Abstract
center dot PURPOSE: To develop deep learning (DL) algorithm to detect glaucoma progression using optical coherence tomography (OCT) images, in the absence of a reference standard. center dot DESIGN: Retrospective cohort study. center dot METHODS: Glaucomatous and healthy eyes with > 5 reliable peripapillary OCT (Spectralis, Heidelberg Engineering) circle scans were included. A weakly supervised time -series learning model, called noise positiveunlabeled (Noise-PU) DL was developed to classify whether sequences of OCT B-scans showed glaucoma progression. The model used 2 learning schemes, one to identify age-related changes by differentiating test sequences from glaucoma vs healthy eyes, and the other to identify test-retest variability based on scrambled OCTs of glaucoma eyes. Both models' bases were convolutional neural networks (CNN) and long short -term memory (LSTM) networks which were combined to form a CNNLSTM model. Model features were combined and jointly trained to identify glaucoma progression, accounting for age-related loss. The DL model's outcomes were compared with ordinary least squares (OLS) regression of retinal nerve fiber layer (RNFL) thickness over time, matched for specificity. The hit ratio was used as a proxy for sensitivity. center dot RESULTS: Eight thousand seven hundred eighty-five follow-up sequences of 5 consecutive OCT tests from 3253 eyes (1859 subjects) were included in the study. The mean follow-up time was 3.5 +/- 1.6 years. In the test sample, the hit ratios of the DL and OLS methods were 0.498 (95%CI: 0.470-0.526) and 0.284 (95%CI: 0.258-0.309) respectively ( P < .001) when the specificities were equalized to 95%. center dot CONCLUSION: A DL model was able to identify longitudinal glaucomatous structural changes in OCT Bscans using a surrogate reference standard for progression. (Am J Ophthalmol 2024;266: 46-55. (c) 2024 Elsevier Inc. All rights reserved.)