Automatic classification of heterogeneous slit-illumination images using an ensemble of cost-sensitive convolutional neural networks

Background: Lens opacity seriously affects the visual development of infants. Slit-illumination images play an irreplaceable role in lens opacity detection; however, these images exhibited varied phenotypes with severe heterogeneity and complexity, particularly among pediatric cataracts. Therefore, it is urgently needed to explore an effective computer-aided method to automatically diagnose heterogeneous lens opacity and to provide appropriate treatment recommendations in a timely manner. Methods: We integrated three different deep learning networks and a cost-sensitive method into an ensemble learning architecture, and then proposed an effective model called CCNN-Ensemble [ensemble of cost-sensitive convolutional neural networks (CNNs)] for automatic lens opacity detection. A total of 470 slit-illumination images of pediatric cataracts were used for training and comparison between the CCNNEnsemble model and conventional methods. Finally, we used two external datasets (132 independent test images and 79 Internet-based images) to further evaluate the model's generalizability and effectiveness. Results: Experimental results and comparative analyses demonstrated that the proposed method was superior to conventional approaches and provided clinically meaningful performance in terms of three grading indices of lens opacity: area (specificity and sensitivity; 92.00% and 92.31%), density (93.85% and 91.43%) and opacity location (95.25% and 89.29%). Furthermore, the comparable performance on the independent testing dataset and the internet-based images verified the effectiveness and generalizability of the model. Finally, we developed and implemented a website-based automatic diagnosis software for pediatric cataract grading diagnosis in ophthalmology clinics. Conclusions: The CCNN-Ensemble method demonstrates higher specificity and sensitivity than conventional methods on multi-source datasets. This study provides a practical strategy for heterogeneous lens opacity diagnosis and has the potential to be applied to the analysis of other medical images.

Automated summary

The study introduced the CCNN-Ensemble model for automatic detection of lens opacity in pediatric cataracts, demonstrating superior performance on multiple indices and verifying the model's generalizability and effectiveness across different datasets. Additionally, a website-based software was developed for pediatric cataract grading diagnosis in ophthalmology clinics.