Deep learning for detection of age-related macular degeneration: A systematic review and meta-analysis of diagnostic test accuracy studies

OBJECTIVE: To evaluate the diagnostic accuracy of deep learning algorithms to identify age-related macular degeneration and to explore factors impacting the results for future model training. METHODS: Diagnostic accuracy studies published in PubMed, EMBASE, the Cochrane Library, and ClinicalTrails.gov before 11 August 2022 which employed deep learning for age-related macular degeneration detection were identified and extracted by two independent researchers. Sensitivity analysis, subgroup, and meta-regression were performed by Review Manager 5.4.1, Meta-disc 1.4, and Stata 16.0. The risk of bias was assessed using QUADAS-2. The review was registered (PROSPERO CRD42022352753). RESULTS: The pooled sensitivity and specificity in this meta-analysis were 94% (P = 0, 95% CI 0.94–0.94, I(2) = 99.7%) and 97% (P = 0, 95% CI 0.97–0.97, I(2) = 99.6%), respectively. The pooled positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the area under the curve value were 21.77(95% CI 15.49–30.59), 0.06 (95% CI 0.04–0.09), 342.41 (95% CI 210.31–557.49), and 0.9925, respectively. Meta-regression indicated that types of AMD (P = 0.1882, RDOR = 36.03) and layers of the network (P = 0.4878, RDOR = 0.74) contributed to the heterogeneity. CONCLUSIONS: Convolutional neural networks are mostly adopted deep learning algorithms in age-related macular degeneration detection. Convolutional neural networks, especially ResNets, are effective in detecting age-related macular degeneration with high diagnostic accuracy. Types of age-related macular degeneration and layers of the network are the two essential factors that impact the model training process. Proper layers of the network will make the model more reliable. More datasets established by new diagnostic methods will be used to train deep learning models in the future, which will benefit for fundus application screening, long-range medical treatment, and reducing the workload of physicians.