Impact of mydriasis on image gradability and automated diabetic retinopathy screening with a handheld camera. A real-world setting evaluation.

Mydriasis significantly improves image gradability and enhances AI performance in diabetic retinopathy screening. Nonetheless, in lowand middle-income countries where pharmacologic dilation may be impractical, optimizing model calibration and thresholding for non-mydriatic images is essential to ensure effective AI implementation in real-world clinical environments.