The UK National Screening Committee (UK NSC) has opened a consultation on evidence relating to the use of automated grading using AI in the diabetic eye screening (DES) programme.
The UK NSC does not currently recommend the incorporation of automated grading in the DES programme. This topic was first reviewed in 2021 when an evidence summary was commissioned to evaluate the use of Automated Retinal Image Analysis Systems (ARIASs). Evidence summaries are comprehensive, question-led reports that evaluate whether new evidence warrants updating screening recommendations.
The 2021 review concluded that, although ARIASs showed promise, the evidence base was insufficient to support widespread implementation of ARIAS at that time. In 2024, the topic was re-submitted to the UK NSC via the open call process. Another evidence summary was commissioned to review the literature published on the topic since the 2021 evidence summary.
The new review concludes that some ARIAS are as good as the first human grader and could be tested in real world NHS services, enabling information to be collected about the effect of ARIAS on patients, staff, and costs.
We have now opened a consultation to ask stakeholders and members of the public to provide feedback on the new evidence summary and its conclusions.
The consultation responses will be collated and reviewed so the UK NSC can consider them before making an updated recommendation.
How to respondTo take part in the consultation, download the consultation documents by clicking on the grey ‘View documents’ button on the UK NSC’s Diabetic retinopathy recommendation page. Then submit your response by clicking on the green ‘Submit comments’ button.
The deadline for responses is 11.59pm BST on Monday 3 August 2026.
About diabetic eye disease and automated gradingDiabetes is a health condition which causes a person’s blood sugar level to be too high. This can harm the retina located at the back of the eye. Damage to the retina, called diabetic retinopathy, can cause loss of eyesight if not found and treated early.
In the UK, people aged 12 and over who have diabetes are invited for a regular eye screening test every 1 or 2 years. Pictures of the back of the eyes are assessed for changes or signs of damage by trained staff, known as primary (or first) graders. Pictures that show eye damage or are hard to read go to a second grader for a second opinion. If the 2 graders do not agree, the pictures go to a third grader to make a final decision.
Individuals who have no signs of eye damage or only mild changes are recalled for their next screening test in 1 or 2 years’ time. People found to have more significant changes may need more tests and treatment. The screening process takes a lot of staff time. As the number of people with diabetes increases, so does the workload of the NHS DES Programme.
ARIAS are software systems which are trained on clinical images and aim to grade patient images at the level of a primary (or first) grader using artificial intelligence.
The evidenceThe 2025 evidence summary identified the following new published evidence since the evidence was collated for the 2021 review:
1. Two new studies from the UK and 5 from similar countries (including Europe and the USA) compared ARIAS to the performance of human graders in detecting diabetic eye disease. The studies found:
most ARIAS are as good as human graders at finding people with more severe diabetic eye disease most ARIAS are not as good as human graders at finding people who do not have eye disease at all the performance of ARIAS differs depending on which company made it, and where it was used some ARIAS may perform differently based on patient ethnicity or age2. Four new studies looked at how ARIAS use affects patients, staff, and a screening programme. It was not clear if the results represented what would happen if ARIAS were introduced in the UK. No studies looked at any other outcomes of using ARIAS.
3. No new UK-based studies looked at whether ARIAS were good value for money.
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seen at 11:32, 11 May in UK National Screening Committee.