Comprehensive Summary
Zhou et al. examined the estimation of corneal elastic properties through the utilization of shear wave optical coherence elastography (OCE), more specifically via the departure from conventional time-of-flight (TOF) processing and towards a DenseNet-based deep learning pipeline. In order to do so, Zhou et al. first addressed the low repeatability, precision, and reproducibility of conventional TOF processing. Then, Zhou et al. were able to design and train a two-dimension plus time (2D + t) convolutional neural network (CNN) called DenseNet. This concentration prediction network was then trained alongside agar phantoms, which have highly reproducible elastic properties. When applied to both phantom and porcine cornea data, Zhou et al. were able to showcase a nonlinear relationship between agar concentration and Young’s modulus (YM), a finding that corroborated prior research despite yielding higher absolute values given the differences in strain. Specifically, the porcine samples demonstrated smaller standard deviations compared to the TOF processing, essentially indicating greater repeatability of the deep-learning approach. For example, the CNN was able to predict agar concentration while maintaining a mean absolute error (MAE) of 0.028 ± 0.036 (training) and 0.036 ± 0.024 (testing), with each data piece representing percentage-point units. In these same porcine samples, the elasticity maps had also highlighted a higher stiffness located at the corneal vertex as opposed to the periphery, hence further reflecting known collagen architecture. However, Zhou et al. also provides a holistic review of the deep-learning approach and notes how the reliable relativity is also balanced with indirect predictions of absolute YM thus requiring much more positional data in order to mitigate this challenge.
Outcomes and Implications
In a medical setting, the DenseNet-based deep-learning approach can be translated through the simplification of OCE signal processing whilst still maintaining repeatability in order to enhance detection accuracy of focal weakening - such as in premature keratoconus. With regards to medicine, this increased reliability of elastic mapping will be able to intervene via the supportive monitoring of corneal cross-linking, which heavily streamlines the OCE workflow when compared to the current analysis techniques via TOF processing. However, a stagnation within the clinical timeline may exist due to the deep-learning approach’s omission of viscosity and Lamb wave physics as well as small ex-vivo sample size. In order to address this, Zhou et. al provide an action plan that emphasizes in-vivo animal studies as well as human trials in order to fully prepare an integration into ophthalmic practice for early disease detection.