Stargardt disease and age-related macular degeneration are the leading causes of blindness in the juvenile and geriatric populations, respectively. The formation of atrophic regions of the macula is a hallmark of the end-stages of both diseases. The progression of these diseases is tracked using various imaging modalities, two of the most common being fundus autofluorescence (FAF) imaging and spectral-domain optical coherence tomography (SD-OCT). This study seeks to investigate the use of longitudinal FAF and SD-OCT imaging (month 0, month 6, month 12, and month 18) data for the predictive modelling of future atrophy in Stargardt and geographic atrophy. To achieve such an objective, we develop a set of novel deep convolutional neural networks enhanced with recurrent network units for longitudinal prediction and concurrent learning of ensemble network units (termed ReConNet) which take advantage of improved retinal layer features beyond the mean intensity features. Using FAF images, the neural network presented in this paper achieved mean (± standard deviation, SD) and median Dice coefficients of 0.895 (± 0.086) and 0.922 for Stargardt atrophy, and 0.864 (± 0.113) and 0.893 for geographic atrophy. Using SD-OCT images for Stargardt atrophy, the neural network achieved mean and median Dice coefficients of 0.882 (± 0.101) and 0.906, respectively. When predicting only the interval growth of the atrophic lesions with FAF images, mean (± SD) and median Dice coefficients of 0.557 (± 0.094) and 0.559 were achieved for Stargardt atrophy, and 0.612 (± 0.089) and 0.601 for geographic atrophy. The prediction performance in OCT images is comparably good to that using FAF which opens a new, more efficient, and practical door in the assessment of atrophy progression for clinical trials and retina clinics, beyond widely used FAF. These results are highly encouraging for a high-performance interval growth prediction when more frequent or longer-term longitudinal data are available in our clinics. This is a pressing task for our next step in ongoing research.

The authors have declared no competing interest.

NCT01977846

This work was supported by the National Eye Institute of the National Institutes of Health under Award Number R21EY029839.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

For the Stargardt data, the ethics reviews and institutional review board approvals were obtained from the local ethics committees of all the nine participating institutions, i.e., The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland (JHU); Greater Baltimore Medical Centre, Baltimore, Maryland (GBMC); Scheie Eye Institute, University of Philadelphia, Philadelphia, Pennsylvania (PENN); Retina Foundation of the Southwest, Dallas, Texas (RFSW); Moran Eye Centre, Salt Lake City, Utah (MEC); Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio (CC); Moorfields Eye Hospital, London, UK (MEH, UK); Universite de Paris 06, Institut national de la sante et de la recherche medicale, Paris, France (INSERM, France); and Eberhard-Karls University Eye Hospital, Tuebingen, Germany (EKU, Germany). For the geographic atrophy data, ethics review and institutional review board approval from the University of California, Los Angeles were obtained.

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