Evaluation of an AI system for the automated detection of glaucoma from stereoscopic optic disc photographs: the European Optic Disc Assessment Study

TL;DR

This study evaluates a deep learning AI system called Pegasus for detecting glaucoma from stereoscopic optic disc photographs, finding its performance comparable to that of ophthalmologists and optometrists, indicating its potential in clinical settings.

Contribution

The paper presents the first comparison of Pegasus AI's glaucoma detection accuracy with that of a large cohort of eye care professionals, demonstrating comparable performance.

Findings

Pegasus achieved 83.4% accuracy in detecting glaucoma.

AI performance was statistically similar to ophthalmologists and optometrists.

The AI system showed high intra-observer agreement (κ=0.74).

Abstract

Objectives: To evaluate the performance of a deep learning based Artificial Intelligence (AI) software for detection of glaucoma from stereoscopic optic disc photographs, and to compare this performance to the performance of a large cohort of ophthalmologists and optometrists. Methods: A retrospective study evaluating the diagnostic performance of an AI software (Pegasus v1.0, Visulytix Ltd., London UK) and comparing it to that of 243 European ophthalmologists and 208 British optometrists, as determined in previous studies, for the detection of glaucomatous optic neuropathy from 94 scanned stereoscopic photographic slides scanned into digital format. Results: Pegasus was able to detect glaucomatous optic neuropathy with an accuracy of 83.4% (95% CI: 77.5-89.2). This is comparable to an average ophthalmologist accuracy of 80.5% (95% CI: 67.2-93.8) and average optometrist accuracy of 80% (95% CI: 67-88) on the same images. In addition, the AI system had an intra-observer agreement (Cohen's Kappa, $\kappa$) of 0.74 (95% CI: 0.63-0.85), compared to 0.70 (range: -0.13-1.00; 95% CI: 0.67-0.73) and 0.71 (range: 0.08-1.00) for ophthalmologists and optometrists, respectively. There was no statistically significant difference between the performance of the deep learning system and ophthalmologists or optometrists. There was no statistically significant difference between the performance of the deep learning system and ophthalmologists or optometrists. Conclusion: The AI system obtained a diagnostic performance and repeatability comparable to that of the ophthalmologists and optometrists. We conclude that deep learning based AI systems, such as Pegasus, demonstrate significant promise in the assisted detection of glaucomatous optic neuropathy.