Abstract
Glaucoma is a leading cause of irreversible blindness worldwide, yet early detection can prevent vision loss. This paper proposes a novel deep learning approach that combines two ophthalmic imaging modalities, fundus photographs and optical coherence tomography scans, as paired images from the same eye of each patient for automated glaucoma detection. We develop separate convolutional neural network models for fundus and optical coherence tomography images and a fusion model that integrates features from both modalities for each eye. The models are trained and evaluated on a private clinical dataset (Bangladesh Eye Hospital and Institute Ltd.) consisting of 216 healthy eye images (108 fundus, 108 optical coherence tomography) from 108 patients and 200 glaucomatous eye images (100 fundus, 100 optical coherence tomography) from 100 patients. Our methodology includes image preprocessing pipelines for each modality, custom convolutional neural network/ResNet-based architectures for single-modality analysis, and a two-branch fusion network combining fundus and optical coherence tomography feature representations. We report the performance (accuracy, sensitivity, specificity, and area under curve) of the fundus-only, optical coherence tomography-only, and fusion models. In addition to a fixed test set evaluation, we perform five-fold cross-validation, confirming the robustness and consistency of the fusion model across multiple data partitions. On our fixed test set, the fundus-only model achieves 86% accuracy (AUC 0.89) and the optical coherence tomography-only model, 84% accuracy (AUC 0.87). Our fused model reaches 92% accuracy (AUC 0.95), an absolute improvement of 6 percentage points and 8 percentage points over the fundus and OCT baselines, respectively. McNemar's test on pooled five-fold validation predictions (b = 3, c = 18) yields χ2=10.7 (p = 0.001), and on optical coherence tomography-only vs. fused (b_o = 5, c_o = 20) χo2=9.0 (p = 0.003), confirming that the fusion gains are significant. Five-fold cross-validation further confirms these improvements (mean AUC 0.952±0.011. We also compare our results with the existing literature and discuss the clinical significance, limitations, and future work. To the best of our knowledge, this is the first time a novel deep learning model has been used on a fusion of paired fundus and optical coherence tomography images of the same patient for the detection of glaucoma.