Automated Detection of Keratorefractive Laser Surgeries on Optical Coherence Tomography using Deep Learning

PURPOSE: To report a deep learning neural network on anterior segment optical coherence tomography (AS-OCT) for automated detection of different keratorefractive laser surgeries, including Laser In-Situ Keratomileusis with femtosecond microkeratome (Femto-LASIK), LASIK with mechanical microkeratome, photorefractive keratectomy (PRK), keratorefractive lenticule extraction (KLEx), and non-operated eyes, while also distinguishing the targeted ametropias, such as myopic and hyperopic treatments, within these procedures. DESIGN: Cross-sectional retrospective study. METHODS: A total of 14,948 eye scans from 2,278 eyes of 1,166 subjects were used to develop a deep learning neural network algorithm with an 80/10/10 patient distribution for training, validation, and testing phases, respectively. The algorithm was evaluated for its accuracy, F1-scores, area under precision-recall curve (AUPRC), and area under receiver operating characteristic curve (AUROC). RESULTS: On the test dataset, the neural network was able to detect the different surgical classes with an accuracy of 96%, a weighted-average F1-score of 96% and a macro-average F1-score of 96%. The neural network was further able to detect hyperopic and myopic subclasses within each surgical class, with an accuracy of 90%, weighted-average F1 score of 90%, and macro-average F1-score of 83%. CONCLUSIONS: Determining a patient's keratorefractive laser history is vital for customizing treatments, performing precise intraocular lens (IOL) calculations, and enhancing ectasia risk assessments, especially when electronic health records are incomplete or unavailable. Neural networks can be used to accurately classify keratorefractive laser history from AS-OCT scans, a step in transforming the AS-OCT from a diagnostic to a screening tool in the refractive clinic. ### Competing Interest Statement Dr Reinstein is a consultant for Carl Zeiss Meditec (Carl Zeiss Meditec AG, Jena, Germany). Dr Reinstein is also a consultant for CSO Italia (Florence, Italy) and has a proprietary interest in the Artemis technology (ArcScan Inc, Golden, Colorado) through patents administered by the Cornell Center for Technology Enterprise and Commercialization (CCTEC), Ithaca, New York. Dr Awwad is a consultant for Carl Zeiss Meditec (Carl Zeiss Meditec AG, Jena, Germany). Drs Assaf and Awwad have financial interest in NeuralVision - FZCO (Dubai, UAE). In addition to the previously disclosed interests, a full patent has been filed by Drs Assaf, Awwad, and Yazbeck pertaining to the methodologies and technologies discussed in this study. The remaining authors have no proprietary or financial interest in the materials presented herein. ### Funding Statement This research was partially funded by the Suhail Muasher Endowed Medical Student Research Award. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRB of the American University of Beirut gave ethical approval for this work. IRB of London Vision Clinic and Aurelios Augenzentrum waived ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.