Predicting the likelihood of need for future keratoplasty intervention using artificial intelligence

Objective: To apply artificial intelligence (AI) for automated identification of corneal condition and prediction of the likelihood of need for future keratoplasty intervention from optical coherence tomography (OCT)-based corneal parameters. Design: Cohort study. Participants: We collected 12,242 corneal OCT images from 3162 subjects using CASIA OCT Imaging Systems (Tomey, Japan). We included 3318 measurements collected at the baseline visit of each patient. A total of 333 eyes had post-operative penetrating keratoplasty (PKP), lamellar keratoplasty (LKP), deep anterior keratoplasty (DALK), descemet's stripping automated endothelial keratoplasty (DSAEK) or descemet's membrane endothelial keratoplasty (DMEK) intervention. Method: We developed a pipeline including linear and nonlinear data transformations followed by unsupervised machine learning and applied on corneal parameters from the baseline visit of each patient. Five non-overlapping clusters of eyes were identified. Post hoc analyses revealed that clusters corresponded to different likelihoods of need for future keratoplasty. These clusters on a 2-dimensional map can be used by clinicians and surgeons to identify patients with higher risk of need for future keratoplasty intervention. Main outcome measures: The likelihood of the need for future surgery. Results: The mean age of participants was 69.7 (standard deviation; SD = 16.1) and 59% were female. The normalized likelihood of need for future corneal keratoplasty intervention for eyes mapped onto clusters one to five were 2.2%, 1.0%, 33.1%, 32.7%, and 31.0%, respectively. Conclusions: The AI system can assist the (cornea) surgeon in identifying those patients who may be at higher risk for future keratoplasty using comprehensive corneal shape, thickness, and elevation parameters. Future research utilizing independent datasets is necessary to validate the proposed system.