Artificial intelligence techniques for automatic screening of amblyogenic factors.

PURPOSE To develop a low-cost automated video system to effectively screen children aged 6 months to 6 years for amblyogenic factors. METHODS In 1994 one of the authors (G.C.) described video vision development assessment, a digitizable analog video-based system combining Brückner pupil red reflex imaging and eccentric photorefraction to screen young children for amblyogenic factors. The images were analyzed manually with this system. We automated the capture of digital video frames and pupil images and applied computer vision and artificial intelligence to analyze and interpret results. The artificial intelligence systems were evaluated by a tenfold testing method. RESULTS The best system was the decision tree learning approach, which had an accuracy of 77%, compared to the "gold standard" specialist examination with a "refer/do not refer" decision. Criteria for referral were strabismus, including microtropia, and refractive errors and anisometropia considered to be amblyogenic. Eighty-two percent of strabismic individuals were correctly identified. High refractive errors were also correctly identified and referred 90% of the time, as well as significant anisometropia. The program was less correct in identifying more moderate refractive errors, below +5 and less than -7. CONCLUSIONS Although we are pursuing a variety of avenues to improve the accuracy of the automated analysis, the program in its present form provides acceptable cost benefits for detecting ambylogenic factors in children aged 6 months to 6 years.