A Multitask Deep-Learning System to Classify Diabetic Macular Edema for Different Optical Coherence Tomography Devices: A Multicenter Analysis
Fangyao Tang, Xi Wang, An Ran Ran, Carmen K. M. Chan, Mary Ho, Wilson W. K. Yip, Alvin L. Young, Jerry Lok, Simon Szeto, Jason C. K. Chan, Fanny Yip, Raymond Wong, Ziqi Tang, Dawei Yang, Danny Siu‐Chun Ng, Li Jia Chen, Mårten Brelén, Victor Chu, Kenneth Li, Tracy H. T. Lai, Gavin Siew Wei Tan, Daniel Shu Wei Ting, Haifan Huang, Haoyu Chen, Jacey Hongjie, Shibo Tang, Theodore Leng, Schahrouz Kakavand, Suria S. Mannil, Robert T. Chang, Gerald Liew, Bamini Gopinath, Timothy Y. Y. Lai, Chi Pui Pang, Peter H. Scanlon, Tien Yin Wong, Clement C. Tham, Hao Chen, Pheng‐Ann Heng, Carol Y. Cheung
Abstract
OBJECTIVE: Diabetic macular edema (DME) is the primary cause of vision loss among individuals with diabetes mellitus (DM). We developed, validated, and tested a deep learning (DL) system for classifying DME using images from three common commercially available optical coherence tomography (OCT) devices. RESEARCH DESIGN AND METHODS: We trained and validated two versions of a multitask convolution neural network (CNN) to classify DME (center-involved DME [CI-DME], non-CI-DME, or absence of DME) using three-dimensional (3D) volume scans and 2D B-scans, respectively. For both 3D and 2D CNNs, we used the residual network (ResNet) as the backbone. For the 3D CNN, we used a 3D version of ResNet-34 with the last fully connected layer removed as the feature extraction module. A total of 73,746 OCT images were used for training and primary validation. External testing was performed using 26,981 images across seven independent data sets from Singapore, Hong Kong, the U.S., China, and Australia. RESULTS: In classifying the presence or absence of DME, the DL system achieved area under the receiver operating characteristic curves (AUROCs) of 0.937 (95% CI 0.920-0.954), 0.958 (0.930-0.977), and 0.965 (0.948-0.977) for the primary data set obtained from CIRRUS, SPECTRALIS, and Triton OCTs, respectively, in addition to AUROCs >0.906 for the external data sets. For further classification of the CI-DME and non-CI-DME subgroups, the AUROCs were 0.968 (0.940-0.995), 0.951 (0.898-0.982), and 0.975 (0.947-0.991) for the primary data set and >0.894 for the external data sets. CONCLUSIONS: We demonstrated excellent performance with a DL system for the automated classification of DME, highlighting its potential as a promising second-line screening tool for patients with DM, which may potentially create a more effective triaging mechanism to eye clinics.