An increasing number of artificial intelligence (AI) systems are being proposed in ophthalmology, motivated by the variety and amount of clinical and imaging data, as well as their potential benefits at the different stages of patient care. Despite achieving close or even superior performance to that of experts, there is a critical gap between development and integration of AI systems in ophthalmic practice. This work focuses on the importance of trustworthy AI to close that gap. We identify the main aspects or challenges that need to be considered along the AI design pipeline so as to generate systems that meet the requirements to be deemed trustworthy, including those concerning accuracy, resiliency, reliability, safety, and accountability. We elaborate on mechanisms and considerations to address those aspects or challenges, and define the roles and responsibilities of the different stakeholders involved in AI for ophthalmic care, i.e., AI developers, reading centers, healthcare providers, healthcare institutions, ophthalmological societies and working groups or committees, patients, regulatory bodies, and payers. Generating trustworthy AI is not a responsibility of a sole stakeholder. There is an impending necessity for a collaborative approach where the different stakeholders are represented along the AI design pipeline, from the definition of the intended use to post-market surveillance after regulatory approval. This work contributes to establish such multi-stakeholder interaction and the main action points to be taken so that the potential benefits of AI reach real-world ophthalmic settings.

越来越多的人工智能 (AI) 系统被提出用于眼科，其动机是临床和影像数据的多样性和数量，以及它们在患者护理不同阶段的潜在益处。尽管实现了与专家相近甚至更优的性能，但人工智能系统在眼科实践中的开发和集成之间仍存在重大差距。这项工作的重点是值得信赖的人工智能在缩小这一差距方面的重要性。我们确定了在 AI 设计流程中需要考虑的主要方面或挑战，以便生成满足被认为值得信赖的要求的系统，包括有关准确性、弹性、可靠性、安全性和问责制的要求。我们详细阐述了解决这些方面或挑战的机制和考虑因素，并定义参与眼科护理人工智能的不同利益相关者的角色和责任，即人工智能开发人员、阅读中心、医疗保健提供者、医疗保健机构、眼科学会和工作组或委员会、患者、监管机构和付款人。生成值得信赖的人工智能不是唯一利益相关者的责任。从预期用途的定义到监管部门批准后的上市后监督，在人工智能设计流程中代表不同利益相关者的协作方法迫在眉睫。这项工作有助于建立这种多方利益相关者的互动以及要采取的主要行动点，以使人工智能的潜在好处达到现实世界的眼科环境。