Objective: Diabetic Retinopathy (DR) is a highly threatening microvascular complication of diabetes mellitus. Diabetic patients must be screened annually for DR; however, it is practically not viable due to the high volume of patients, lack of resources, economic burden, and cost of the screening procedure. The use of machine learning (ML) classifiers in medical science is an emerging frontier and can help in assisted diagnosis. The few available proposed models perform best when used in similar population cohorts and their external validation has been questioned. Therefore, the purpose of our research is to classify the DR using different ML methods on Saudi diabetic data, propose the best method based on accuracy and identify the most discriminative interpretable features using the socio-demographic and clinical information.
Patients and methods: This cross-sectional study was conducted among 327 diabetic patients in Almajmaah, Saudi Arabia. Socio-demographic and clinical data were collected using a systematic random sampling technique. For DR classification, ML algorithm including, linear discriminant analysis, support vector machine, K nearest neighbor, random forest and its variate ranger random forest classifiers were used through cross-validation resampling procedure.
Results: In classifying DR, ranger random forest outperforms the other methods by accurately classifying 86% of the DR patients on the test data. HbA1c (p<0.001) and duration of diabetes (p<0.001) were the most influential risk factor that best discriminated the DR patients. Other influential risk factors were the body mass index (p<0.001), age-onset (p<0.001), age (p<0.001), systolic blood pressure (p<0.05), and the use of medication (p<0.05) that significantly discriminated the DR patients.
Conclusions: Based on the present study findings, integrating ophthalmology and ML can transform diagnosing the disease pattern that can help generate a compelling clinical effect. ML can be used as an added tool for clinical decision-making and must not be the sole substitute for a clinician. We will work to examine the classification performance of multi-class data using more sophisticated ML methods.