Abstract
Diabetic retinopathy is one of the leading causes of avoidable blindness among adults globally, and screening programmes can enable early diagnosis and prevention of progression. Artificial intelligence (AI) diagnostic solutions have been developed to diagnose diabetic retinopathy. The aim of this review is to identify ethical concerns related to AI-enabled diabetic retinopathy diagnostics and enable future research to explore these issues further. This is a narrative review that uses thematic analysis methods to develop key findings. We searched two databases, PubMed and Scopus, for papers focused on the intersection of AI, diagnostics, ethics, and diabetic retinopathy and conducted a citation search. Primary research articles published in English between 1 January 2013 and 14 June 2024 were included. From the 1878 papers that were screened, nine papers met inclusion and exclusion criteria and were selected for analysis. We found that existing literature highlights ensuring patient data has appropriate protection and ownership, that bias in algorithm training data is minimised, informed patient decision-making is encouraged, and negative consequences in the context of clinical practice are mitigated. While the technical developments in AI-enabled diabetic retinopathy diagnostics receive the bulk of the research focus, we found that insufficient attention is paid to how this technology is accessed equitably in different settings and which safeguards are needed against exploitative practices. Such ethical issues merit additional exploration and practical problem-solving through primary research. AI-enabled diabetic retinopathy screening has the potential to enable screening at a scale that was previously not possible and could contribute to reducing preventable blindness. It will only achieve this if ethical issues are emphasised, understood, and addressed throughout the translation of this technology to clinical practice.
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