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Original Investigation
February 13, 2020

Assessment of a Segmentation-Free Deep Learning Algorithm for Diagnosing Glaucoma From Optical Coherence Tomography Scans

Author Affiliations
  • 1Vision, Imaging and Performance Laboratory (VIP), Duke Eye Center, Duke University, Durham, North Carolina
  • 2Department of Statistical Science and Forge, Duke University, Durham, North Carolina
JAMA Ophthalmol. Published online February 13, 2020. doi:10.1001/jamaophthalmol.2019.5983
Key Points

Question  Does a segmentation-free deep learning algorithm using the entire circle B-scan image from optical coherence tomography perform better than retinal nerve fiber layer for detecting glaucomatous damage?

Findings  In this cross-sectional study of 1154 eyes of 635 individuals, the deep learning algorithm had a greater area under the curve than retinal nerve fiber layer global and sector parameters. This appeared to be even more likely in early disease.

Meaning  These findings suggest a deep learning algorithm using the entire B-scan may be better able to detect glaucomatous disease than conventional retinal nerve fiber layer parameters from optical coherence tomography.


Importance  Conventional segmentation of the retinal nerve fiber layer (RNFL) is prone to errors that may affect the accuracy of spectral-domain optical coherence tomography (SD-OCT) scans in detecting glaucomatous damage.

Objective  To develop a segmentation-free deep learning (DL) algorithm for assessment of glaucomatous damage using the entire circle B-scan image from SD-OCT.

Design, Setting, and Participants  This cross-sectional study at a single institution used data from SD-OCT images of eyes with glaucoma (perimetric and preperimetric) and normal eyes. The data set was randomly split at the patient level into a training (50%), validation (20%), and test data set (30%). Data were collected from March 2008 to April 2019, and analysis began April 2018.

Exposures  A convolutional neural network was trained to discriminate glaucomatous from normal eyes using the SD-OCT circle B-scan without segmentation lines.

Main Outcomes and Measures  The ability to discriminate glaucoma from healthy eyes was evaluated by comparing the area under the receiver operating characteristic curve and sensitivity at 80% or 95% specificity for the DL algorithm’s predicted probability of glaucoma vs conventional RNFL thickness parameters given by SD-OCT software. The performance was also assessed in preperimetric glaucoma, as well as by visual field severity using Hodapp-Parrish-Anderson criteria.

Results  A total of 20 806 SD-OCT images from 1154 eyes of 635 individuals (612 [53%] with glaucoma and 542 normal eyes [47%]) were included. The mean (SD) age at SD-OCT scan was 70.8 (10.4) years in individuals with glaucoma and 55.8 (14.1) years in controls. There were 187 women (53.3%) in the glaucoma group and 165 (59.8%) in the control group. Of 612 eyes with glaucoma, 432 (70.4%) had perimetric and 180 (29.6%) had preperimetric glaucoma. The DL algorithm had a significantly higher area under the receiver operating characteristic curve than global RNFL thickness (0.96 vs 0.87; difference = 0.08 [95% CI, 0.04-0.12]) and each RNFL thickness sector for discriminating between glaucoma and controls (all P < .001). At 95% specificity, the DL algorithm (81%; 95% CI, 64%-97%) was more sensitive than global RNFL thickness (67%; 95% CI, 58%-76%). The areas under the receiver operating characteristic curve were also significantly greater for the DL algorithm compared with RNFL thickness at each stage of disease, especially preperimetric and mild perimetric glaucoma.

Conclusions and Relevance  A segmentation-free DL algorithm performed better than conventional RNFL thickness parameters for diagnosing glaucomatous damage on OCT scans, especially in early disease. Future studies should investigate how such an approach contributes to diagnostic decisions when combined with other relevant clinical information, such as risk factors and perimetry results.

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