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International journal of ophthalmology

Why Isn't AI in Eye Clinics Yet? A Systematic Review of Barriers and Pathways for AI-Based Fundus Image Diagnostics

This systematic review evaluates 34 studies from 2018 to 2025, finding that AI often exceeds 90% accuracy and can match or outperform expert clinicians in diagnosing common ocular diseases such as diabetic retinopathy, glaucoma, retinopathy of prematurity, and age-related macular degeneration, yet real-world deployment remains constrained by three gaps—disjointed integration into clinical workflows, lack of transparency in AI decision-making, and poor generalizability across diverse populations—and it proposes actionable pathways to bridge the "last-mile gap" between research and clinical practice.