Background: Diabetic retinopathy (DR) is a top leading cause of blindness worldwide, requiring early detection for timely intervention. Artificial Intelligence (AI) has emerged as a promising tool to improve DR screening efficiency, accessibility, and cost-effectiveness. This study conducted a systematic review of literature and meta-analysis on the economic outcomes of AI-based DR screening. Methods: A systematic review of studies published before September 2024 was conducted throughout PubMed, Scopus, Embase, the Cochrane Library, the National Health Service Economic Evaluation Database, and the Cost-Effectiveness Analysis Registry. Eligible studies were included if they were (1) conducted among type 1 diabetes mellitus or type 2 diabetes mellitus  adult diabetic population; (2) studies compared AI-based DR screening strategy to non-AI screening; and (3) performed a cost-effectiveness analysis. Meta-analysis was applied to pool incremental net benefit (INB) across studies stratified by country income and study perspective using a random-effects model. Statistical heterogeneity among studies was assessed using the I² statistic, Cochrane Q statistics, and meta regression. Results: Nine studies were included in the analysis. From a healthcare system/payer perspective, AI-based DR screening was significantly cost-effective compared to non-AI-based screening, with a pooled INB of 615.77 (95% confidence interval [CI]: 558.27, 673.27). Subgroup analysis showed robust cost-effectiveness of AI-based DR screening in high-income countries (INB = 613.62, 95% CI: 556.06, 671.18) and upper-/lower- middle income countries (INB = 1739.97, 95% CI: 423.13, 3056.82) with low heterogeneity. From a societal perspective, AI-based DR screening was generally cost-effective (INB= 5102.33, 95% CI: -815.47, 11020.13), though the result lacked statistical significance and showed high heterogeneity. Conclusions: AI-based DR screening is generally cost-effective from a healthcare system perspective, particularly in high-income countries. Heterogeneity in cost-effectiveness across different perspectives highlights the importance of context-specific evaluations, to accurately evaluate the potential of AI-based DR screening in reducing global healthcare disparities.

Background: Diabetic retinopathy (DR) is a top leading cause of blindness worldwide, requiring early detection for timely intervention. Artificial Intelligence (AI) has emerged as a promising tool to improve DR screening efficiency, accessibility, and cost-effectiveness. This study conducted a systematic review of literature and meta-analysis on the economic outcomes of AI-based DR screening. Methods: A systematic review of studies published before September 2024 was conducted throughout PubMed, Scopus, Embase, the Cochrane Library, the National Health Service Economic Evaluation Database, and the Cost-Effectiveness Analysis Registry. Eligible studies were included if they were (1) conducted among type 1 diabetes mellitus or type 2 diabetes mellitus  adult diabetic population; (2) studies compared AI-based DR screening strategy to non-AI screening; and (3) performed a cost-effectiveness analysis. Meta-analysis was applied to pool incremental net benefit (INB) across studies stratified by country income and study perspective using a random-effects model. Statistical heterogeneity among studies was assessed using the I² statistic, Cochrane Q statistics, and meta regression. Results: Nine studies were included in the analysis. From a healthcare system/payer perspective, AI-based DR screening was significantly cost-effective compared to non-AI-based screening, with a pooled INB of 615.77 (95% confidence interval [CI]: 558.27, 673.27). Subgroup analysis showed robust cost-effectiveness of AI-based DR screening in high-income countries (INB = 613.62, 95% CI: 556.06, 671.18) and upper-/lower- middle income countries (INB = 1739.97, 95% CI: 423.13, 3056.82) with low heterogeneity. From a societal perspective, AI-based DR screening was generally cost-effective (INB= 5102.33, 95% CI: -815.47, 11020.13), though the result lacked statistical significance and showed high heterogeneity. Conclusions: AI-based DR screening is generally cost-effective from a healthcare system perspective, particularly in high-income countries. Heterogeneity in cost-effectiveness across different perspectives highlights the importance of context-specific evaluations, to accurately evaluate the potential of AI-based DR screening in reducing global healthcare disparities.

Myopia, a common cause of visual impairment, together with the global decline in physical fitness and increasing prevalence of childhood obesity, has become a prominent global health problem. The beneficial effect of increasing the time of outdoor activities on the incidence of myopia and physical well-being in children has been widely recognized. However, in countries with highly competitive education systems, such as China, parents and school administrators may be reluctant to increase their children's time for extracurricular outdoor activities for fear of affecting their academic performance. Therefore, it is crucial to accurately assess the role of after-school outdoor activities in preventing and controlling myopia, as well as in promoting the physical and mental development of adolescents. Schools and families should be encouraged to collaboratively support children’s engagement in outdoor activities to foster their healthy growth. 

Given the dual benefits of outdoor activities—improving visual health and promoting overall physical and mental well-being—it is essential to encourage schools and families to work together to support children's engagement in such activities. By doing so, it is hoped that a balanced environment can be created, one that values both academic achievement and healthy development. Policymakers, educators, and parents must recognize the long-term advantages of integrating outdoor activities into children's daily lives, as this approach can help alleviate the burden of myopia, enhance physical fitness, and support emotional and cognitive development. Ultimately, fostering a culture that views outdoor activities as an essential component of education and health will be key to ensuring the well-rounded development of future generations.

Myopia, a common cause of visual impairment, together with the global decline in physical fitness and increasing prevalence of childhood obesity, has become a prominent global health problem. The beneficial effect of increasing the time of outdoor activities on the incidence of myopia and physical well-being in children has been widely recognized. However, in countries with highly competitive education systems, such as China, parents and school administrators may be reluctant to increase their children's time for extracurricular outdoor activities for fear of affecting their academic performance. Therefore, it is crucial to accurately assess the role of after-school outdoor activities in preventing and controlling myopia, as well as in promoting the physical and mental development of adolescents. Schools and families should be encouraged to collaboratively support children’s engagement in outdoor activities to foster their healthy growth.

Given the dual benefits of outdoor activities—improving visual health and promoting overall physical and mental well-being—it is essential to encourage schools and families to work together to support children's engagement in such activities. By doing so, it is hoped that a balanced environment can be created, one that values both academic achievement and healthy development. Policymakers, educators, and parents must recognize the long-term advantages of integrating outdoor activities into children's daily lives, as this approach can help alleviate the burden of myopia, enhance physical fitness, and support emotional and cognitive development. Ultimately, fostering a culture that views outdoor activities as an essential component of education and health will be key to ensuring the well-rounded development of future generations.