Abstract
BACKGROUND/OBJECTIVES: To evaluate the effectiveness of deep learning (DL) algorithms in diagnosing Retinopathy of Prematurity (ROP) cases that requires treatment using fundus images submitted to the ROP clinic as part of a telemedicine consultation system. SUBJECTS/METHODS: This retrospective cross-sectional study analysed 1700 RetCam fundus images from 141 preterm infants screened for ROP at Khatam-Al-Anbia Eye Hospital. The images underwent preprocessing using Contrast Limited Adaptive Histogram Equalisation (CLAHE), Automated Multiscale Retinex (AMSR), and a machine learning-based optimisation approach (ML). Various convolutional neural network (CNN) models such as MobileNet, ResNet-18, ResNet-50, and DenseNet-121, were evaluated for their diagnostic performance utilising accuracy, sensitivity, specificity, and F1-score metrics. RESULTS: Among the models tested, MobileNet with CLAHE preprocessing achieved the highest accuracy (91.39%) and sensitivity (94.90%), establishing it as the most effective model for ROP detection. DenseNet-121 with CLAHE preprocessing showcased high sensitivity (94.26%) but slightly lower accuracy (90.98%). Additionally, ResNet-50 with AMSR preprocessing also demonstrated high accuracy (90.58%) and sensitivity (91.44%). These findings underscore the feasibility of DL models for real-time ROP screening in telemedicine environments. CONCLUSION: MobileNet with CLAHE preprocessing exhibited the highest diagnostic performance in identifying treatment-requiring ROP, positioning it as a promising tool for AI-assisted screening. Further validation in varied clinical settings is necessary to confirm its real-world applicability.