Machine learning couched treatment algorithms tailored to individualized profile of patients with primary anterior chamber angle closure predisposed to the glaucomatous optic neuropathy

Abstract

Abstract Background: Primary angle-closure glaucoma (PACG) is still one of the leading causes of irreversible blindness, with a trend towards an increase in the number of patients to 32.04 million by 2040, an increase of 58.4% compared with 2013. Health-risk assessment based on multi-level diagnostics and machine learning couched treatment algorithms tailored to individualized profile of patients with primary anterior chamber angle closure are considered essential tools to reverse the trend and protect vulnerable subpopulations against health-to-disease progression. Aim: To develop a methodology for personalized choice of an effective method of primary angle closure (PAC) treatment based on comparing the prognosis of intraocular pressure (IOP) changes due to laser peripheral iridotomy (LPI) or lens extraction (LE). Methods: The multi-parametric data analysis was used to develop models predicting individual outcome of the primary angle closure (PAC) treatment with LPI and LE. For doing this, we suggested a positive dynamics in the intraocular pressure (IOP) after treatment, as the objective measure of a successful treatment. Thirty seven anatomical parameters have been considered by applying artificial intelligence to the prospective study on 30 (LE)+30 (LPI) patients with PAC. Results and data interpretation in the framework of 3P medicine: Based on the anatomical and topographic features of the patients with PAC, mathematical models have been developed that provide a personalized choice of LE or LPI in the treatment. The multi-level diagnostics is the key-tool in the overall advanced approach. To this end, for the future application of AI in the area it is strongly recommended to consider 1. clinically relevant phenotyping applicable to advanced population screening 2. systemic effects causing suboptimal health conditions considered in order to cost-effectively protect affected individuals against health-to-disease transition 3. clinically relevant health risk assessment utilizing health/disease-specific molecular patterns detectable in body fluids with high predictive power such as a comprehensive tear fluid analysis.