RT Journal Article SR Electronic T1 Automated expert-level scleral spur detection and quantitative biometric analysis on the ANTERION anterior segment OCT system JF British Journal of Ophthalmology JO Br J Ophthalmol FD BMJ Publishing Group Ltd. SP 702 OP 709 DO 10.1136/bjo-2022-322328 VO 108 IS 5 A1 Bolo, Kyle A1 Apolo Aroca, Galo A1 Pardeshi, Anmol A A1 Chiang, Michael A1 Burkemper, Bruce A1 Xie, Xiaobin A1 Huang, Alex S A1 Simonovsky, Martin A1 Xu, Benjamin Y YR 2024 UL http://bjo.bmj.com/content/108/5/702.abstract 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.