# Investigating the capability of deep learning models to predict age and biological sex from anterior segment ophthalmic imaging: a multi-centre retrospective study

## TL;DR

This study shows that deep learning models can predict age and biological sex from eye images, suggesting the anterior segment holds biological information.

## Contribution

The study introduces a deep learning model trained on diverse anterior segment imaging data to predict age and biological sex.

## Key findings

- Age prediction models achieved mean absolute errors of 5.1 to 6.2 years across different imaging types.
- Gender classification models achieved ROC-AUC scores of 0.73 to 0.88.
- Saliency maps revealed the model focused on specific corneal regions for age and gender prediction.

## Abstract

To assess the capability of a convolutional neural network trained by transfer learning on anterior segment optical coherence tomography (AS-OCT) images, Placido-disk corneal topography images and external photographs to predict age and biological sex.

Development of a deep learning model trained on retrospectively collected data using transfer learning.

A multicentre secondary care public health trust based in London.

We included 557,468 scans from 40,592 eyes of 20,542 patients. Data were extracted from all patients who underwent MS-39 imaging within our trust from October 2020 to March 2023.

Primary outcome measures for biological sex classification included accuracy, precision, recall, F1-score and area under the receiver operating curve (ROC-AUC). Primary outcome measures for age prediction were Pearson correlation coefficients (r), coefficients of determination (R²) and the mean absolute error (MAE) to evaluate the predictive performance. The secondary outcome was to visualise and interpret the model’s decision-making process through the construction of saliency maps.

For age prediction, the MAEs for the Placido, AS-OCT and external photograph models were 5.2, 5.1 and 6.2 years, respectively. For gender classification, the same models achieved ROC-AUCs of 0.88, 0.73 and 0.81, respectively. No difference in performance was found in the analysis of corneas with pathological topography. The saliency maps highlighted the peri-limbal cornea for age prediction and the central cornea for gender discrimination.

Our study demonstrates that deep learning models can extract age and gender information from anterior segment images. These findings support the concept that the anterior segment, like the retina, encodes important biological information. Future research should explore whether these models can predict specific systemic conditions.