pone.0340802.t005 -

Diabetic retinopathy (DR) is a common complication of diabetes that can lead to vision loss. Early detection and prevention of DR is crucial to reduce the burden of this disease. The purpose of this study was to build a prediction model for DR using pupillary abnormalities as biomarkers. Pupillary parameters including Dark-adapted Baseline Pupillary Diameter (BPD), Amplitude of Pupillary Constriction (APC), Velocity of Pupillary Constriction (VPC), Amplitude of Pupil Re-dilatation after Maximum Constriction, and Velocity of Pupillary Dilatation (VPD) were collected and analyzed using machine learning algorithm including Support Vector Machine, Decision Trees, Artificial Neural Networks (ANN), Logistic Regressions, Random Forest, Naive Bayes Classifier. Utilizing ROC analysis and the Youden index, this study identified cut-off values for pupillary abnormalities to detect DR risk. The study found that ANN performed well with an accuracy of 0.807 (95% CI: 0.65–0.94) and AUC of 0.879 (95% CI: 0.71–0.98) in predicting DR using pupillary abnormalities as biomarkers. The findings of this research offer significant insights into the predictive value of pupillary abnormalities for DR, establishing a strong foundation for early intervention strategies. Particularly, the superior performance of ANN in detecting DR presents an opportunity to refine risk stratification and prevention approaches, potentially transforming the prognosis for individuals at elevated risk of this condition.