central
vision
• Generalised
blurring
• Floaters of black
spots/red spots
(blood)
• Distortion of
images (from
traction of the
retina)
• Pain and red eyes

21. Diabetic Retinopathy

22. CPG- Diabetic
Retinopathy
Screening

23. This is alarming
as DR is
asymptomatic in
its early stage
when it is most
amendable to
treatment.
However, the
National Health
and Morbidity
Survey (NHMS)
2015 reported
that only 47% of
patients with
known DM ever
had an eye
examination
It has been
recommended
that all DM
patients should
have at least a
yearly eye
examination

24. Following that the
patients will be
given referral to
see an
ophthalmologist,
if necessary, as
per clinical
practice
guidelines
recommendation
The goal
standard for
screening for
Diabetic
retinopathy is
using non
mydriatic fundus
camera, to detect
the retinal
changes by the
graders
Hence, any
national DR
screening
initiatives must be
comprehensive,
covering all
individuals with
DM in Malaysia.

25. Current Challenges
in DR Screening
DRS - done majority in
Health Care centres
(Klinik kesihatan)

26. Current Challenges
in DR Screening
Accessibility for
screening is unequal

27. Current Challenges
in DR Screening
Goal standard -
Non mydriatric
fundus camera

28. Current Challenges
in DR Screening
Photographer/ grader
~ same person/ two
tier system

29. Current Challenges
in DR Screening
Standard of graders

30. Current Challenges
in DR Screening
Immediate report/
delay report

31. Current Challenges
in DR Screening
Referral system

32. Artificial Intelligence for DR Screening

33. There are many available
systems in the current market
looking at AI for diabetic
retinopathy images.
Artificial Intelligence for DR Screening

34. However, majority of the
systems are only focusing on
the presence or absence of
disease and not able to give
the grading in detail.
Artificial Intelligence for DR Screening

35. Different grading severity
will require different referral
urgency
Artificial Intelligence for DR Screening

36. The earlier the patients been
referred; the earlier treatment
can be commenced and the
better the vision can be
preserved
Artificial Intelligence for DR Screening

37. Technology will always be part of eye health
Therefore thoughtful applications are needed to maximise the
potential of technology to improve the current challenges :
Coverage Accessibility Affordability Efficiency Effectiveness

43. SAMPLE RETINA IMAGES 14,334 IMAGES

44. SENSITIVITY : 87.17%
SPECIFICITY : 97.17%
ACCURACY : 93.3%
FINAL OUTCOME

45. UI – MAY / JUNE TO START AT 4 KKs

46. Take home message

47. Diabetic retinopathy is a preventable complication of DM
Early and timely screening with good control of DM will delay and reduce the
development of severe form of DR
Screening of DR can be done in any health center. However easy access,
affordable, effective dan efficient system is required to ensure that no one is
left behind
AI – will ensure that screening is fast / affordable and effective as well as
efficient as human graders
Early referral system can be generated to ensure patient is seen in timely
manner