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Lingham G, Loughman J, Panah DS, Harrington S, Saunders KJ, Ying GS, Cui H, Kobia-Acquah E, Flitcroft DI. The long and short of it: a comprehensive assessment of axial length estimation in myopic eyes from ocular and demographic variables. Eye (Lond) 2024; 38:1333-1341. [PMID: 38200321 PMCID: PMC11076636 DOI: 10.1038/s41433-023-02899-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND/OBJECTIVES Axial length, a key measurement in myopia management, is not accessible in many settings. We aimed to develop and assess machine learning models to estimate the axial length of young myopic eyes. SUBJECTS/METHODS Linear regression, symbolic regression, gradient boosting and multilayer perceptron models were developed using age, sex, cycloplegic spherical equivalent refraction (SER) and corneal curvature. Training data were from 8135 (28% myopic) children and adolescents from Ireland, Northern Ireland and China. Model performance was tested on an additional 300 myopic individuals using traditional metrics alongside the estimated axial length vs age relationship. Linear regression and receiver operator characteristics (ROC) curves were used for statistical analysis. The contribution of the effective crystalline lens power to error in axial length estimation was calculated to define the latter's physiological limits. RESULTS Axial length estimation models were applicable across all testing regions (p ≥ 0.96 for training by testing region interaction). The linear regression model performed best based on agreement metrics (mean absolute error [MAE] = 0.31 mm, coefficient of repeatability = 0.79 mm) and a smooth, monotonic estimated axial length vs age relationship. This model was better at identifying high-risk eyes (axial length >98th centile) than SER alone (area under the curve 0.89 vs 0.79, respectively). Without knowing lens power, the calculated limits of axial length estimation were 0.30 mm for MAE and 0.75 mm for coefficient of repeatability. CONCLUSIONS In myopic eyes, we demonstrated superior axial length estimation with a linear regression model utilising age, sex and refractive metrics and showed its clinical utility as a risk stratification tool.
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Affiliation(s)
- Gareth Lingham
- Centre for Eye Research Ireland, Environmental Sustainability & Health Institute, Technological University Dublin, Dublin, Ireland
- Ocumetra Ltd., Dublin, Ireland
- Centre for Ophthalmology and Visual Science (incorporating the Lions Eye Institute), the University of Western Australia, Perth, WA, Australia
| | - James Loughman
- Centre for Eye Research Ireland, Environmental Sustainability & Health Institute, Technological University Dublin, Dublin, Ireland
- Ocumetra Ltd., Dublin, Ireland
| | - Davoud Shariat Panah
- Ocumetra Ltd., Dublin, Ireland
- School of Computer Science, Technological University Dublin, Dublin, Ireland
| | - Siofra Harrington
- Centre for Eye Research Ireland, Environmental Sustainability & Health Institute, Technological University Dublin, Dublin, Ireland
- School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Kathryn J Saunders
- Centre for Optometry and Vision Science, School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland
| | - Gui-Shuang Ying
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Hongguang Cui
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Emmanuel Kobia-Acquah
- Centre for Eye Research Ireland, Environmental Sustainability & Health Institute, Technological University Dublin, Dublin, Ireland
| | - Daniel Ian Flitcroft
- Centre for Eye Research Ireland, Environmental Sustainability & Health Institute, Technological University Dublin, Dublin, Ireland.
- Ocumetra Ltd., Dublin, Ireland.
- Department of Ophthalmology, Children's Health Ireland at Temple Street Hospital, Dublin, Ireland.
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