Deep learning in glaucoma with optical coherence tomography: a review.

Deep learning (DL), a subset of artificial intelligence (AI) based on deep neural networks, has made significant breakthroughs in medical imaging, particularly for image classification and pattern recognition. In ophthalmology, applying DL for glaucoma assessment with optical coherence tomography (OCT), including OCT traditional reports, two-dimensional (2D) B-scans, and three-dimensional (3D) volumetric scans, has increasingly raised research interests. Studies have demonstrated that using DL for interpreting OCT is efficient, accurate, and with good performance for discriminating glaucomatous eyes from normal eyes, suggesting that incorporation of DL technology in OCT for glaucoma assessment could potentially address some gaps in the current practice and clinical workflow. However, further research is crucial in tackling some existing challenges, such as annotation standardization (i.e., setting a standard for ground truth labelling among different studies), development of DL-powered IT infrastructure for real-world implementation, prospective validation in unseen datasets for further evaluation of generalizability, cost-effectiveness analysis after integration of DL, the AI "black box" explanation problem. This review summarizes recent studies on the application of DL on OCT for glaucoma assessment, identifies the potential clinical impact arising from the development and deployment of the DL models, and discusses future research directions.