Keratoconus is a disease of the cornea that affects people between the ages of 10 and 40 years. In those affected, the cornea weakens and thins over the years, gradually bulging into the typical cone‐like shape, which leads to reduced vision. Glasses can resolve this problem in the early stages of keratoconus, but no longer offer a satisfying solution as the disease becomes more severe. Early diagnosis is imperative to ensure follow‐up and treatment and thus prevent loss of vision.
The diagnosis of keratoconus is based on an eye exam and imaging (computer‐assisted techniques that create three‐dimensional pictures or maps of the cornea). Interpreting the images can be challenging, especially in primary eye care settings and in the early stages of the disease. AI gives machines the ability to adapt, reason, and find solutions. Algorithms can be developed and trained to analyse images of the cornea and recognize keratoconus.
63 studies were found that used three different units (eyes, participants, and images) to analyse the accuracy of AI for detecting keratoconus: Forty‐four studies analysed 23,771 eyes, four studies analysed 3843 participants, and 15 studies analysed 38,832 images.
Fifty‐four articles evaluated the detection of manifest keratoconus, defined as a cornea that showed any clinical sign of keratoconus. The accuracy of AI seems almost perfect, with a summary sensitivity of 98.6% (95% confidence interval (CI) 97.6% to 99.1%) and a summary specificity of 98.3% (95% CI 97.4% to 98.9%).
Twenty‐eight articles evaluated the detection of subclinical keratoconus, The tests showed good accuracy, with a summary sensitivity of 90.0% (95% CI 84.5% to 93.8%) and a summary specificity of 95.5% (95% CI 91.9% to 97.5%).
AI appears to be a promising triage tool in ophthalmologic practice for diagnosing keratoconus. Test accuracy was very high for manifest keratoconus and slightly lower for subclinical keratoconus, indicating a higher chance of missing a diagnosis in people without clinical signs. This could lead to progression of keratoconus or an erroneous indication for refractive surgery, which would worsen the disease.
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