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    Elastic Deformation of Optical Coherence Tomography Images of Diabetic Macular Edema for Deep-Learning Models Training: How Far to Go?

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    &#x2013; Objective: To explore the clinical validity of elastic deformation of optical coherence tomography (OCT) images for data augmentation in the development of deep-learning model for detection of diabetic macular edema (DME). Methods: Prospective evaluation of OCT images of DME (n &#x003D; 320) subject to elastic transformation, with the deformation intensity represented by ( σ\sigma ). Three sets of images, each comprising 100 pairs of scans (100 original &#x0026; 100 modified), were grouped according to the range of ( σ\sigma ), including low-, medium- and high-degree of augmentation; ( σ\sigma &#x003D; 1-6), ( σ\sigma &#x003D; 7-12), and ( σ\sigma &#x003D; 13-18), respectively. Three retina specialists evaluated all datasets in a blinded manner and designated each image as &#x2019;original&#x2018; versus &#x2019;modified&#x2018;. The rate of assignment of &#x2019;original&#x2018; value to modified images (false-negative) was determined for each grader in each dataset. Results: The false-negative rates ranged between 71-77&#x0025; for the low-, 63-76&#x0025; for the medium-, and 50-75&#x0025; for the high-augmentation categories. The corresponding rates of correct identification of original images ranged between 75-85&#x0025; ( \text{p}> 0.05) in the low-, 73-85&#x0025; ( \text{p}> 0.05 for graders 1 &#x0026; 2, p &#x003D; 0.01 for grader 3) in the medium-, and 81-91&#x0025; ( \text{p} < 0.005 ) in the high-augmentation categories. In the subcategory ( σ\sigma &#x003D; 7-9) the false-negative rates were 93-83&#x0025;, whereas the rates of correctly identifying original images ranged between 89-99&#x0025; ( \text{p}> 0.05 for all graders). Conclusions: Deformation of low-medium intensity ( σ\sigma &#x003D; 1-9) may be applied without compromising OCT image representativeness in DME. Clinical and Translational Impact Statement&#x2014;Elastic deformation may efficiently augment the size, robustness, and diversity of training datasets without altering their clinical value, enhancing the development of high-accuracy algorithms for automated interpretation of OCT images
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