This article discusses the implementation and impact of autonomous artificial intelligence (AI) systems for diabetic eye disease testing at the Johns Hopkins Medicine health system, highlighting improvements in screening rates, access to care, and health equity for underserved populations. The AI technology has been effective in both adult and pediatric populations and has reduced disparities and increased follow-up with eye care professionals. While considering the challenges and successes of this approach, this article also highlights the potential long-term impact of AI systems in improving visual health outcomes for people with diabetes in diverse health care settings.