PT - JOURNAL ARTICLE AU - Bolo, Kyle AU - Apolo Aroca, Galo AU - Pardeshi, Anmol A AU - Chiang, Michael AU - Burkemper, Bruce AU - Xie, Xiaobin AU - Huang, Alex S AU - Simonovsky, Martin AU - Xu, Benjamin Y TI - Automated expert-level scleral spur detection and quantitative biometric analysis on the ANTERION anterior segment OCT system AID - 10.1136/bjo-2022-322328 DP - 2024 May 01 TA - British Journal of Ophthalmology PG - 702--709 VI - 108 IP - 5 4099 - http://bjo.bmj.com/content/108/5/702.short 4100 - http://bjo.bmj.com/content/108/5/702.full SO - Br J Ophthalmol2024 May 01; 108 AB - Aim To perform an independent validation of deep learning (DL) algorithms for automated scleral spur detection and measurement of scleral spur-based biometric parameters in anterior segment optical coherence tomography (AS-OCT) images.Methods Patients receiving routine eye care underwent AS-OCT imaging using the ANTERION OCT system (Heidelberg Engineering, Heidelberg, Germany). Scleral spur locations were marked by three human graders (reference, expert and novice) and predicted using DL algorithms developed by Heidelberg Engineering that prioritise a false positive rate <4% (FPR4) or true positive rate >95% (TPR95). Performance of human graders and DL algorithms were evaluated based on agreement of scleral spur locations and biometric measurements with the reference grader.Results 1308 AS-OCT images were obtained from 117 participants. Median differences in scleral spur locations from reference locations were significantly smaller (p<0.001) for the FPR4 (52.6±48.6 µm) and TPR95 (55.5±50.6 µm) algorithms compared with the expert (61.1±65.7 µm) and novice (79.4±74.9 µm) graders. Intergrader reproducibility of biometric measurements was excellent overall for all four (intraclass correlation coefficient range 0.918–0.997). Intergrader reproducibility of the expert grader (0.567–0.965) and DL algorithms (0.746–0.979) exceeded that of the novice grader (0.146–0.929) for images with narrow angles defined by OCT measurement of angle opening distance 500 µm anterior to the scleral spur (AOD500)<150 µm.Conclusions DL algorithms on the ANTERION approximate expert-level measurement of scleral spur-based biometric parameters in an independent patient population. These algorithms could enhance clinical utility of AS-OCT imaging, especially for evaluating patients with angle closure and performing intraocular lens calculations.Data are available on reasonable request.