Diagnostic performance of deep learning in infectious keratitis: a systematic review and meta-analysis protocol

Zun Zheng Ong, Youssef Sadek, Xiaoxuan Liu, Riaz Qureshi, Su-Hsun Liu, Tianjing Li, Viknesh Sounderajah, Hutan Ashrafian, Daniel Shu Wei Ting, Dalia G Said, Jodhbir S Mehta, Matthew J Burton, Harminder Singh Dua, Darren Shu Jeng Ting*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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Introduction: Infectious keratitis (IK) represents the fifth-leading cause of blindness worldwide. A delay in diagnosis is often a major factor in progression to irreversible visual impairment and/or blindness from IK. The diagnostic challenge is further compounded by low microbiological culture yield, long turnaround time, poorly differentiated clinical features and polymicrobial infections. In recent years, deep learning (DL), a subfield of artificial intelligence, has rapidly emerged as a promising tool in assisting automated medical diagnosis, clinical triage and decision-making, and improving workflow efficiency in healthcare services. Recent studies have demonstrated the potential of using DL in assisting the diagnosis of IK, though the accuracy remains to be elucidated. This systematic review and meta-analysis aims to critically examine and compare the performance of various DL models with clinical experts and/or microbiological results (the current ‘gold standard’) in diagnosing IK, with an aim to inform practice on the clinical applicability and deployment of DL-assisted diagnostic models. Methods and analysis: This review will consider studies that included application of any DL models to diagnose patients with suspected IK, encompassing bacterial, fungal, protozoal and/or viral origins. We will search various electronic databases, including EMBASE and MEDLINE, and trial registries. There will be no restriction to the language and publication date. Two independent reviewers will assess the titles, abstracts and full-text articles. Extracted data will include details of each primary studies, including title, year of publication, authors, types of DL models used, populations, sample size, decision threshold and diagnostic performance. We will perform meta-analyses for the included primary studies when there are sufficient similarities in outcome reporting. Ethics and dissemination: No ethical approval is required for this systematic review. We plan to disseminate our findings via presentation/publication in a peer-reviewed journal. PROSPERO registration number: CRD42022348596.
Original languageEnglish
Article numbere065537
Number of pages6
JournalBMJ open
Issue number5
Publication statusPublished - 10 May 2023


  • Artificial intelligence
  • Corneal infection
  • Ophthalmology
  • Keratitis
  • Diagnosis


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