Artificial intelligence for the detection of age-related macular degeneration in color fundus photographs: A systematic review and meta-analysis

BACKGROUND: Age-related macular degeneration (AMD) is one of the leading causes of vision loss in the elderly population. The application of artificial intelligence (AI) provides convenience for the diagnosis of AMD. This systematic review and meta-analysis aimed to quantify the performance of AI in detecting AMD in fundus photographs. METHODS: We searched PubMed, Embase, Web of Science and the Cochrane Library before December 31st, 2020 for studies reporting the application of AI in detecting AMD in color fundus photographs. Then, we pooled the data for analysis. PROSPERO registration number: CRD42020197532. FINDINGS: 19 studies were finally selected for systematic review and 13 of them were included in the quantitative synthesis. All studies adopted human graders as reference standard. The pooled area under the receiver operating characteristic curve (AUROC) was 0.983 (95% confidence interval (CI):0.979–0.987). The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were 0.88 (95% CI:0.88–0.88), 0.90 (95% CI:0.90–0.91), and 275.27 (95% CI:158.43–478.27), respectively. Threshold analysis was performed and a potential threshold effect was detected among the studies (Spearman correlation coefficient: -0.600, P = 0.030), which was the main cause for the heterogeneity. For studies applying convolutional neural networks in the Age-Related Eye Disease Study database, the pooled AUROC, sensitivity, specificity, and DOR were 0.983 (95% CI:0.978–0.988), 0.88 (95% CI:0.88–0.88), 0.91 (95% CI:0.91–0.91), and 273.14 (95% CI:130.79–570.43), respectively. INTERPRETATION: Our data indicated that AI was able to detect AMD in color fundus photographs. The application of AI-based automatic tools is beneficial for the diagnosis of AMD. FUNDING: Capital Health Research and Development of Special (2020–1–2052).