Generalizable Deep Learning for the Detection of Incomplete and Complete Retinal Pigment Epithelium and Outer Retinal Atrophy: A MACUSTAR Report

Translational Vision Science & Technology, vol. 13, pp. 11

Abstract

Purpose: The purpose of this study was to develop a deep learning algorithm for detecting and quantifying incomplete retinal pigment epithelium and outer retinal atrophy (iRORA) and complete retinal pigment epithelium and outer retinal atrophy (cRORA) in optical coherence tomography (OCT) that generalizes well to data from different devices and to validate in an intermediate age-related macular degeneration (iAMD) cohort. Methods: The algorithm comprised a domain adaptation (DA) model, promoting generalization across devices, and a segmentation model for detecting granular biomarkers defining iRORA/cRORA, which are combined into iRORA/cRORA segmentations. Manual annotations of iRORA/cRORA in OCTs from different devices in the MACUSTAR study (168 patients with iAMD) were compared to the algorithm's output. Eye level classification metrics included sensitivity, specificity, and quadratic weighted Cohen's κ score (κw). Segmentation performance was assessed quantitatively using Bland-Altman plots and qualitatively. Results: For ZEISS OCTs, sensitivity and specificity for iRORA/cRORA classification were 38.5% and 93.1%, respectively, and 60.0% and 96.4% for cRORA. For Spectralis OCTs, these were 84.0% and 93.7% for iRORA/cRORA, and 62.5% and 97.4% for cRORA. The κw scores for 3-way classification (none, iRORA, and cRORA) were 0.37 and 0.73 for ZEISS and Spectralis, respectively. Removing DA reduced κw from 0.73 to 0.63 for Spectralis. Conclusions: The DA-enabled iRORA/cRORA segmentation algorithm showed superior consistency compared to human annotations, and good generalization across OCT devices. Translational Relevance: The application of this algorithm may help toward precise and automated tracking of iAMD-related lesion changes, which is crucial in clinical settings and multicenter longitudinal studies on iAMD.

Authors 11

1. Coen de Vente

   Radboud University Nijmegen · Amsterdam UMC Location University of Amsterdam · Radboud University Medical Center · University of Amsterdam

   Affiliation as printed

   Amsterdam UMC location University of Amsterdam, Biomedical Engineering and Physics, Amsterdam, The Netherlands

   Diagnostic Image Analysis Group (DIAG), Department of Radiology and Nuclear Medicine, Radboud UMC, Nijmegen, The Netherlands

   Quantitative Healthcare Analysis (qurAI) Group, Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands

2. Philippe Valmaggia

   University of Basel · Institute of Molecular and Clinical Ophthalmology Basel

   Affiliation as printed

   Department of Biomedical Engineering, Universität Basel, Basel, Basel-Stadt, Switzerland

   Institute of Molecular and Clinical Ophthalmology Basel, Basel, Basel-Stadt, Switzerland

3. Carel B. Hoyng

   Radboud University Nijmegen · Radboud University Medical Center

   Affiliation as printed

   Department of Ophthalmology, Radboudumc, Nijmegen, The Netherlands

4. Frank Gerhard Holz

   University Hospital Bonn

   Affiliation as printed

   Department of Ophthalmology and GRADE Reading Center, University Hospital Bonn, Germany

5. Mohammad Mainul Islam

   Amsterdam UMC Location University of Amsterdam · University of Amsterdam

   Affiliation as printed

   Amsterdam UMC location University of Amsterdam, Biomedical Engineering and Physics, Amsterdam, The Netherlands

   Quantitative Healthcare Analysis (qurAI) Group, Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands

6. Caroline C. W. Klaver

   Radboud University Nijmegen · Erasmus MC · Radboud University Medical Center

   Affiliation as printed

   Department of Ophthalmology, Radboudumc, Nijmegen, The Netherlands

   Ophthalmology and Epidemiology, Erasmus MC, Rotterdam, The Netherlands

7. Camiel J. F. Boon Aachen Department of Ophthalmology, Leiden University Medical Center

   Leiden University Medical Center · Amsterdam University Medical Centers

   Affiliation as printed

   Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands

   Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands

8. Steffen Schmitz‐Valckenberg

   University of Utah · University Hospital Bonn

   Affiliation as printed

   Department of Ophthalmology and GRADE Reading Center, University Hospital Bonn, Germany

   John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA

9. Adnan Tufail

   Moorfields Eye Hospital NHS Foundation Trust

   Affiliation as printed

   Moorfields Eye Hospital NHS Foundation Trust, London, UK

10. Marlene Saßmannshausen

    University Hospital Bonn

    Affiliation as printed

    Department of Ophthalmology and GRADE Reading Center, University Hospital Bonn, Germany

11. Clara I. Sá‎nchez corresponding

    Amsterdam UMC Location University of Amsterdam · University of Amsterdam

    Affiliation as printed

    Amsterdam UMC location University of Amsterdam, Biomedical Engineering and Physics, Amsterdam, The Netherlands

    Quantitative Healthcare Analysis (qurAI) Group, Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands