Development and Evaluation of a Deep Learning System for Screening Retinal Hemorrhage Based on Ultra-Widefield Fundus Images

PURPOSE: To develop and evaluate a deep learning (DL) system for retinal hemorrhage (RH) screening using ultra-widefield fundus (UWF) images. METHODS: A total of 16,827 UWF images from 11,339 individuals were used to develop the DL system. Three experienced retina specialists were recruited to grade UWF images independently. Three independent data sets from 3 different institutions were used to validate the effectiveness of the DL system. The data set from Zhongshan Ophthalmic Center (ZOC) was selected to compare the classification performance of the DL system and general ophthalmologists. A heatmap was generated to identify the most important area used by the DL model to classify RH and to discern whether the RH involved the anatomical macula. RESULTS: In the three independent data sets, the DL model for detecting RH achieved areas under the curve of 0.997, 0.998, and 0.999, with sensitivities of 97.6%, 96.7%, and 98.9% and specificities of 98.0%, 98.7%, and 99.4%. In the ZOC data set, the sensitivity of the DL model was better than that of the general ophthalmologists, although the general ophthalmologists had slightly higher specificities. The heatmaps highlighted RH regions in all true-positive images, and the RH within the anatomical macula was determined based on heatmaps. CONCLUSIONS: Our DL system showed reliable performance for detecting RH and could be used to screen for RH-related diseases. TRANSLATIONAL RELEVANCE: As a screening tool, this automated system may aid early diagnosis and management of RH-related retinal and systemic diseases by allowing timely referral.