A Deep Learning Approach to Accurately Discriminate Between Optic Disc Drusen and Papilledema on Fundus Photographs

Abstract

Abstract Objective: To assess the performance of a deep learning system (DLS) to discriminate between optic disc drusen (ODD) and papilledema caused by intracranial hypertension, using standard color ocular fundus photographs collected in a large international multi-ethnic population. Design: Retrospective study. Participants: The study included 4,508 color fundus images in 2,180 patients from 30 neuro-ophthalmology centers (19 countries) participating in the Brain and Optic Nerve Study with Artificial Intelligence (BONSAI) Group. Methods: We trained, validated, and tested a dedicated DLS for binary classification of ODD vs. papilledema (including various subgroups within each category), on conventional mydriatic digital ocular fundus photographs. For training and internal validation, we used 857 ODD images and 3,230 papilledema images, in 1,959 patients. External-testing was subsequently performed on an independent dataset (221 patients) including 207 images with ODD (96 visible and 111 buried), provided by 3 centers of the Optic Disc Drusen Studies Consortium, and 214 images of papilledema (92 mild-to-moderate and 122 severe) from a previously validated study. Main outcome measures: Area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity were used to discriminate between ODD and papilledema. Results: Overall, the DLS could accurately distinguish between all ODD and papilledema (all severities included): AUC 0.97 (95% confidence interval [CI], 0.96 to 0.98), accuracy 90.5% (95% CI, 88.0% to 92.9%), sensitivity 86.0% (95% CI, 82.1% to 90.1%), and specificity 94.9% (95% CI, 92.3% to 97.6%). The performance of the DLS remained high for discrimination of buried ODD from mild-to-moderate papilledema: AUC 0.93 (95% CI, 0.90 to 0.96), accuracy 84.2% (95% CI, 80.2%-88.6%), sensitivity 78.4% (95% CI, 72.2% to 84.7%), and specificity 91.3% (95% CI, 87.0% to 96.4%). Conclusions: A dedicated DLS can accurately distinguish between ODD and papilledema caused by elevated intracranial pressure, even when considering buried ODD vs mild-to-moderate papilledema. Future studies are required to validate the utility of this DLS in clinical practice.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

The study was supported by the Singapore National Medical Research Council (Clinician Scientist Individual Research grant CIRG18Nov-0013), the Duke-NUS Medical School, Ophthalmology and Visual Sciences Academic Clinical Program grant (05/FY2019/P2/06-A60).

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

SINGHEALTH CENTRALISED INSTITUTIONAL REVIEW BOARD(CIRB)of Singapore Eye Research Institute gave ethical approval for this work and waived informed consent based on ethical consideration (Aim 1 of the study, on retrospective cohort, where only de-identified data will be used for analysis).

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Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors

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