Using AI to Advance Equity in Eye Care: Grayson W. Armstrong, MD, MPH

Artificial intelligence (AI) could help close gaps in eye care for underserved communities, but only if the tools reach the clinics that need them most, according to Grayson W. Armstrong, MD, MPH, director, Massachusetts Eye and Ear, who spoke with The American Journal of Managed Care^® at the American Academy of Ophthalmology 2026 Annual Meeting.

Armstrong said AI, if trained properly, can flag patients in medical records who may be at risk of health disparities. His team’s federally funded work uses AI to analyze photos of the back of the eye to screen for diabetic retinopathy and glaucoma. The goal is to make sure underserved patients have “the same access, if not better, to eye care than all the other patients,” he said, because they face the greatest risk of blindness from these diseases.

Many AI tools are expensive and hard to implement, Armstrong noted, and capturing retinal images takes time that overwhelmed, understaffed clinics often lack. His research aims to show that AI screening can be cost-effective and sustainable, does not take much time, and ultimately benefits patients.

On the policy side, Armstrong said the FDA’s role is to ensure that AI tools are safe and effective. Developers must also include underserved populations in training datasets to avoid bias. He called for ethical frameworks that direct the tools to under-resourced clinics rather than only to wealthy practices that can afford them.

Armstrong stressed that eye care professionals must be involved in deploying these technologies. Giving a primary care office a fundus camera is not enough, he said.

“It’s absolutely critical that optometrists are involved in the deployment of these technologies and the implementation,” Armstrong said. Giving a primary care office a fundus camera is not enough, he added. “If there’s no one for them to refer to at the end of the day, and they don’t have a partner and a champion on the ophthalmology side, then it’s going to fail.”