Prediction of fellow eye neovascularization in type 3 macular neovascularization (Retinal angiomatous proliferation) using deep learning.

Purpose: To establish a deep learning artificial intelligence model to predict the risk of long-term fellow eye neovascularization in unilateral type 3 macular neovascularization (MNV).

Methods: This retrospective study included 217 patients (199 in the training/validation of the AI model and 18 in the testing set) with a diagnosis of unilateral type 3 MNV. The purpose of the AI model was to predict fellow eye neovascularization within 24 months after the initial diagnosis. The data used to train the AI model included a baseline fundus image and horizontal/vertical cross-hair scan optical coherence tomography images in the fellow eye. The neural network of this study for AI-learning was based on the visual geometry group with modification. The precision, recall, accuracy, and the area under the curve values of receiver operating characteristics (AUCROC) were calculated for the AI model. The accuracy of an experienced (examiner 1) and less experienced (examiner 2) human examiner was also evaluated.

Results: The incidence of fellow eye neovascularization over 24 months was 28.6% in the training/validation set and 38.9% in the testing set (P = 0.361). In the AI model, precision was 0.562, recall was 0.714, accuracy was 0.667, and the AUCROC was 0.675. The sensitivity, specificity, and accuracy were 0.429, 0.727, and 0.611, respectively, for examiner 1, and 0.143, 0.636, and 0.444, respectively, for examiner 2.

Conclusions: This is the first AI study focusing on the clinical course of type 3 MNV. While our AI model exhibited accuracy comparable to that of human examiners, overall accuracy was not high. This may partly be a result of the relatively small number of patients used for AI training, suggesting the need for future multi-center studies to improve the accuracy of the model.