Predicting Glaucoma Progression Requiring Surgery Using Clinical Free-Text Notes and Transfer Learning With Transformers

PURPOSE: We evaluated the use of massive transformer-based language models to predict glaucoma progression requiring surgery using ophthalmology clinical notes from electronic health records (EHRs). METHODS: Ophthalmology clinical notes for 4512 glaucoma patients at a single center from 2008 to 2020 were identified from the EHRs. Four different pre-trained Bidirectional Encoder Representations from Transformers (BERT)-based models were fine-tuned on ophthalmology clinical notes from the patients’ first 120 days of follow-up for the task of predicting which patients would require glaucoma surgery. Models were evaluated with standard metrics, including area under the receiver operating characteristic curve (AUROC) and F1 score. RESULTS: Of the patients, 748 progressed to require glaucoma surgery (16.6%). The original BERT model had the highest AUROC (73.4%; F1 = 45.0%) for identifying these patients, followed by RoBERTa, with an AUROC of 72.4% (F1 = 44.7%); DistilBERT, with an AUROC of 70.2% (F1 = 42.5%); and BioBERT, with an AUROC of 70.1% (F1 = 41.7%). All models had higher F1 scores than an ophthalmologist's review of clinical notes (F1 = 29.9%). CONCLUSIONS: Using transfer learning with massively pre-trained BERT-based models is a natural language processing approach that can access the wealth of clinical information stored within ophthalmology clinical notes to predict the progression of glaucoma. Future work to improve model performance can focus on integrating structured or imaging data or further tailoring the BERT models to ophthalmology domain–specific text. TRANSLATIONAL RELEVANCE: Predictive models can provide the basis for clinical decision support tools to aid clinicians in identifying high- or low-risk patients to maximally tailor glaucoma treatments.