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Predictive, preventive, and personalized management of retinal fluid via computer-aided detection app for optical coherence tomography scans

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Computer-aided detection systems for retinal fluid could be beneficial for disease monitoring and management by chronic age-related macular degeneration (AMD) and diabetic retinopathy (DR) patients, to assist in disease prevention via early detection before the disease progresses to a “wet AMD” pathology or diabetic macular edema (DME), requiring treatment. We propose a proof-of-concept AI-based app to help predict fluid via a “fluid score”, prevent fluid progression, and provide personalized, serial monitoring, in the context of predictive, preventive, and personalized medicine (PPPM) for patients at risk of retinal fluid complications.


The app comprises a convolutional neural network–Vision Transformer (CNN-ViT)–based segmentation deep learning (DL) network, trained on a small dataset of 100 training images (augmented to 992 images) from the Singapore Epidemiology of Eye Diseases (SEED) study, together with a CNN-based classification network trained on 8497 images, that can detect fluid vs. non-fluid optical coherence tomography (OCT) scans. Both networks are validated on external datasets.


Internal testing for our segmentation network produced an IoU score of 83.0% (95% CI = 76.7–89.3%) and a DICE score of 90.4% (86.3–94.4%); for external testing, we obtained an IoU score of 66.7% (63.5–70.0%) and a DICE score of 78.7% (76.0–81.4%). Internal testing of our classification network produced an area under the receiver operating characteristics curve (AUC) of 99.18%, and a Youden index threshold of 0.3806; for external testing, we obtained an AUC of 94.55%, and an accuracy of 94.98% and an F1 score of 85.73% with Youden index.


We have developed an AI-based app with an alternative transformer-based segmentation algorithm that could potentially be applied in the clinic with a PPPM approach for serial monitoring, and could allow for the generation of retrospective data to research into the varied use of treatments for AMD and DR. The modular system of our app can be scaled to add more iterative features based on user feedback for more efficient monitoring. Further study and scaling up of the algorithm dataset could potentially boost its usability in a real-world clinical setting.

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This study was funded by SingHealth Duke-NUS AM (AM-NHIC/JMT010/2020/SRDUKAMR20M0).

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Authors and Affiliations



T.H.R. conceptualized the study. T.C.Q. developed the algorithms and application, pre-processed images with associated data, and edited all manuscript versions. K.T. and T.H.R. contributed equally to the annotation/labelling of ground truth and sorted image data into their classes for training. H.G.K., S.S.K., H.N., and G.L. provided external validation data for the validation of the deep learning algorithm. S.T. provided comments on the potential operational implementation of the algorithm and app in clinical practice, in the context of PPPM. M.D., R.T., K.T., and T.Y.C. provided comments to improve the overall manuscript.

Corresponding author

Correspondence to Tyler Hyungtaek Rim.

Ethics declarations

Ethics approval

This retrospective study was deemed exempt from institutional review board (IRB) review by the SingHealth Centralised Institutional Review Board (CIRB). This study was conducted in adherence to the tenets of the Declaration of Helsinki.

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Written informed consent was obtained from the participants of the original studies involved.

Consent for publication

This article has been approved for publication by the principal investigator (PI) of this study, T.H.R.

Competing interests

T.H.R. was a former scientific adviser and owns stock of Medi Whale. All other authors declare no competing interests.

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Gerald Liew and Ching-Yu Cheng are co-last authors.

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Quek, T.C., Takahashi, K., Kang, H.G. et al. Predictive, preventive, and personalized management of retinal fluid via computer-aided detection app for optical coherence tomography scans. EPMA Journal 13, 547–560 (2022).

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