2023-11-01 デューク大学(Duke)
◆この高速な予測は、臨床試験の募集を効率化し、高齢者の視力を保護するための治療の展開に役立つ可能性があります。
<関連情報>
- https://medschool.duke.edu/news/algorithm-aids-early-detection-age-related-eye-disease
- https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2810428
スペクトル領域光干渉断層計における地理的萎縮への短期的進行を予測する深層学習アルゴリズム A Deep-Learning Algorithm to Predict Short-Term Progression to Geographic Atrophy on Spectral-Domain Optical Coherence Tomography
Eliot R. Dow,Hyeon Ki Jeong,Ella Arnon Katz,Cynthia A. Toth,Dong Wang,Terry Lee,David Kuo,Michael J. Allingham,Majda Hadziahmetovic,Priyatham S. MettuStefanie Schuman,Lawrence Carin, Pearse A. Keane,Ricardo Henao, Eleonora M. Lad
JAMA Ophthalmology Published:October 19, 2023
DOI:10.1001/jamaophthalmol.2023.4659
Key Points
Question Can a convolutional neural network-based deep learning algorithm predict progression from intermediate age-related macular degeneration (iAMD) to geographic atrophy (GA) from a volumetric spectral-domain optical coherence tomography (SD-OCT) scan?
Findings In this cohort study of 417 patients, a convolutional neural network accurately predicted eyes that progressed from iAMD to GA within 1 year using volumetric SD-OCT scans. Simulations using the convolutional neural network for clinical trial recruitment of patients at risk for disease progression resulted in a greater yield in identifying patients progressing to GA in the trial cohort.
Meaning The findings in this study suggest that automated prediction of imminent GA progression could facilitate clinical trials aimed at preventing disease and guide clinical decision-making regarding screening frequency or treatment initiation.
Abstract
Importance The identification of patients at risk of progressing from intermediate age-related macular degeneration (iAMD) to geographic atrophy (GA) is essential for clinical trials aimed at preventing disease progression. DeepGAze is a fully automated and accurate convolutional neural network–based deep learning algorithm for predicting progression from iAMD to GA within 1 year from spectral-domain optical coherence tomography (SD-OCT) scans.
Objective To develop a deep-learning algorithm based on volumetric SD-OCT scans to predict the progression from iAMD to GA during the year following the scan.
Design, Setting, and Participants This retrospective cohort study included participants with iAMD at baseline and who either progressed or did not progress to GA within the subsequent 13 months. Participants were included from centers in 4 US states. Data set 1 included patients from the Age-Related Eye Disease Study 2 AREDS2 (Ancillary Spectral-Domain Optical Coherence Tomography) A2A study (July 2008 to August 2015). Data sets 2 and 3 included patients with imaging taken in routine clinical care at a tertiary referral center and associated satellites between January 2013 and January 2023. The stored imaging data were retrieved for the purpose of this study from July 1, 2022, to February 1, 2023. Data were analyzed from May 2021 to July 2023.
Exposure A position-aware convolutional neural network with proactive pseudointervention was trained and cross-validated on Bioptigen SD-OCT volumes (data set 1) and validated on 2 external data sets comprising Heidelberg Spectralis SD-OCT scans (data sets 2 and 3).
Main Outcomes and Measures Prediction of progression to GA within 13 months was evaluated with area under the receiver-operator characteristic curves (AUROC) as well as area under the precision-recall curve (AUPRC), sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.
Results The study included a total of 417 patients: 316 in data set 1 (mean [SD] age, 74 [8]; 185 [59%] female), 53 in data set 2, (mean [SD] age, 83 [8]; 32 [60%] female), and 48 in data set 3 (mean [SD] age, 81 [8]; 32 [67%] female). The AUROC for prediction of progression from iAMD to GA within 1 year was 0.94 (95% CI, 0.92-0.95; AUPRC, 0.90 [95% CI, 0.85-0.95]; sensitivity, 0.88 [95% CI, 0.84-0.92]; specificity, 0.90 [95% CI, 0.87-0.92]) for data set 1. The addition of expert-annotated SD-OCT features to the model resulted in no improvement compared to the fully autonomous model (AUROC, 0.95; 95% CI, 0.92-0.95; P = .19). On an independent validation data set (data set 2), the model predicted progression to GA with an AUROC of 0.94 (95% CI, 0.91-0.96; AUPRC, 0.92 [0.89-0.94]; sensitivity, 0.91 [95% CI, 0.74-0.98]; specificity, 0.80 [95% CI, 0.63-0.91]). At a high-specificity operating point, simulated clinical trial recruitment was enriched for patients progressing to GA within 1 year by 8.3- to 20.7-fold (data sets 2 and 3).
Conclusions and Relevance The fully automated, position-aware deep-learning algorithm assessed in this study successfully predicted progression from iAMD to GA over a clinically meaningful time frame. The ability to predict imminent GA progression could facilitate clinical trials aimed at preventing the condition and could guide clinical decision-making regarding screening frequency or treatment initiation.
