  Background: Patients with neovascular age-related macular degeneration (AMD)
can avoid vision loss via certain therapy. However, methods to predict the
progression to neovascular age-related macular degeneration (nvAMD) are
lacking. Purpose: To develop and validate a deep learning (DL) algorithm to
predict 1-year progression of eyes with no, early, or intermediate AMD to
nvAMD, using color fundus photographs (CFP). Design: Development and validation
of a DL algorithm. Methods: We trained a DL algorithm to predict 1-year
progression to nvAMD, and used 10-fold cross-validation to evaluate this
approach on two groups of eyes in the Age-Related Eye Disease Study (AREDS):
none/early/intermediate AMD, and intermediate AMD (iAMD) only. We compared the
DL algorithm to the manually graded 4-category and 9-step scales in the AREDS
dataset. Main outcome measures: Performance of the DL algorithm was evaluated
using the sensitivity at 80% specificity for progression to nvAMD. Results: The
DL algorithm's sensitivity for predicting progression to nvAMD from
none/early/iAMD (78+/-6%) was higher than manual grades from the 9-step scale
(67+/-8%) or the 4-category scale (48+/-3%). For predicting progression
specifically from iAMD, the DL algorithm's sensitivity (57+/-6%) was also
higher compared to the 9-step grades (36+/-8%) and the 4-category grades
(20+/-0%). Conclusions: Our DL algorithm performed better in predicting
progression to nvAMD than manual grades. Future investigations are required to
test the application of this DL algorithm in a real-world clinical setting.
