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. 2023 Feb 6;108(2):268–273. doi: 10.1136/bjo-2022-322237

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© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Retinal photographs of the 8/217 eyes diagnosed as vision-threatening diabetic retinopathy (vtDR) by the reference standard but missed by the deep learning system (DLS). According to the reference standard, A–F were graded as diabetic macular oedema (DMO), G was graded as proliferative diabetic retinopathy and H as severe non-proliferative diabetic retinopathy (NPDR). The DLS graded C as mild NPDR and the remainder as moderate NPDR, all without DMO. The single retinal specialist agreed with the DLS classification of no vtDR in all cases except D.