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Significance: Our retinal image-based deep learning (DL) cardiac biological age (BioAge) model could facilitate fast, accurate, noninvasive screening for cardiovascular disease (CVD) in novel community settings and thus improve outcome with those with limited access to health care services., Purpose: This study aimed to determine whether the results issued by our DL cardiac BioAge model are consistent with the known trends of CVD risk and the biomarker leukocyte telomere length (LTL), in a cohort of individuals from the UK Biobank., Methods: A cross-sectional cohort study was conducted using those individuals in the UK Biobank who had LTL data. These individuals were divided by sex, ranked by LTL, and then grouped into deciles. The retinal images were then presented to the DL model, and individual's cardiac BioAge was determined. Individuals within each LTL decile were then ranked by cardiac BioAge, and the mean of the CVD risk biomarkers in the top and bottom quartiles was compared. The relationship between an individual's cardiac BioAge, the CVD biomarkers, and LTL was determined using traditional correlation statistics., Results: The DL cardiac BioAge model was able to accurately stratify individuals by the traditional CVD risk biomarkers, and for both males and females, those issued with a cardiac BioAge in the top quartile of their chronological peer group had a significantly higher mean systolic blood pressure, hemoglobin A 1c , and 10-year Pooled Cohort Equation CVD risk scores compared with those individuals in the bottom quartile (p<0.001). Cardiac BioAge was associated with LTL shortening for both males and females (males: -0.22, r2 = 0.04; females: -0.18, r2 = 0.03)., Conclusions: In this cross-sectional cohort study, increasing CVD risk whether assessed by traditional biomarkers, CVD risk scoring, or our DL cardiac BioAge, CVD risk model, was inversely related to LTL. At a population level, our data support the growing body of evidence that suggests LTL shortening is a surrogate marker for increasing CVD risk and that this risk can be captured by our novel DL cardiac BioAge model., Competing Interests: Conflict of Interest Disclosure: Ehsan Vaghefi and David Squirrell are employees of Toku Eyes, which paid for the cost of the research., (Copyright © 2024 The Author(s).)

Deep learning (DL) models have shown promise in detecting chronic kidney disease (CKD) from fundus photographs. However, previous studies have utilized a serum creatinine-only estimated glomerular rate (eGFR) equation to measure kidney function despite the development of more up-to-date methods. In this study, we developed two sets of DL models using fundus images from the UK Biobank to ascertain the effects of using a creatinine and cystatin-C eGFR equation over the baseline creatinine-only eGFR equation on fundus image-based DL CKD predictors. Our results show that a creatinine and cystatin-C eGFR significantly improved classification performance over the baseline creatinine-only eGFR when the models were evaluated conventionally. However, these differences were no longer significant when the models were assessed on clinical labels based on ICD10. Furthermore, we also observed variations in model performance and systemic condition incidence between our study and the ones conducted previously. We hypothesize that limitations in existing eGFR equations and the paucity of retinal features uniquely indicative of CKD may contribute to these inconsistencies. These findings emphasize the need for developing more transparent models to facilitate a better understanding of the mechanisms underpinning the ability of DL models to detect CKD from fundus images., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: E. Vaghefi is a co-founder and CEO of Toku Eyes Limited New Zealand. D. Squirrell is a co-founder and medical advisor at Toku Eyes Limited NZ. S. An, S. Yang and L. Xie are employees of Toku Eyes Limited NZ. The authors report no other conflicts of interest in this work., (Copyright: © 2023 An et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This systematic review was performed to identify the specifics of an optimal diabetic retinopathy deep learning algorithm, by identifying the best exemplar research studies of the field, whilst highlighting potential barriers to clinical implementation of such an algorithm. Searching five electronic databases (Embase, MEDLINE, Scopus, PubMed, and the Cochrane Library) returned 747 unique records on 20 December 2019. Predetermined inclusion and exclusion criteria were applied to the search results, resulting in 15 highest-quality publications. A manual search through the reference lists of relevant review articles found from the database search was conducted, yielding no additional records. A validation dataset of the trained deep learning algorithms was used for creating a set of optimal properties for an ideal diabetic retinopathy classification algorithm. Potential limitations to the clinical implementation of such systems were identified as lack of generalizability, limited screening scope, and data sovereignty issues. It is concluded that deep learning algorithms in the context of diabetic retinopathy screening have reported impressive results. Despite this, the potential sources of limitations in such systems must be evaluated carefully. An ideal deep learning algorithm should be clinic-, clinician-, and camera-agnostic; complying with the local regulation for data sovereignty, storage, privacy, and reporting; whilst requiring minimum human input. [ABSTRACT FROM AUTHOR]

Background and Objective. To determine if using a multi-input deep learning approach in the image analysis of optical coherence tomography (OCT), OCT angiography (OCT-A), and colour fundus photographs increases the accuracy of a CNN to diagnose intermediate dry age-related macular degeneration (AMD). Patients and Methods. Seventy-five participants were recruited and divided into three cohorts: young healthy (YH), old healthy (OH), and patients with intermediate dry AMD. Colour fundus photography, OCT, and OCT-A scans were performed. The convolutional neural network (CNN) was trained on multiple image modalities at the same time. Results. The CNN trained using OCT alone showed a diagnostic accuracy of 94%, whilst the OCT-A trained CNN resulted in an accuracy of 91%. When multiple modalities were combined, the CNN accuracy increased to 96% in the AMD cohort. Conclusions. Here we demonstrate that superior diagnostic accuracy can be achieved when deep learning is combined with multimodal image analysis. [ABSTRACT FROM AUTHOR]