Xinjia Xu ¹ Mingchen Zhang ² Sihong Huang ^1* Xiaoying Li ^1* Xiaoyan Kui ^3* Jun Liu ^1*

• ¹ Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
• ² Capital Medical University,Beijing Tongren Hospital, Beijing, China
• ³ School of Computer Science and Engineering, Central South University, Changsha, Hunan, 410083, China, Changsha, Anhui Province, China

In recent years, artificial intelligence (AI), especially deep learning models, has increasingly been integrated into diagnosing and treating diabetic retinopathy (DR). From delving into the singular realm of ocular fundus photography to the gradual development of proteomics and other molecular approaches, from machine learning(ML) to deep learning(DL)，the journey has seen a transition from a binary diagnosis of "presence or absence" to the capability of discerning the progression and severity of DR based on images from various stages of the disease course. Since the FDA approval of IDx-DR in 2018, a plethora of AI models has mushroomed, gradually gaining recognition through a myriad of clinical trials and validations. AI has greatly improved early DR detection, and we're nearing the use of AI in telemedicine to tackle medical resource shortages and health inequities in various areas. This comprehensive review meticulously analyzes the literature and clinical trials of recent years, highlighting key AI models for DR diagnosis and treatment, including their theoretical bases, features, applicability, and addressing current challenges like bias, transparency, and ethics. It also presents a prospective outlook on the future development in this domain.