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Wang R, He J, Chen Q, Ye L, Sun D, Yin L, Zhou H, Zhao L, Zhu J, Zou H, Tan Q, Huang D, Liang B, He L, Wang W, Fan Y, Xu X. Efficacy of a Deep Learning System for Screening Myopic Maculopathy Based on Color Fundus Photographs. Ophthalmol Ther 2022; 12:469-484. [PMID: 36495394 PMCID: PMC9735275 DOI: 10.1007/s40123-022-00621-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The maculopathy in highly myopic eyes is complex. Its clinical diagnosis is a huge workload and subjective. To simply and quickly classify pathologic myopia (PM), a deep learning algorithm was developed and assessed to screen myopic maculopathy lesions based on color fundus photographs. METHODS This study included 10,347 ocular fundus photographs from 7606 participants. Of these photographs, 8210 were used for training and validation, and 2137 for external testing. A deep learning algorithm was trained, validated, and externally tested to screen myopic maculopathy which was classified into four categories: normal or mild tessellated fundus, severe tessellated fundus, early-stage PM, and advanced-stage PM. The area under the precision-recall curve, the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, and Cohen's kappa were calculated and compared with those of retina specialists. RESULTS In the validation data set, the model detected normal or mild tessellated fundus, severe tessellated fundus, early-stage PM, and advanced-stage PM with AUCs of 0.98, 0.95, 0.99, and 1.00, respectively; while in the external-testing data set of 2137 photographs, the model had AUCs of 0.99, 0.96, 0.98, and 1.00, respectively. CONCLUSIONS We developed a deep learning model for detection and classification of myopic maculopathy based on fundus photographs. Our model achieved high sensitivities, specificities, and reliable Cohen's kappa, compared with those of attending ophthalmologists.
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Affiliation(s)
- Ruonan Wang
- grid.452752.30000 0004 8501 948XDepartment of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, 200040 China ,grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, Shanghai, 200080 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080 China ,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, 200080 China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200080 China
| | - Jiangnan He
- grid.452752.30000 0004 8501 948XDepartment of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, 200040 China ,grid.24516.340000000123704535School of Medicine, Tongji University, Shanghai, China
| | - Qiuying Chen
- grid.452752.30000 0004 8501 948XDepartment of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, 200040 China ,grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, Shanghai, 200080 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080 China ,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, 200080 China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200080 China
| | - Luyao Ye
- grid.452752.30000 0004 8501 948XDepartment of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, 200040 China ,grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, Shanghai, 200080 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080 China ,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, 200080 China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200080 China
| | - Dandan Sun
- grid.452752.30000 0004 8501 948XDepartment of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, 200040 China ,grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, Shanghai, 200080 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080 China ,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, 200080 China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200080 China
| | - Lili Yin
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, Shanghai, 200080 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080 China ,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, 200080 China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200080 China
| | - Hao Zhou
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, Shanghai, 200080 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080 China ,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, 200080 China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200080 China
| | - Lijun Zhao
- Suzhou Life Intelligence Industry Research Institute, Suzhou, 215124 China
| | - Jianfeng Zhu
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 China
| | - Haidong Zou
- grid.452752.30000 0004 8501 948XDepartment of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, 200040 China ,grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, Shanghai, 200080 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080 China ,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, 200080 China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200080 China
| | - Qichao Tan
- Suzhou Life Intelligence Industry Research Institute, Suzhou, 215124 China
| | - Difeng Huang
- Suzhou Life Intelligence Industry Research Institute, Suzhou, 215124 China
| | - Bo Liang
- grid.459411.c0000 0004 1761 0825School of Biology and Food Engineering, Changshu Institute of Technology, Changshu, China
| | - Lin He
- Suzhou Life Intelligence Industry Research Institute, Suzhou, 215124 China
| | - Weijun Wang
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, Shanghai, 200080 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080 China ,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, 200080 China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200080 China ,No. 100 Haining Road, Shanghai, 200080 China
| | - Ying Fan
- grid.452752.30000 0004 8501 948XDepartment of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, 200040 China ,grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, Shanghai, 200080 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080 China ,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, 200080 China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200080 China ,No. 380 Kangding Road, Shanghai, 200080 China
| | - Xun Xu
- grid.452752.30000 0004 8501 948XDepartment of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, 200040 China ,grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, Shanghai, 200080 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080 China ,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, 200080 China ,grid.412478.c0000 0004 1760 4628Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200080 China
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Lu L, Ren P, Tang X, Yang M, Yuan M, Yu W, Huang J, Zhou E, Lu L, He Q, Zhu M, Ke G, Han W. AI-Model for Identifying Pathologic Myopia Based on Deep Learning Algorithms of Myopic Maculopathy Classification and "Plus" Lesion Detection in Fundus Images. Front Cell Dev Biol 2021; 9:719262. [PMID: 34722502 PMCID: PMC8554089 DOI: 10.3389/fcell.2021.719262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/20/2021] [Indexed: 01/24/2023] Open
Abstract
Background: Pathologic myopia (PM) associated with myopic maculopathy (MM) and “Plus” lesions is a major cause of irreversible visual impairment worldwide. Therefore, we aimed to develop a series of deep learning algorithms and artificial intelligence (AI)–models for automatic PM identification, MM classification, and “Plus” lesion detection based on retinal fundus images. Materials and Methods: Consecutive 37,659 retinal fundus images from 32,419 patients were collected. After excluding 5,649 ungradable images, a total dataset of 32,010 color retinal fundus images was manually graded for training and cross-validation according to the META-PM classification. We also retrospectively recruited 1,000 images from 732 patients from the three other hospitals in Zhejiang Province, serving as the external validation dataset. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, and quadratic-weighted kappa score were calculated to evaluate the classification algorithms. The precision, recall, and F1-score were calculated to evaluate the object detection algorithms. The performance of all the algorithms was compared with the experts’ performance. To better understand the algorithms and clarify the direction of optimization, misclassification and visualization heatmap analyses were performed. Results: In five-fold cross-validation, algorithm I achieved robust performance, with accuracy = 97.36% (95% CI: 0.9697, 0.9775), AUC = 0.995 (95% CI: 0.9933, 0.9967), sensitivity = 93.92% (95% CI: 0.9333, 0.9451), and specificity = 98.19% (95% CI: 0.9787, 0.9852). The macro-AUC, accuracy, and quadratic-weighted kappa were 0.979, 96.74% (95% CI: 0.963, 0.9718), and 0.988 (95% CI: 0.986, 0.990) for algorithm II. Algorithm III achieved an accuracy of 0.9703 to 0.9941 for classifying the “Plus” lesions and an F1-score of 0.6855 to 0.8890 for detecting and localizing lesions. The performance metrics in external validation dataset were comparable to those of the experts and were slightly inferior to those of cross-validation. Conclusion: Our algorithms and AI-models were confirmed to achieve robust performance in real-world conditions. The application of our algorithms and AI-models has promise for facilitating clinical diagnosis and healthcare screening for PM on a large scale.
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Affiliation(s)
- Li Lu
- Department of Ophthalmology, Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Peifang Ren
- Department of Ophthalmology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xuyuan Tang
- Department of Ophthalmology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ming Yang
- Department of Ophthalmology, Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Minjie Yuan
- Department of Ophthalmology, Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wangshu Yu
- Department of Ophthalmology, Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiani Huang
- Department of Ophthalmology, Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Enliang Zhou
- Department of Ophthalmology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Lixian Lu
- College of Computer Science and Technology, Zhejiang University, Hangzhou, China
| | - Qin He
- Department of Ophthalmology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Miaomiao Zhu
- Department of Ophthalmology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Genjie Ke
- Department of Ophthalmology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Wei Han
- Department of Ophthalmology, Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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