Camera-Agnostic Autonomous Diagnosis of Glaucomatous Optic Neuropathy using Macular Fundus Imaging and Machine Learning

PurposeGlaucoma, a leading cause of irreversible vision loss, often remains undiagnosed due to its asymptomatic progression and the limitations of existing screening methods. This study aimed to validate an artificial intelligence machine learning algorithm for the camera-agnostic detection of glaucomatous optic neuropathy using macula-centered fundus images. MethodsData were collected from EyePACS, a teleretinal screening system, comprising 25,000 macula-centered fundus images from 12,500 patients at U.S. primary care centers. A secondary dataset from the Philadelphia Telemedicine Glaucoma Follow-up Study was used for independent validation. A convolutional neural network was developed to detect glaucomatous optic neuropathy. Expert-graded fundus images served as the ground truth. Images underwent quality filtering to ensure the visibility of the optic nerve. Bilateral images were analyzed to produce patient-level diagnoses. Validation involved a secondary dataset of fundus images. ResultsThe sensitivity and specificity of the algorithm in detecting glaucomatous optic neuropathy is calculated in comparison to expert grading. From the EyePACS dataset, 21,792 images (10,986 subjects) met quality standards. The algorithm demonstrated a sensitivity of 90.6% and specificity of 90.5%. Validation on the secondary dataset (200 fundus images from 100 subjects) resulted in a sensitivity of 96.4% and specificity of 85.3%. ConclusionsThe algorithm achieved high sensitivity and specificity in detecting glaucomatous optic neuropathy using macula-centered fundus images, demonstrating its potential for integration into diverse clinical settings. Its camera-agnostic design and robust performance offer a scalable solution for improving glaucoma screening pathways, making them more accessible and efficient.