Aim: To evaluate a real-world clinical integration of an autonomous artificial intelligence (AI) system (AEYE Diagnostic Screening (AEYE-DS), AEYE Health, USA) for diabetic retinopathy (DR) screening using the Topcon NW500 camera (Topcon, Japan) in an endocrinology clinic. Methods: Adults with type 1 or type 2 diabetes without previously reported DR attending routine endocrinology follow-up were invited to participate. Non-mydriatic, macula-centred fundus photographs were acquired by a novice, non-ophthalmic operator. Images were analysed by AEYE-DS to detect more-than-mild DR (mtmDR). AI-positive results prompted physician counselling and automated referral for internal confirmatory examination. Results: Definitive AEYE-DS results were obtained for 95.7% (245/256) of participants without pharmacological dilation. Seventy-six (29.6%) patients screened positive for mtmDR, of whom 34 (44.7%) completed confirmatory examination at the institution’s retina clinic; externally completed follow-up was not captured. Four patients (11.8% of those evaluated) required treatment with intravitreal anti-vascular endothelial growth factor therapy or panretinal photocoagulation. Additional previously unrecognised ocular conditions were identified among several AI-positive patients. Patient satisfaction was high, with >80% reporting the screening was easy to use, time-efficient and recommendable. Conclusions: In a real-world endocrinology clinic, autonomous AI screening for DR using AEYE-DS integrated with the Topcon NW500 enabled efficient DR screening and achieved high non-mydriatic imageability. A clinically relevant proportion of patients requiring ophthalmic evaluation has been captured. Internal referral for confirmatory testing enabled assessment of downstream outcomes. The findings support scalable, point-of-care autonomous screening and a stepped-referral approach for AI-positive patients.

Objectives: Axial myopia is a risk factor for glaucoma, yet the mechanism(s) linking axial length (AL) to visual field (VF) damage remain unclear. This pilot study investigates to what extent peripapillary vessel density (pVD) mediates the relationship between AL and VF outcomes in patients with primary open-angle glaucoma (POAG). Methods: This cross-sectional pilot study included a primary cohort of 26 POAG eyes with directly measured AL, with an exploratory expanded cohort of 71 POAG eyes used to assess the consistency of findings. Optical coherence tomography angiography quantified pVD across eight sectors. VF outcomes included mean deviation, pattern standard deviation, and visual field index. Mediation analyses used ordinary least squares regression adjusted for age, intraocular pressure, and scan quality. Indirect effects were assessed via bias-corrected bootstrap confidence intervals. Results: In both primary and expanded cohorts, inferior-temporal pVD mediated the relationship between AL and all VF outcomes. Additional sectors emerged as mediators in the expanded cohort, suggesting broader vascular involvement. Conclusions: Peripapillary microvascular compromise significantly mediates the impact of AL on glaucomatous VF loss, supporting a possible biomechanical–vascular model of POAG eyes across a range of axial lengths.