Deep Learning Classifiers for Automated Detection of Gonioscopic Angle Closure Based on Anterior Segment OCT Images

To develop and test deep learning classifiers that detect gonioscopic angle closure and primary angle closure disease (PACD) based on fully automated analysis of anterior segment OCT (AS-OCT) images.

Subjects were recruited as part of the Chinese-American Eye Study (CHES), a population-based study of Chinese Americans in Los Angeles, California, USA. Each subject underwent a complete ocular examination including gonioscopy and AS-OCT imaging in each quadrant of the anterior chamber angle (ACA). Deep learning methods were used to develop 3 competing multi-class convolutional neural network (CNN) classifiers for modified Shaffer grades 0, 1, 2, 3, and 4. Binary probabilities for closed (grades 0 and 1) and open (grades 2, 3, and 4) angles were calculated by summing over the corresponding grades. Classifier performance was evaluated by 5-fold cross-validation and on an independent test dataset. Outcome measures included area under the receiver operating characteristic curve (AUC) for detecting gonioscopic angle closure and PACD, defined as either 2 or 3 quadrants of gonioscopic angle closure per eye.

A total of 4036 AS-OCT images with corresponding gonioscopy grades (1943 open, 2093 closed) were obtained from 791 CHES subjects. Three competing CNN classifiers were developed with a cross-validation dataset of 3396 images (1632 open, 1764 closed) from 664 subjects. The remaining 640 images (311 open, 329 closed) from 127 subjects were segregated into a test dataset. The best-performing classifier was developed by applying transfer learning to the ResNet-18 architecture. For detecting gonioscopic angle closure, this classifier achieved an AUC of 0.933 (95% confidence interval, 0.925-0.941) on the cross-validation dataset and 0.928 on the test dataset. For detecting PACD based on 2- and 3-quadrant definitions, the ResNet-18 classifier achieved AUCs of 0.964 and 0.952, respectively, on the test dataset.

Deep learning classifiers effectively detect gonioscopic angle closure and PACD based on automated analysis of AS-OCT images. These methods could be used to automate clinical evaluations of the ACA and improve access to eye care in high-risk populations.