Effective automatic classification methods via deep learning for myopic maculopathy.

Background: Pathologic myopia (PM) associated with myopic maculopathy (MM) is a significant cause of visual impairment, especially in East Asia, where its prevalence has surged. Early detection and accurate classification of myopia-related fundus lesions are critical for managing PM. Traditional clinical analysis of fundus images is time-consuming and dependent on specialist expertise, driving the need for automated, accurate diagnostic tools. Methods: This study developed a deep learning-based system for classifying five types of MM using color fundus photographs. Five architectures-ResNet50, EfficientNet-B0, Vision Transformer (ViT), Contrastive Language-Image Pre-Training (CLIP), and RETFound-were utilized. An ensemble learning approach with weighted voting was employed to enhance model performance. The models were trained on a dataset of 2,159 annotated images from Shenzhen Eye Hospital, with performance evaluated using accuracy, sensitivity, specificity, F1-Score, Cohen's Kappa, and area under the receiver operating characteristic curve (AUC). Results: The ensemble model achieved superior performance across all metrics, with an accuracy of 95.4% (95% CI: 93.0-97.0%), sensitivity of 95.4% (95% CI: 86.8-97.5%), specificity of 98.9% (95% CI: 97.1-99.5%), F1-Score of 95.3% (95% CI: 93.2-97.2%), Kappa value of 0.976 (95% CI: 0.957-0.989), and AUC of 0.995 (95% CI: 0.992-0.998). The voting ensemble method demonstrated robustness and high generalization ability in classifying complex lesions, outperforming individual models. Conclusion: The ensemble deep learning system significantly enhances the accuracy and reliability of MM classification. This system holds potential for assisting ophthalmologists in early detection and precise diagnosis, thereby improving patient outcomes. Future work could focus on expanding the dataset, incorporating image quality assessment, and optimizing the ensemble algorithm for better efficiency and broader applicability.