A computational learning pipeline for glaucoma progression detection based on the prediction of visual field changes from fundus photographs

Detection of glaucoma progression is crucial to managing patients, permitting individualized care plans and treatment. It is a challenging task requiring the assessment of structural changes to the optic nerve head and functional changes based on visual field testing. Artificial intelligence, especially deep learning techniques, has shown promising results in many applications, including glaucoma diagnosis. This paper proposes a two-stage computational learning pipeline for detecting glaucoma progression using only fundus photographs. In the first stage, a deep learning model takes a time series of fundus photographs as input and outputs a vector of predictions where each element represents the overall rate of change in visual field (VF) sensitivity values for a sector (region) of the optic nerve head (ONH). We implemented two deep learning models—ResNet50 and InceptionResNetV2—for this stage. In the second stage, a binary classifier (weighted logistic regression) takes the predicted vector as input to detect progression. We also propose a novel method for constructing annotated datasets from temporal sequences of clinical fundus photographs and corresponding VF data suitable for machine learning. Each dataset element comprises a temporal sequence of photographs together with a vector-valued label. The label is derived by computing the pointwise linear regression of VF sensitivity values at each VF test location, mapping these locations to eight ONH sectors, and assigning the overall rate of change in each sector to one of the elements of the vector. We used a retrospective clinical dataset with 82 patients collected at multiple timepoints over five years in our experiments. The InceptionResNetV2-based implementation yielded the best performance, achieving detection accuracies of 97.28 ± 1.10 % for unseen test data (i.e., each dataset element is unseen but originates from the same set of patients appearing in the training dataset), and 87.50 ± 0.70 % for test data from unseen patients (training and testing patients are entirely different). The testing throughput was 11.60 ms per patient. These results demonstrate the efficacy of the proposed method for detecting glaucoma progression from fundus photographs.