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The supervised deep learning approach provides state-of-the-art performance in a variety of fundus image classification tasks, but it is not applicable for screening tasks with numerous or unknown disease types. The unsupervised anomaly detection (AD) approach, which needs only normal samples to develop a model, may be a workable and cost-saving method of screening for ocular diseases.

This study aimed to develop and evaluate an AD model for detecting ocular diseases on the basis of color fundus images.

A generative adversarial network–based AD method for detecting possible ocular diseases was developed and evaluated using 90,499 retinal fundus images derived from 4 large-scale real-world data sets. Four other independent external test sets were used for external testing and further analysis of the model’s performance in detecting 6 common ocular diseases (diabetic retinopathy [DR], glaucoma, cataract, age-related macular degeneration, hypertensive retinopathy [HR], and myopia), DR of different severity levels, and 36 categories of abnormal fundus images. The area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity of the model’s performance were calculated and presented.

Our model achieved an AUC of 0.896 with 82.69% sensitivity and 82.63% specificity in detecting abnormal fundus images in the internal test set, and it achieved an AUC of 0.900 with 83.25% sensitivity and 85.19% specificity in 1 external proprietary data set. In the detection of 6 common ocular …