Neil M. Bressler

Philippe Burlina, Neil Joshi, William Paul et al.

This study evaluated generative methods to potentially mitigate AI bias when diagnosing diabetic retinopathy (DR) resulting from training data imbalance, or domain generalization which occurs when deep learning systems (DLS) face concepts at test/inference time they were not initially trained on. The public domain Kaggle-EyePACS dataset (88,692 fundi and 44,346 individuals, originally diverse for ethnicity) was modified by adding clinician-annotated labels and constructing an artificial scenario of data imbalance and domain generalization by disallowing training (but not testing) exemplars for images of retinas with DR warranting referral (DR-referable) and from darker-skin individuals, who presumably have greater concentration of melanin within uveal melanocytes, on average, contributing to retinal image pigmentation. A traditional/baseline diagnostic DLS was compared against new DLSs that would use training data augmented via generative models for debiasing. Accuracy (95% confidence intervals [CI]) of the baseline diagnostics DLS for fundus images of lighter-skin individuals was 73.0% (66.9%, 79.2%) vs. darker-skin of 60.5% (53.5%, 67.3%), demonstrating bias/disparity (delta=12.5%) (Welch t-test t=2.670, P=.008) in AI performance across protected subpopulations. Using novel generative methods for addressing missing subpopulation training data (DR-referable darker-skin) achieved instead accuracy, for lighter-skin, of 72.0% (65.8%, 78.2%), and for darker-skin, of 71.5% (65.2%,77.8%), demonstrating closer parity (delta=0.5%) in accuracy across subpopulations (Welch t-test t=0.111, P=.912). Findings illustrate how data imbalance and domain generalization can lead to disparity of accuracy across subpopulations, and show that novel generative methods of synthetic fundus images may play a role for debiasing AI.

Mike Pekala, Neil Joshi, David E. Freund et al.

Our objective is to evaluate the efficacy of methods that use deep learning (DL) for the automatic fine-grained segmentation of optical coherence tomography (OCT) images of the retina. OCT images from 10 patients with mild non-proliferative diabetic retinopathy were used from a public (U. of Miami) dataset. For each patient, five images were available: one image of the fovea center, two images of the perifovea, and two images of the parafovea. For each image, two expert graders each manually annotated five retinal surfaces (i.e. boundaries between pairs of retinal layers). The first grader's annotations were used as ground truth and the second grader's annotations to compute inter-operator agreement. The proposed automated approach segments images using fully convolutional networks (FCNs) together with Gaussian process (GP)-based regression as a post-processing step to improve the quality of the estimates. Using 10-fold cross validation, the performance of the algorithms is determined by computing the per-pixel unsigned error (distance) between the automated estimates and the ground truth annotations generated by the first manual grader. We compare the proposed method against five state of the art automatic segmentation techniques. The results show that the proposed methods compare favorably with state of the art techniques, resulting in the smallest mean unsigned error values and associated standard deviations, and performance is comparable with human annotation of retinal layers from OCT when there is only mild retinopathy. The results suggest that semantic segmentation using FCNs, coupled with regression-based post-processing, can effectively solve the OCT segmentation problem on par with human capabilities with mild retinopathy.