A multi-feature deep learning system to enhance glaucoma severity diagnosis with high accuracy and fast speed

Glaucoma is the leading cause of irreversible blindness, and the early detection and timely treatment are essential for glaucoma management. However, due to the interindividual variability in the characteristics of glaucoma onset, a single feature is not yet sufficient for monitoring glaucoma progression in isolation. There is an urgent need to develop more comprehensive diagnostic methods with higher accuracy. In this study, we proposed a multi- feature deep learning (MFDL) system based on intraocular pressure (IOP), color fundus photograph (CFP) and visual field (VF) to classify the glaucoma into four severity levels. We designed a three-phase framework for glaucoma severity diagnosis from coarse to fine, which contains screening, detection and classification. We trained it on 6,131 samples from 3,324 patients and tested it on independent 240 samples from 185 patients. Our results show that MFDL achieved a higher accuracy of 0.842 (95 % CI, 0.795-0.888) than the direct four classification deep learning (DFC-DL, accuracy of 0.513 [0.449-0.576]), CFP-based single-feature deep learning (CFP-DL, accuracy of 0.483 [0.420-0.547]) and VF-based single-feature deep learning (VF-DL, accuracy of 0.725 [0.668-0.782]). Its performance was statistically significantly superior to that of 8 juniors. It also outperformed 3 seniors and 1 expert, and was comparable with 2 glaucoma experts (0.842 vs 0.854, p = 0.663; 0.842 vs 0.858, p = 0.580). With the assistance of MFDL, junior ophthalmologists achieved statistically significantly higher accuracy performance, with the increased accuracy ranged from 7.50 % to 17.9 %, and that of seniors and experts were 6.30 % to 7.50 % and 5.40 % to 7.50 %. The mean diagnosis time per patient of MFDL was 5.96 s. The proposed model can potentially assist ophthalmologists in efficient and accurate glaucoma diagnosis that could aid the clinical management of glaucoma.