Cardiometabolic Assessment in Patients with Overweight, Obesity, or Type 2 Diabetes Undergoing Artificial Intelligence-Based Retinal Screening: A Real-World Evidence Study

Background: Overweight, obesity, and type 2 diabetes (T2DM) increase the risk of vascular complications, including retinal vascular alterations. Artificial intelligence (AI)-based retinal screening enables early detection of microvascular damage, potentially contributing to appropriate cardiometabolic prevention strategies. We performed a realworld evidence observational study to assess cardiometabolic parameters as well as retinal vascular alterations using novel AI-based retinal imaging.Methods: Between September and December 2025, we recruited 301 consecutive adults with overweight,obesity, or T2DM; cardiometabolic assessment was performed, and all participants also underwent retinal screening with the Aireen AI system, distinguishing those who resulted positive (n = 42), negative (n = 204), or undetermined (n = 55) at the screening.Results: All patients who resulted positive at the screening were confirmed with a diagnosis of retinal alterations by the ophthalmologists. The presence of positive retinal screening (RS+) progressively increased with worsening fasting glycemia, glycated hemoglobin (HbA1c) levels, carotid intima-media thickness, and endothelial function (P < 0.001 for all). Multivariate logistic regression analysis revealed independent associations of RS+ with HbA1c [odds ratio (OR) 2.29, P < 0.001], carotid stenosis (OR 1.06, P < 0.001), fasting glucose (OR 1.02, P < 0.001), and the triglyceride/high-density lipoprotein cholesterol ratio (OR 2.19, P = 0.010).Conclusions: These findings suggest that AIbased retinal screening with advanced tools can effectively identify early microvascular damage in individuals with overweight, obesity, or T2DM, with RS+ prevalence reflecting glycemic burden and vascular dysfunction. Therefore, integrating AI retinal assessment into cardiometabolic prevention programs may enable timely interventions to prevent progression to vision-threatening complications and support comprehensive cardiovascular risk management.