Prospective pragmatic trial of automated retinal photography and AI glaucoma screening in Australian primary care

Abstract There are no prospective clinical studies evaluating artificial intelligence implementation for glaucoma detection in real-world settings. We developed an automated retinal photography and AI-based screening system and prospectively assessed its accuracy, feasibility, and acceptability in Australian general practice (GP) clinics. Adults aged 50 years or older were recruited during routine GP visits, with retinal images captured using an automated fundus camera and analysed by the AI system for glaucoma risk classification. Of 414 participants, 277 (66.9%) had analysable images, with a total of 483 eyes included. The AI system achieved an AUROC of 0.80, sensitivity of 65.0%, and specificity of 94.6%. Among 161 previously undiagnosed patients, 18 (11.2%) were identified as referable glaucoma. Patient feedback was positive, and clinic staff supported AI-assisted screening to enhance glaucoma care. Despite challenges such as lower sensitivity and image acquisition limitations, the system shows promise for opportunistic screening in primary care settings.