Keratoconus Detection-based on Dynamic Corneal Deformation Videos Using Deep Learning

Objective: To assess the performance of convolutional neural networks (CNNs) for automated detection of keratoconus (KC) in standalone Scheimpflug-based dynamic corneal deformation videos.Design: Retrospective cohort study.Participants: We retrospectively analyzed datasets with records of 734 nonconsecutive, refractive surgery candidates, and patients with unilateral or bilateral KC.Methods: We first developed a video preprocessing pipeline to translate dynamic corneal deformation videos into 3-dimensional pseudoimage representations and then trained a CNN to directly identify KC from pseudoimages. We calculated the model's KC probability score cut-off and evaluated the performance by subjective and objective accuracy metrics using 2 independent datasets.Main Outcome Measures: Area under the receiver operating characteristics curve (AUC), accuracy, specificity, sensitivity, and KC probability score.Results: The model accuracy on the test subset was 0.89 with AUC of 0.94. Based on the external validation dataset, the AUC and accuracy of the CNN model for detecting KC were 0.93 and 0.88, respectively.Conclusions: Our deep learning-based approach was highly sensitive and specific in separating normal from keratoconic eyes using dynamic corneal deformation videos at levels that may prove useful in clinical practice.Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. Ophthalmology Science 2024;4:100380 (c) 2023 by the American Academy of Ophthalmology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).