Hybrid and transformer based artificial intelligence for diabetic retinopathy diagnosis a systematic review of methods challenges and clinical readiness
TL;DR
This systematic review examines 27 recent studies to map the evolving landscape of AI-driven DR diagnosis and argues that future efforts must prioritize lightweight, interpretable, and temporally aware AI systems that integrate multimodal patient data.
Abstract
Diabetic retinopathy (DR) remains a leading cause of preventable blindness worldwide, placing a growing burden on healthcare systems. While artificial intelligence (AI) offers promising tools for early detection and scalable screening, its transition from research to real-world clinical use faces significant hurdles. This systematic review, guided by PRISMA principles, examines 27 recent studies (2023–2025) to map the evolving landscape of AI-driven DR diagnosis. We categorize approaches into five families: convolutional neural networks (CNNs), hybrid CNN–machine learning models, transformer-based architectures, clinical data–driven predictors, and multimodal fusion systems. Our analysis reveals that while transformers excel in severity grading and hybrid models demonstrate practical robustness, critical gaps persist—including poor early-DR sensitivity, limited generalizability across imaging devices, and a lack of clinical explainability. We argue that future efforts must prioritize lightweight, interpretable, and temporally aware AI systems that integrate multimodal patient data. By bridging technical innovation with clinical pragmatism, this review aims to accelerate the development of deployable AI solutions for global DR screening.