Abstract
Purpose: To construct quantifiable models of imaging features by machine learning describing early changes of optic disc and peripapillary region, and to explore their performance as early indicators for choroidal thickness (ChT) in young myopic patients.Methods: Eight hundred and ninety six subjects were enrolled. Imaging features were extracted from fundus photographs. Macular ChT (mChT) and peripapillary ChT (pChT) were measured on swept-source optical coherence tomography scans. All participants were divided randomly into training (70%) and test (30%) sets. Imaging features correlated with ChT were selected by LASSO regression and combined into new indicators of optic disc (IODs) for mChT (IOD_mChT) and for pChT (IOD_pChT) by multivariate regression models in the training set. The performance of IODs was evaluated in the test set.Results: A significant correlation between IOD_mChT and mChT (r = 0.650, R2 = 0.423, P < 0.001) was found in the test set. IOD_mChT was negatively associated with axial length (AL) (r = −0.562, P < 0.001) and peripapillary atrophy (PPA) area (r = −0.738, P < 0.001) and positively associated with ovality index (r = 0.503, P < 0.001) and torsion angle (r = 0.242, P < 0.001) in the test set. Every 1 × 10 μm decrease in IOD_mChT was associated with an 8.87 μm decrease in mChT. A significant correlation between IOD_pChT and pChT (r = 0.576, R2 = 0.331, P < 0.001) was found in the test set. IOD_pChT was negatively associated with AL (r = −0.478, P < 0.001) and PPA area (r = −0.651, P < 0.001) and positively associated with ovality index (r = 0.285, P < 0.001) and torsion angle (r = 0.180, P < 0.001) in the test set. Every 1 × 10 μm decrease in IOD_pChT was associated with a 9.64 μm decrease in pChT.Conclusions: The study introduced a machine learning approach to acquire imaging information of early changes of optic disc and peripapillary region and constructed quantitative models significantly correlated with choroidal thickness. The objective models from fundus photographs represented a new approach that offset limitations of human annotation and could be applied in other areas of fundus diseases.
Highlights
Myopia is one of the major causes of visual impairment, of which the prevalence has been increasing worldwide in recent decades [1,2,3]
Because the current study focused on the features of optic disc and peripapillary region, and the explanatory power of the axial length (AL) was greater than that of the spherical equivalent, only variations in AL and features of optic disc were used for multivariate regression analysis
The analysis showed that sex (P = 0.001), AL (P < 0.001) and IOD_mChT (P < 0.001) were independently associated with macular ChT (mChT) in all subjects
Summary
Myopia is one of the major causes of visual impairment, of which the prevalence has been increasing worldwide in recent decades [1,2,3]. The progression of myopia is accompanied by various characteristic changes of optic disc and peripapillary region. Characteristic features in the temporal adjacent area appear, including peripapillary atrophy (PPA), a crescent-shaped atrophic chorioretinal abnormality, and increasing disc fovea distance [10,11,12,13]. The onset of chorioretinal atrophy, which leads to a gradual decrease of choroidal thickness (ChT), has become a common concern in predicting the progression of high myopia and pathological myopia. Subfoveal ChT correlated positively with visual acuity and negatively with axial elongation in mild myopia in a cohort study aged from 14 to 65 years [14]. Subfoveal ChT is an independent predictor for myopic maculopathy progression in high myopes in a recent 2-year longitudinal study [17]
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