Abstract
Purpose: To evaluate the performance of deep learning (DL) in diagnosing glaucoma and predicting its progression using fundus photography and retinal optical coherence tomography (OCT) images. Materials and Methods: Relevant studies published up to 30 October 2024 were retrieved from PubMed, Medline, EMBASE, Cochrane Library, Web of Science, and ClinicalKey. A bivariate random-effects model was employed to calculate pooled sensitivity, specificity, positive and negative likelihood ratios, and area under the receiver operating characteristic curve (AUROC). Results: A total of 48 studies were included in the meta-analysis. DL algorithms demonstrated high diagnostic performance in glaucoma detection using fundus photography and OCT images. For fundus photography, the pooled sensitivity and specificity were 0.92 (95% CI: 0.89-0.94) and 0.93 (95% CI: 0.90-0.95), respectively, with an AUROC of 0.90 (95% CI: 0.88-0.92). For the OCT imaging, the pooled sensitivity and specificity were 0.90 (95% CI: 0.84-0.94) and 0.87 (95% CI: 0.81-0.91), respectively, with an AUROC of 0.86 (95% CI: 0.83-0.90). In predicting glaucoma progression, DL models generally showed less robust performance, with pooled sensitivities and specificities ranging lower than in diagnostic tasks. Internal validation datasets showed higher accuracy than external validation datasets. Conclusions: DL algorithms achieve excellent performance in diagnosing glaucoma using fundus photography and OCT imaging. To enhance the prediction of glaucoma progression, future DL models should integrate multimodal data, including functional assessments, such as visual field measurements, and undergo extensive validation in real-world clinical settings.