Automated quantification of central corneal epithelial thickness for the diagnosis of limbal stem cell deficiency

Limbal Stem Cell Deficiency (LSCD) is a corneal disorder characterized by conjunctivalization of the cornea. Central corneal epithelial thickness, measured using Anterior Segment Optical Coherence Tomography (AS-OCT), is a biomarker for LSCD. Manual measurement of epithelial thickness remains the gold standard for diagnosis because existing automated commercial software is unreliable in severe cases. Standard machine learning approaches have limited applicability for automating this measurement due to the difficulty of distinguishing corneal epithelium from scar tissue, and imprecise clinical labels. The goal of this study is to develop a deep learning pipeline to automate measurement of central epithelial thickness in AS-OCT images of eyes with LSCD. To accomplish this goal, we developed AI-CE, a model based on Multi-scale U-Net (MSU-Net) trained to accurately delineate the epithelial layer. The primary dataset comprised of 134 patient eyes, including 47 healthy normal eyes (35.0%), 34 with Stage 1 (25.4%), 34 with Stage 2 (25.4%), and 19 with Stage 3 (14.2%) LSCD. Performance was evaluated by calculating the average mean absolute error between model segmentations and manually measured clinical assessments. AI-CE model performance was compared against a commercially available segmentation software to demonstrate its improvement over the current state-of-the-art. The proposed model achieved a mean absolute error of 5.10 μm, significantly improving (p < 0.01) over clinical software (12.20 μm). This result was verified in a secondary retrospective dataset which similarly showed significant improvement over commercial software. We also demonstrate that clinical epithelial thickness values provided by AI-CE can distinguish between LSCD stages similarly to manual evaluations.