Comparison of AI-Automated and Manual Subfoveal Choroidal Thickness Measurements in an Elderly Population Using Optical Coherence Tomography.

PURPOSE: To evaluate the agreement and correlation between manual and automated measurements of subfoveal choroidal thickness (SFCT) using enhanced depth imaging spectral-domain optical coherence tomography in an elderly population and to investigate the factors influencing measurement discrepancies.

METHODS

Based on the Beijing Eye Study, SFCT was measured manually using Heidelberg Eye Explorer software and automatically via a TransUNet-based deep learning model. Agreement between manual and automated SFCT measurements was assessed using Bland-Altman plots, intraclass correlation coefficients (ICC), and Pearson correlation coefficients.

RESULTS

Among 2896 participants, automated and manual measurements of SFCT demonstrated strong correlation (ICC = 0.971; 95% confidence interval [CI], 0.969-0.973; Pearson = 0.974, P < 0.001). Subgroup analyses showed similarly high correlation across participants aged ≥60 years (ICC = 0.954, Pearson = 0.974), aged <60 years (ICC = 0.971; Pearson = 0.953), with axial length ≥23 mm (ICC = 0.969; Pearson = 0.974), and axial length <23 mm (ICC = 0.959; Pearson = 0.963). Participants with SFCT <300 µm showed higher consistency (ICC = 0.942; Pearson = 0.944) compared to those with SFCT ≥300 µm (ICC = 0.867; Pearson = 0.868). Significant fixed and proportional biases were observed in all subgroups (P < 0.001), with manual measurements consistently lower than automated values.

CONCLUSIONS

Despite the presence of systematic biases, automated SFCT measurements showed excellent consistency and strong correlation with manual measurements across a large elderly population. These findings support the potential utility of AI-assisted SFCT measurement in clinical settings.

TRANSLATIONAL RELEVANCE: This study validates AI-based SFCT measurement in a large elderly cohort, enhancing diagnostic accuracy and bridging research with practice.