254 IEEE TRANSACTIONS ON MEDICAL IMAGING, VOL. 41, NO.
2, FEBRUARY 2022
Hybrid Variation-Aware Network for
Angle-Closure Assessment in AS-OCT
Jinkui Hao , Fei Li , Huaying Hao, Huazhu Fu , Senior Member, IEEE, Yanwu Xu , Risa Higashita,
Xiulan Zhang, Jiang Liu , Senior Member, IEEE, and Yitian Zhao
Abstract — Automatic angle-closure assessment in Ante-
rior Segment OCT (AS-OCT) images is an important task
for the screening and diagnosis of glaucoma, and the most
recent computer-aided models focus on a binary classifica-
tion of anterior chamber angles (ACA) in AS-OCT, i.e., open-
angle and angle-closure. In order to assist clinicians who
seek better to understand the development of the spec-
trum of glaucoma types, a more discriminating three-class
classification scheme was suggested, i.e., the classifica-
tion of ACA was expended to include open-, appositional-
and synechial angles. However, appositional and synechial
angles display similar appearances in an AS-OCT image,
which makes classification models struggle to differentiate
angle-closure subtypes based on static AS-OCT images.
In order to tackle this issue, we propose a 2D-3D Hybrid
Variation-aware Network (HV-Net) for open-appositional-
synechial ACA classification from AS-OCT imagery. Specifi-
cally, taking into account clinical priors, we first reconstruct
Manuscript received July 16, 2021; revised August 29, 2021; accepted
September 1, 2021. Date of publication September 6, 2021; date
of current version February 2, 2022. This work was supported in
part by Zhejiang Provincial Natural Science Foundation under Grant
LZ19F010001, in part by the Youth Innovation Promotion Association
Chinese Academy of Sciences (CAS) under Grant 2021298, and in part
by Ningbo 2025 S&T Megaprojects under Grant 2019B10033 and Grant
2019B10061. (Jinkui Hao and Fei Li contributed equally to this work.)
(Corresponding authors: Xiulan Zhang; Jiang Liu; Yitian Zhao.)
Jinkui Hao is with Cixi Institute of Biomedical Engineering, Ningbo
Institute of Materials Technology and Engineering, Chinese Academy
of Sciences, Ningbo 315201, China, and also with the University
of Chinese Academy of Sciences, Beijing 100864, China (e-mail:
haojinkui@nimte.ac.cn).
Fei Li and Xiulan Zhang are with the State Key Laboratory of
Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen Univer-
sity, Guangzhou 510275, China, and also with the Glaucoma Arti-
ficial Intelligence Diagnosis and Imaging Analysis Joint Research
Lab, Guangzhou and Ningbo, China (e-mail: lifei.aletheus@gmail.com;
zhangxl2@mail.sysu.edu.cn).
Huaying Hao, Yanwu Xu, and Yitian Zhao are with Cixi Institute of
Biomedical Engineering, Ningbo Institute of Materials Technology and
Engineering, Chinese Academy of Sciences, Ningbo 315201, China,
and also with the Glaucoma Artificial Intelligence Diagnosis and Imaging
Analysis Joint Research Lab, Guangzhou and Ningbo, China (e-mail:
haohuaying@nimte.ac.cn; ywxu@ieee.org; yitian.zhao@nimte.ac.cn).
Huazhu Fu is with the Institute of High Performance Computing,
Agency for Science, Technology and Research, Singapore 117684
(e-mail: hzfu@ieee.org).
Risa Higashita is with Tomey Corporation, Nagoya 451-0051, Japan
(e-mail: k-chen@tomey.co.jp).
Jiang Liu is with the Department of Computer Science and Engineering,
Southern University of Science and Technology, Shenzhen 518055,
China, and also with the Glaucoma Artificial Intelligence Diagnosis and
Imaging Analysis Joint Research Lab, Guangzhou and Ningbo, China
(e-mail: liuj@sustech.edu.cn).
Digital Object Identifier 10.1109/TMI.2021.3110602
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the 3D iris surface from an AS-OCT sequence, and obtain
the geometrical characteristics necessary to provide global
shape information. 2D AS-OCT slices and 3D iris rep-
resentations are then fed into our HV-Net to extract
cross-sectional appearance features and iris morphological
features, respectively. To achieve similar results to those
of dynamic gonioscopy examination, which is the current
gold standard for diagnostic angle assessment, the paired
AS-OCT images acquired in dark and light illumination
conditions are used to obtain an accurate characterization
of configurational changes in ACAs and iris shapes, using
a Variation-aware Block. In addition, an annealing loss
function was introduced to optimize our model, so as to
encourage the sub-networks to map the inputs into the more
conducive spaces to extract dark-to-light variation repre-
sentations, while retaining the discriminative power of the
learned features. The proposed model is evaluated across
1584 paired AS-OCT samples, and it has demonstrated its
superiority in classifying open-, appositional- and synechial
angles.
Index Terms — Anterior chamber angles, glaucoma,
AS-OCT.
I. I NTRODUCTION
G LAUCOMA is a major cause of irreversible blindness
worldwide. The current gold standard for glaucoma diag-
nostic assessment is gonioscopic examination of the anterior
segment angle (ACA). Depending on the configuration of ACA
after biometric examination, glaucoma can be classified into
either of two subcategories: primary angle-closure glaucoma
(PACG) and primary open-angle glaucoma (POAG). As the
most severe stage of primary angle-closure disease, PACG is
the leading cause of blindness in Asian populations [1].
Epidemiological studies [2] have found that primary angle-
closure disease can be further divided into different sub-types:
primary angle-closure suspect (PACS), primary angle-closure
(PAC), and PACG.
PACS denotes an ACA with appositional angle-closure but
in which permanent peripheral anterior synechial contact has
not yet developed, as shown in Fig. 1 (B). PAC/PACG denotes
the appositional closure with elevated intraocular pressure
(IOP), or the presence of peripheral anterior synechial contact
(occludable ACA), as shown in Fig. 1 (C). In addition, PACG
displays optical neuropathy. The identification of appositional-
and synechial-angle closure is vital to guide clinicians in
developing personalized treatment plans: for example, laser
peripheral iridotomy might be used prophylactically for PACS,
so as to relieve angle closure [3]. In addition, this further
HAO et al.: HV-NET FOR ANGLE-CLOSURE ASSESSMENT IN AS-OCT
Fig. 1. (A)-(C) Image samples of open-appositional-synechial ACA
grading. (D) Visual demonstration of manual annotations by gonioscopy
for one AS-OCT volume. ACA angles in the 12-1 o’clock region (red)
viewed with synechiae, and 3-4 o’clock (green) viewed with appositional
ACAs, and a sequence of AS-OCT images of a randomly-selected
15◦ radial area. Iridotrabecular contact (ITC, as shown in (B) and (C)),
defined as the iris appearing to touch the anterior chamber angle at
the posterior pigmented trabecular meshwork, is a common presence of
angle-closure.
grading (PACS and PAC/PACG) will facilitate understanding
of the progression of the spectrum of angle-closure glaucoma
types.
In clinical practice, the current clinical standard used for
angle assessment is the observation of the ACA with the aid of
gonioscopy. Gonioscopic angle closure is defined as inability
to visualize the pigmented trabecular meshwork (TM). Oph-
thalmologists perform gonioscopy by quadrant or by clock
hour (by clock hour in our work): ophthalmologists make an
annotation for every 15◦ radial segment of the eye, while
moving the gonioscope counterclockwise, which accurately
describes the angle status in this 15◦ radial area. Fig. 1 (D)
shows an example of manual annotations. However, direct con-
tact between the gonioscope and the eyes during examination
can be uncomfortable for the patient and may distort the ACA,
leading to incorrect diagnostic results. Furthermore, gonio-
scopic examination is time-consuming, subjective, and may
cause inter-observer and intra-observer variability. To this end,
development of an automated approach is highly desirable.
Over the last decade, several methods have been proposed
for the classification of open-angle and angle-closure from
AS-OCT, including the recent Angle closure Glaucoma Evalu-
ation Challenge (AGE)1 [4]. AS-OCT, as a non-contact, non-
invasive technique, can be used for cross-sectional views of
anterior segment structures(e.g, the iris and the ACA). Never-
theless, almost all of the existing methods focus mainly on the
binary classification system of open-angle and angle-closure,
while a more discriminative three-class approach (i.e., open-,
appositional- and synechial angles) has rarely been explored.
On the one hand, due to the lack of spatial information,
1 https://age.grand-challenge.org/
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255
2D slices of AS-OCT are of limited use in distinguishing
sub-types of angle-closure, probably because the 2D image
provides only a single cross-sectional slice view of the entire
anterior segment and, therefore, other slices are not taken into
account in determining the angle status [5]. On the other
hand, the appositional and synechial angle display similar
appearances in an AS-OCT image. Due to the lack of capa-
bilities identical to those of dynamic gonioscopy, it is difficult
to differentiate these two angle-closure subtypes from static
AS-OCT images. Fig. 1 shows the different types of ACAs.
Recent studies [6], [7] have established that the iris plays a
key role in the pathophysiology of the angle-closure disease.
For example, quantitative iris parameters are independently
associated with appositional ACA, and an anteriorly-bowed
iris may be associated with the degree of progression of
angle-closure [8]. Moreover, morphological changes in the iris
surface are an important sign revealing and enabling the under-
standing of the pathogenesis of angle-closure glaucoma [9].
Iris convexity is steeper in open-angle and appositional-
angle eyes, while those with a synechial-angle are flatter.
Iris in eyes with angle-closure may have less stretch and
form a more convex structures with pupil dilation, increas-
ing the risk of apposition to the trabecular meshwork [10].
In addition, prior studies [11], [12] have demonstrated that
dynamic dark-light change of the anterior chamber angle
under shirting conditions of illumination from weak to strong
can be imaged and analyzed with AS-OCT, dark-to-light
changes of iris configurations and angle width are involved in
angle narrowing.
Based on the above clinical priors, i.e., 1) iris shape is a
significant sign on understanding and revealing of the patho-
genesis of different glaucoma types [8], [9]; 2) angle width and
iris configurations vary widely depending on illumination, and
dynamic changes in iris configuration may be associated with
the risk and mechanism of angle-closure [11], [12], we aim to
use 3D iris geometrical characteristics and dark-light change
captured by AS-OCT to promote the distinction between the
appositional and synechial ACA. 3D representation usually is
more suitable than 2D slice for supporting global information
analysis, as it provides neighborhood features. So we aim
to extract 3D characteristics by using paired-images that
are obtained under bright and dark illumination conditions
(Fig. 2). In this work, we introduce a hybrid deep learning
model that uses both the 2D and 3D representations to provide
complementary information. It is worth noting that this is
a extension of our previous work [23], which only utilized
3D iris representation for the binary classification of open-
angle and angle-closure. The main contributions of this work
include:
1) We believe that this work to be the first attempt to classify
anterior chamber angle into open, appositional and synechial
subtypes by utilizing 3D iris representations. We designed a
2D-3D Hybrid Variation-aware Network (HV-Net), and by
using both 2D slices and 3D iris representations to obtain
2D cross-sectional appearance and 3D iris geometrical char-
acteristics, so as to assist the classification of the anterior
chamber angle into three subtypes.
256
Fig. 2. Example AS-OCT images acquired under dark and light
illumination conditions. The appositional angle under dark illumination
may open a particular angle when under light illumination conditions,
while the synechial angle will not due to progression to permanent
contact.
2) We constructed a paired AS-OCT dataset obtained under
bright and dark illumination conditions. Here, a Variation-
aware Block (VAB) and an annealing loss were introduced to
obtain an accurate characterization of configurational changes
in angle and iris shape during illumination changes.
II. R ELATED W ORKS
In this section, we briefly review previous work investi-
gating AS-OCT imaging as a means to identify open-angle
and angle-closure glaucoma, including both conventional and
deep-learning-based methods.
Console et al. [24] developed an algorithm and measure-
ment method for the anterior chamber angle in AS-OCT
images. This method requires the user to input the locations
of two scleral spurs: this made it impossible to analyze large-
scale datasets automatically. Ni et al. [15] assessed angle-
closure glaucoma by quantifying angle structure configurations
via AS-OCT images, such as mean iris curvature and the
trapezoidal area of the iridocorneal angle. Tian et al. [13]
proposed a method to detect Schwalbe’s line and measure the
anterior chamber angle in AS-OCT images. Xu et al. [14]
extracted the visual features of the ACA region from the
AS-OCT image. These were then utilized to classify angle-
closure glaucoma. Fu et al. [16] introduced a data-driven
method to segment the cornea and iris prior to measuring
the clinical parameters used to screen glaucoma via AS-OCT
images.
These conventional methods employ specific clinical
measurements, or handcrafted visual features (e.g., anterior
chamber area [16], iris curvature [15], or histograms of ori-
ented gradients (HOG) [14]) to construct classifiers, which
may yield sub-optimal diagnosis due to lack of essential
information. Recently, convolutional neural networks (CNN)-
based methods have been proposed to extract high-level
features in a data-driven manner for medical image clas-
sification [25], and medical image segmentation [26], [27].
For anterior chamber angles classification, several recent
works have achieved promising performance, as a result of
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IEEE TRANSACTIONS ON MEDICAL IMAGING, VOL. 41, NO. 2, FEBRUARY 2022
discriminative feature representation extracted by deep learn-
ing technology. For example, Fu et al. [17] developed a
multi-context deep learning network for diagnosis of angle-
closure glaucoma, where imagery from different regions and
at a variety of scales is processed through parallel network
streams. Li et al. [20] first localized the scleral spur (SS)
points, and an ACA region centered on the detected SS was
then cropped as the input of the classification model with
a view to more accurate performance. Ferreira et al. [21]
employed multilevel convolutional neural networks based on
transfer learning to classify open and angle-closure glaucomas,
and achieved an AUC of 0.972. Xu et al. [28] utilized deep
learning classifiers to detect angle closure and primary angle-
closure disease (PACD). Amil et al. [18] extracted features
in an unsupervised manner to order and classify AS-OCT
images. Fu et al. [19] proposed a Multi-Level Deep Network
architecture using multiple parallel sub-networks to learn how
to construct multi-level representations.
The above methods all focus solely on analyzing structural
properties identified from 2D slices. In order to utilize the
information of adjacent slices, Hao et al. [22] proposed a
sequence multi-scale aggregation network for classification of
open-, appositional-, and synechial-ACAs, in which multiple
2D slices are used to generate AS-OCT sequences as the input
of the model, with the intention of acquiring temporal dynamic
features. Williams et al. [29] presented a method to produce
3D maps of the anterior segment, so as to further assist
the diagnosis of angle-closure glaucoma using 3D features.
A summary of the existing methods for angle assessment using
AS-OCT images is given in Table I.
III. P ROPOSED M ETHOD
We introduce our method in detail in this section: iris
3D reconstruction and quantification, the architecture of our
classification network and a specific loss function.
A. 3D Iris Surface Reconstruction and Quantification
AS-OCT automatically scans 360◦ areas of the eye to
obtain multiple consecutive radial slices that can be used to
reconstruct a 3D mesh of the iris surface, as shown in Fig. 3.
Briefly, we first apply a segmentation network to obtain the
initial boundary of the iris from successive AS-OCT slices.
Then we apply a guided optimization method with Poisson-
disk sampling to reconstruct the 3D iris surface. Finally,
several surface-based features are extracted to be used for
subsequent angle-closure glaucoma detection. Fig. 3 illustrates
the pipeline of this section.
1) Surface Reconstruction: A U-shaped network with
wavelet refinement blocks, which can better identify the
iris boundaries in ITC regions, is first utilized to extract
an initial iris boundary. The automatic iris segmentation is
implemented by a well-trained model: see [23] for more
details. The detected upper boundaries are then used to gen-
erate a point cloud of the iris, however, these point clouds
are sparse and non-uniform, resulting in a generated mesh
HAO et al.: HV-NET FOR ANGLE-CLOSURE ASSESSMENT IN AS-OCT 257

TABLE I
S UMMARY OF THE E XISTING M ETHODS FOR A NGLE A SSESSMENT U SING AS-OCT I MAGES

Fig. 3. Flowchart of the reconstruction and quantification of an iris surface in 3D. For (A) an AS-OCT sector within a radial region of 15◦ , a segmentation
network first extracts the boundaries of the iris (B). Then the segmentation results are converted into a 3D point cloud and a mesh is generated (C).
Afterwards, a constrained Poisson-disk sampling step is used to refine the coarse point cloud and mesh (D) to achieve a more accurate surface.
Finally, several surface measurements (E) are calculated for the subsequent diagnostic purposes.

that is coarse and lacking in local detail. As shown by the
representative patch shown in Fig. 4 (A), the distortion of the
triangular mesh lead to misrepresentation of the iris surface.
Additionally, due to the presence of iris frill, the geometric
variation is more dramatic in some regions than in others,
resulting in a higher density of point cloud than in smooth
areas, which leads to a low-quality surface mesh, as shown
in Fig. 3 (C).
To address this problem, we employ a constrained Poisson
disk sampling algorithm [30] for coarse meshes to refine the
surface. This approach generates a more uniform and dense
point cloud, while ensuring that objects of a given size will
be distributed according to the sampling scheme and will not
overlap. Specifically, we use an adaptive radius r in practice to
obtain a more accurate and at the same time as uniform point
cloud representation as possible: if the maximum curvature
of a point is greater than the global average, r is set to r1 :
otherwise, it is specified as r2 . In our work, based on empirical
tests, we set r1 and r2 to 6 and 10, respectively. Fig. 3 (D)
and Fig. 4 (B) show the point cloud and mesh after algorithm
optimization, which are more effective in characterizing geo-
metrical details.
2) Feature Extraction: The study has shown [9] that some
quantitative indicators related to the iris (e.g., iris curvature),
are independently correlated with the severity of progres-
sion of angle-closure. Therefore, we calculated the several
curvature-related measurements after reconstructing the iris
surface for subsequent diagnostic classification of closed-angle
disease, which including: principal curvatures (maximum and
minimum), Gaussian curvature, mean curvature, and shape
index [31].
The shape index E of each point may be defined as
2 C2 + C1
E = arctan , (1)
π C2 − C1
where C1 and C2 are the maximum and minimum curvatures
of a point, respectively, and E ∈ [−1, 1]. In contrast to the
curvature, shape index is not affected by shape scaling and can
yield a simple measure of local shape because it can represent
flat, concave and convex regions [31].
B. Network Architecture for ACA Assessment
As shown in Fig. 5, our proposed Hybrid Variation-aware
Network (HV-Net) consists of three components: 1) 2D feature

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258
Fig. 4. Overview of 3D iris reconstruction and surface measurement process. (A) The original point cloud and mesh generated by our 2D iris
segmentation model. (B) The optimized point cloud and mesh. (C) Visualization of different surface measurements.
extraction sub-networks; 2) 3D feature extraction sub-
networks; and 3) Variation-aware Block. Briefly, paired
AS-OCT representations in a 15◦ radial area are fed into
the 2D and 3D sub-networks (Section III-B.1 and III-B.2)
to extract 2D cross-sectional appearance features and 3D iris
morphological features, respectively. In order to capture con-
figurational change in angle and iris shape, dark and light
features are integrated and processed by the Variation-aware
Block.
The proposed HV-Net is detailed as follows.
1) 2D Sub-Networks: The inputs of 2D sub-networks are
AS-OCT sequences with a size of n ∗ n ∗ T , n and T denoting
the size of an AS-OCT slice and the number of the slice within
a 15◦ radial area, respectively. We first use a conventional
neural network (CNN) encoder to extract feature maps at
the slice level. The encoder can be any fully-convolutional
network such as a ResNet [32]-based or VGG [33]-based
network. We employed ResNet-34 [32], which retains the first
four blocks as a encoder module. Then, a bi-directional convo-
lutional long short-term memory (Bi-ConvLSTM) module [34]
is employed to process the feature sequence from the encoder.
Then a global average pooling layer is used to fuse these
features. The ConvLSTM can model temporal dependencies
while preserving spatial information and contains less redun-
dancy for spatial data compared with fully-connected LSTM
(FC-LSTM). ConvLSTM is defined as follows:
= σ (W
it  xi ∗ Xt + Whi ∗ Ht −1 + Wci ◦ Ct −1 + bi ) ,
ft = σ Wx f ∗ Xt + Wh f ∗ Ht −1 + Wc f ◦ Ct −1 + b f ,
Ct = ft ◦ Ct −1 + i t ◦ tanh (Wxc ∗ Xt + Whc ∗ Ht −1 + bc ) ,
ot = σ (Wxo ∗ Xt + Who ∗ Ht −1 + Wco ◦ Ct + bo ) ,
Ht = ot ◦ tanh (Ct ) , (2)
where ‘∗’ denotes the convolution operator, ‘◦’ denotes the
Hadamard product, and σ is the sigmoid activation function.
Xt is the input tensor, and Ht is the hidden state tensor. i t , f t
and ot denote the input, forget and output gates, respectively.
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IEEE TRANSACTIONS ON MEDICAL IMAGING, VOL. 41, NO. 2, FEBRUARY 2022
A memory cell Ct is used to store the historical information.
Wx∗ and Whi are 2D convolution kernels of the input and
hidden state. Bi-ConvLSTM makes decisions on the current
input by processing the input data into forward and backward
dependencies, and is able to enhance the predictive power of
the model by analyzing the input from both directions [35].
In the present work, the ConvLSTM module has one layer
with a kernel size of 3, and the number of hidden units is 64.
The justification for using both a CNN and a ConvLSTM
is that the CNN is good at learning local representations
from spatial data, but lacks the ability to learn sequential
correlations, while the ConvLSTM can be specialized for
sequential modeling, but is unable to extract features in
a parallel manner. Their combination ensures that features
from different slices are integrated efficiently and discrimina-
tive cross-sectional appearance features are obtained. In our
implementation, the 2D sub-networks share weights across
light and dark branches to limit the number of learnable
parameters.
2) 3D Sub-Networks: The inputs of the 3D sub-networks
are 3D iris representations and their corresponding measure-
ments, as obtained in Section III-A. As in the case of the
2D sub-networks, dark and light branches share the weights
in order to reduce the number of learnable parameters. Specif-
ically, to process the 3D point cloud representations of the
iris and corresponding measurements, we apply the multi-
layer perceptrons, followed by a max-pooling as a symmetric
function. This module seems simple; however, it has been
proven to have interesting properties, and can achieve strong
performance in point cloud applications [36]. For convenience,
we adopt the same architecture configuration with [36] as a
feature extractor, which consists of multi-layer perceptrons and
affine transformation networks, and then aggregates features
by max pooling. It should be noted that, this component can
be replaced by any existing state-of-the-art pointcloud-based
feature extractor.
HAO et al.: HV-NET FOR ANGLE-CLOSURE ASSESSMENT IN AS-OCT
Fig. 5. Illustration of our Hybrid Variation-aware Network (HV-Net), which includes three components: 1) 2D feature extraction sub-networks,
2) 3D feature extraction sub-networks, and 3) Variation-aware block. MLP: Multi-layer perceptron. BN: Batch Normalization. FC: Fully connected
layer. GAP: Global average pooling.
3) Variation-Aware Block: As introduced in Section I, appo-
sitional and synechial angle display similar appearances in
static AS-OCT images. To achieve a similar effect to that
obtained by dynamic gonioscopy, we designed a Variation-
aware Block (VAB) using the paired dark and light feature
representations to capture the configurational changes in the
anterior segment angle and iris shape. Taking into account the
clinical priors, angle width and iris configurations may vary
widely depending on illumination, and dynamic changes in iris
configuration may be associated with the risk and mechanism
of angle-closure [11], [12]. We hypothesized that, the dark-
to-light changes under variation of illumination intensity in
cases of open and appositional angles would be significant,
whereas, the synechial angle would change little due to the
permanent contact typical of this diagnosis. To capture dark-
to-light variations features - as shown in Fig. 5, the difference
between dark and light features is first obtained by an element-
wise subtraction across feature maps acquired from the prior
step. The fully connected (FC) layers with normalization (BN)
then are applied to the output. Thereafter, a sigmoid activation
is employed to obtain variation attention weights, which are
used to perform multiplication with dark and light features.
The final output of the block is the concatenation of weighted
dark and light features.
To map the inputs, i.e., the 2D sequence and the 3D iris
representation, reconstruction into the feature spaces that best
satisfy our hypothesis, we apply a contrastive loss func-
tion [37] to optimize the sub-networks. For open and appo-
sitional angle samples, the Euclidean distances between dark
and light features are large, while the distances between dark
and light features in synechial angle samples should be small.
Furthermore, we adopt an annealing strategy to map the inputs
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259
into space where the features best satisfies our hypothesis,
without affecting the discriminative power of the extracted
2D and 3D features.
C. Annealing Loss Function
1) Basic Loss Function: As shown in Fig. 5, we can
obtain multiple outputs, i.e., 2D dark, light and variation
features, as well as 3D dark, light and variation features.
We cascade all the outputs, and then add a full con-
nected layer followed by asoft-max layer. Specifically, let
 N
X nD2 , X nL 2 , X nD3 , X nL 3 , Yn be a training set containing
n=1
N samples, where X nD2 , X nL 2 denote 2D dark and light
sequences for n t h sample, X nD3 , X nL 3 denote 3D dark and
light iris representations for n t h sample, and Yn ∈ {1, . . . , C}
denotes the corresponding class label. W2d , W3d , and Wv
are the parameters of the 2D, 3D sub-network and VAB,
respectively. Our basic cross-entropy loss function is defined
as:
L B (W2d,3d,v )
11
N C
=− δn,c log(P(Ŷn = c | X nD2 ,L 2 ,D3 ,L 3 ; W2d,3d,v )),
N C
n=1 c=1
(3)
where δn,c is a binary indicator of the ground truth class
label, which equals 1 if Yn = c. P(· | ·) denotes the
probability obtained by our model, in terms of a given sam-
ple (e.g., X nD2 ,L 2 ,D3 ,L 3 ) being diagnosed as a specific class
(e.g., Ŷn = c). It is worth noting that the cascaded layers
weight the various outputs and enables our model to learn the
contributions of each type of features automatically.
260
2) Annealing Loss Term: Mapping the inputs into the feature
space that best satisfies our hypothesis, changes under varying
illumination will be significant in the case of open and
appositional angle and negligible in the case of synechial
angle, is of importance to obtain accurate variation features.
Accordingly, we apply a contrastive loss function [37], which
was first proposed for the face verification task, to optimize
the 2D and 3D sub-networks. Taking the 2D sub-network as
an example, thelabel Z n of
 each paired dark and light input
samples Sn2d = X nD2 , X nL 2 satisfies:
• Z n = 0, if Sn is diagnostic of synechial angle.
• Z n = 1, if Sn is diagnostic of open or appositional angle.
 Ophthalmic Center, China. All AS-OCT volumes were cap-
D2 L2
For each pair X n , X n in the training set, if Z n = 0, then
update W2d to decrease Euclidean distance DW2d between the
outputs (i.e., dark and light features) of the 2D parametric
sub-network G W2d ; if Z n = 1, then update W2d to increase
DW2d . Here, the Euclidean distance DW2d may be defined as
DW2d = G W2d (X nD2 ) − G W2d (X nL 2 ) 2 .
The decrease and increase of Euclidean distances in the
output space of 2D sub-network is obtained by minimizing
the contrastive loss function:

N
LC (W2d ) = L(W2d , (Z , X D2 , X L 2 )n ),
i=1
where the L(·) is defined as
L(W2d , (Z , X D2 , X L 2 )n )
1 1
= (1 − Z ) (DW2d )2 + (Z ) max(0, m − DW2d ) .
2 2
where (Z , X D2 , X L 2 )n is n t h labeled 2D sample pair, and m
> 0 is a margin. Open or appositional angle pairs contribute
to the loss function only if the distance DW2d is within this
margin. The contrastive loss function of the 3D sub-network is
denoted as LC (W3d ). A direct way to fuse the basic loss and
contrastive loss functions would be to weight them, as follows:
LT ot al = u 1 ∗ L B (W2d,3d,v )+u 2 ∗ LC (W2d )+u 3 ∗ LC (W3d ),
where u i denotes the corresponding weights (i = 1, 2, 3).
However, we find that the classification performance of our
model dropped when this loss was minimized (see Table IV).
This may be because the use of the contrastive loss func-
tion interferes with the learning of 2D and 3D features,
making the extracted features less powerfully discriminative.
To encourage the sub-networks to map the inputs into spaces
more conducive to the extraction of dark-to-light variation
representations, while retaining the discriminatory power of
the learned features, we use an annealing strategy. Specifically,
we treat contrastive loss functions as an annealing term,
and slowly reduced it during training phase. The final loss
is
LT ot al = λL B (W2d,3d,v ) + βα t (LC (W2d ) + LC (W3d )),
here β and 0 < α < 1 are hyper-parameters that controls the
annealing schedule, and t is the number of iteration during
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IEEE TRANSACTIONS ON MEDICAL IMAGING, VOL. 41, NO. 2, FEBRUARY 2022
training. As βα t  1, the second term encourages the sub-
networks to map the inputs into a space that is more conducive
to the extraction of dark-to-light variation features. When t
increases, this constraint gradually disappears. λ is the trade-
off parameter.
IV. E XPERIMENTS
A. Data Description
A clinical dataset comprising images of 66 eyes with
open-appositional-synechial angles (annotated by dynamic
gonioscopic examinations) was established by Zhongshan
tured along the perpendicular direction by the CASIA-2
machine (Tomey Inc., Japan). Each AS-OCT volume contains
128 slices, each with a resolution of 2144 × 1876 pixels.
To acquire dark and light data, AS-OCT imaging of each
patient was performed first in the dark room (< 1 lux illu-
mination by digital light meter). Prior to image acquisition,
patients were allowed to undergo a 5-minute dark adap-
tation. Images under illumination conditions were acquired
at the 15th second after the room lights were turned on
(350-400 lux). It is worth noting that the paired data obtained
under light and dark illumination may have slight misalign-
(4)
ment due to the movement of the subject, so we first perform
a global alignment of dark and light images using an iterative
diamond search strategy [38]. In practice, in our experiments,
we found that this operation has little effect on the classifi-
cation performance, suggesting that there may have been few
(5) misalignments in this dataset.
Particularly, in this in-house dataset, 13 eyes (PACS) are
diagnosed with appositional ACA, 21 eyes (POAG) are diag-
nosed with open ACA, and 32 eyes (PAC/PACG) are with
appositional ACA and closed ACA images. PACS is appo-
sitional angle-closure, the eye is diagnosed with PAC/PACG
when the adhesive angle appeared. A senior ophthalmolo-
gist with more than 30 years of experience in glaucoma
analysis performed the gonioscopic examination and annotated
every 15◦ ACAs in one eye, with one eye yielding 24 annota-
(6) tions. Notably, appositional and synechial angles may appear
in one eye at the same time.
We formed a sequence of AS-OCT slices in each 15◦ region
as the input of the 2D branch. Considering the computa-
tional load, all 2D sequences were cropped and resized to
448 × 448 pixels by localizing the ACA regions using the
method described in [39]. Meanwhile, we performed the
3D iris reconstruction and quantification to obtain the inputs of
the 3D branch. Consequently, we obtained 1584 dark-and-light
paired inputs, which include a total of 16,896 images. 504 of
which were annotated with open ACA (5376 images in total),
742 samples were instances of appositional ACA (7915 images
in total), and 338 samples were instances of synechial ACA
(3605 images in total).
(7) B. Evaluation Metrics
We employ several commonly-used metrics to evalu-
ate the performance of multi-class classification: weighted
HAO et al.: HV-NET FOR ANGLE-CLOSURE ASSESSMENT IN AS-OCT 261

sensitivity (Sen), specificity (Spe), and balanced accuracy TABLE II

(B-Acc): T HE P ERFORMANCE OF O PEN -A PPOSITIONAL -
S YNECHIAL ACA S C LASSIFICATION

Nc
TNi c N
TPi
Spe = ai , Sen = ai ,
TNi + FPi TPi + FNi
i=1 i=1
(Sen+Spe)
B-Acc = ,
2
where TPi is true positives, TNi is true negatives, FPi is false
positives, and FNi is false negatives for the i-th classification
label; and ai represents the percentage of samples whose
ground truth labels are i . We also provide kappa analysis
and F-measure (F1 score) to reflect the trade off between Sen
and Spe.

C. Implementation Details
We evaluated our model in 5-fold cross-validation across
all 1584 samples for more reliable analysis over this relatively
small dataset. We split these samples into 5 subsets, and kept
the number of samples in each subset equal. For each fold,
we used 4 subsets for training and the remaining subset for
testing. It is worth noting that samples in each subset were
divided s based on the subject, so that two samples of one eye
would not be separated between the training and test sets.
The proposed networks were implemented using Python
based on the Pytorch package, and the PC we used contained
two GPUs (i.e, NVIDIA GeForce GTX 1080 Ti 11GB). The
Adam optimizer with recommended parameters was used to
optimize the model, and the batch size was set as 8. The
maximum epoch was 500. For the loss function, following
empirical testing we set β = 100 and α = 0.98, which caused
the second term being phased out around t = 400. The margin
of the contrastive loss was set to 2. The trade-off parameter λ
was set to 1.5.
D. Classification Performances
The proposed HV-Net method was first compared a con-
ventional method [40] which was designed for ACAs clas-
sification. This method first obtained the HOG feature, and
linear SVM [41] was used to classify the ACA subtypes.
We also compared the proposed method to the state-of-
the-art deep methods by using 2D slices: VGG-16 [33],
Inception-V3 [42], ResNet-34 [32], Xception [43], and two
specifically designed ACA type classification networks Multi-
Level Deep Network (MLDN) [19], Multi-Scale Regions Con-
volutional Neural Networks (MSDNN) [39]. In addition, as the
2D branch of our model inputs the image sequence, this could
be treated as 3D data. Thus, the some 3D methods were also
applied as baselines: C3D [44], S3D [45], I3D [46] and Multi-
Sequence Deep Network (MSDN) [22]. Note, MSDN is a
model specifically proposed for ACA grading.
1) Classification of the Open-Appositional-Synechial ACAs:
The classification performances of these methods are reported
in Table II. Deep learning methods have better classification
results than conventional methods, and by relatively large
margins. This shows that, as high-level features are extracted
in a data-driven manner, representations learned by using
Fig. 6. AUC curves of different deep-learning-based approaches in
classifying appositional and synechial ACA.
CNN are more powerful than visual features (e.g., HOG).
Sequence-based deep models achieve higher performances
than the slice-based deep models, which underlines the
importance of the integration of neighborhood information.
Compared with the state-of-the-art deep learning method
(i.e., 2D and 3D methods), our proposed HV-Net demonstrated
competitive performance across all metrics. The main reason
may be that the integration of 2D cross-sectional appear-
ance features, 3D iris morphologica features and dark-to-
light variation features is beneficial for improving diagnostic
performance, as these different features can complement each
other when distinguishing the types of ACA, especially of
appositional and synechial angles. Fig. 7 shows the confusion
matrices of the different methods, compared with MSDN, our
HV-Net has better performance in distinguishing appositional
and synechial angles.
It is worth noting that due to the limited condition, there
is a data imbalance between the appositional and synechial
angles in our dataset (742 for appositional ACA and 338 for
synechial ACA), in which the appositional ACA is the majority
class and the synechial ACA is the minority class. Deep
learning models trained on the imbalance dataset will exhibit
bias towards the majority class and may ignore the minority
class [47], so the algorithm tends to predict the synechial

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262 IEEE TRANSACTIONS ON MEDICAL IMAGING, VOL. 41, NO. 2, FEBRUARY 2022

Fig. 7. Confusion matrices of the different methods at sequence level. The numbers in the confusion matrices denote the percentage (above) and
number (below) of the predicted class. Notably, (A)-(C) are results of methods using 2D slices, while (D)-(E) are the results of 3D approaches, so the
total numbers of samples shown are different between them.

angle as the appositional angle, as shown in Fig. 7 (A) - (E). TABLE III
However, our model (see Fig. 7 (F)) performs better in dis- C OMPARISON OF D IFFERENT D EEP -L EARNING -B ASED M ETHODS
IN C LASSIFYING A PPOSITIONAL AND S YNECHIAL ACA
tinguishing synechial angles from appositional angles, which
shows that our algorithm has better robustness for imbalanced
data because of the explicit use of clinical prior.
2) Classification of the Appositional-Synechial ACAs: As
introduced in Section I, the classification of ACAs into open
and angle-closure is easier, and recent studies have shown
excellent performances (AUC ≥ 0.98) [19]. In consequence,
we only report the results in classifying of appositional and
synechial angles. As shown in Fig. 6, the proposed method
receive an AUC = 0.8587, outperforming other deep-learning-
based methods. Table III summaries the performance data of
these models.

E. Ablation Study
Our HV-Net employs three main components to form its
classification framework: 2D and 3D sub-networks, Variation-
aware Block (VAB) and an annealing loss function, so we
analyze the our model under different scenarios to validate
the performance of each key component of our model. The
results of different combinations of these modules are reported
in Table IV.
1) The Effectiveness of the 3D Sub-Network: To explore the
3D sub-network contributions, we used the 2D network only as
the backbone. Note that, as shown in Table IV, a 3D network-
only method is inferior to the backbone, yet a 2D + 3D method
outperforms the backbone, with an improvement of about 1.4%
in the F1 score. This indicates that the 3D branch provides
extra information, and the 3D iris morphological feature is
profitable for the differentiation of ACA sub-types, consistent
with the conclusion of the epidemiological study.
2) The Effectiveness of the VAB and Paired Data: As intro-
duced in Section III-B.3, a key component of our proposed
method is Variation-aware Block designed to capture the dark-
to-light variation features from the image pairs, with the
intention of solving the problem of the similar appearance
of appositional and synechial angels in the static AS-OCT
images. In this group of experiments, we evaluated the effec-
tiveness of the VAB as well as the paired data. We first

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HAO et al.: HV-NET FOR ANGLE-CLOSURE ASSESSMENT IN AS-OCT
TABLE IV
P ERFORMANCE C OMPARISONS OF A BLATION S TUDIES . W AND A D ENOTE W EIGHTED L OSS AND A NNEALING L OSS , R ESPECTIVELY
TABLE V
C OMPARISON OF MSDN M ETHOD AND O UR HV-N ET IN C LASSIFYING
A PPOSITIONAL AND S YNECHIAL A NGLE B ASED
ON 15◦ AND 5◦ S EGMENT ACA
compared the 2D + 3D + VAB method with a 2D + 3D only
method. In the results presented in Table IV, we found that
the 2D + 3D + VAB method slightly improves classification
performance compared with the 2D + 3D only method. This
is intuitive and reasonable, since the VAB is matched with
the annealing term in the annealing loss function. Without
any constraints, it is difficult for the VAB to obtain precise
weak-to-strong illumination variations that satisfy the clinical
prior, i.e., the weak-to-strong illumination changes of open and
appositional angles would be significant, while the synechial
angle would change little due to the progression to permanent
contacts. Therefore, we applied a contrastive loss function to
optimize the 2D and 3D sub-networks.
Moreover, we then replaced paired data with only dark/light
data as inputs. The corresponding experimental results are
presented in No.5 and No.6 in Table IV. We found that
using dark/light data only achieved similar results to the
2D + 3D method, which means taht the VAB and the
annealing term are non-contributing, due to the lack of paired
data.
3) The Effectiveness of the Annealing Loss Function: As
introduced in Section III-C, we used an annealing loss
function to optimize our model. We verified the annealing
loss function’s effectiveness by comparing the 2D + 3D +
VAB + annealing loss method with 2D + 3D + VAB +
weighted loss (i.e., Equation 6) method. We observed that
the annealing strategy improves classification more effec-
tively performance than the weighted loss function. In addi-
tion, when compared with the 2D + 3D + VAB method,
the use of weighted loss makes the performance degradation.
This implies that the annealing strategy encourage the sub-
networks to map the inputs into the space more conducive
to the extraction of dark-to-light variation representations,
while not affecting the discriminative power of the learned
features.
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263
V. D ISCUSSIONS AND C ONCLUSION
The conventional ACA classification approaches only focus
on binary classification, i.e., open-angle and angle-closure.
In this study, we introduced a deep learning-based method
to identify open-appositional-synechial ACA sub-types from
AS-OCT imagery. However, the identification of ACAs into
three subtypes is not that straightforward, as two challenges
need to be tackled: 2D slices of AS-OCT lack sufficient spatial
information while determining angle status; and second, that
appositional and synechial angle display similar appearances
in AS-OCT, which makes it difficult to accurately differentiate
angle-closure subtypes from static AS-OCT images. The main
contribution of our work is to incorporate clinical priors into
the deep learning algorithm through 3D reconstruction and
quantification of the iris, as well as the explicit use of light-
dark paired data to stimulate the dynamic gonioscopy exam-
ination, aiming to improve the accuracy of appositional and
synechial ACA classification. The ablation study demonstrates
that the effectiveness of our specific-designed components.
A. Limitations
In this work, the dataset we used is still small to train
such a complex model well, despite the data augmentation
was applied during the training phase. We have verified the
effectiveness of each components through ablation studies,
our model does not show significant advantages in classifi-
cation performance when compared with the previous model,
i.e., MSDN, in classifying appositional and synechial ACA.
This is most likely caused by the dataset being small, the great
similarity between the appositional and synechial ACA makes
it necessary to have more samples to allow the model to
learn more generalized knowledge, and we consider the limited
training data as one of the major limitations of this work.
However, we do believe our HV-Net would have significant
improvement than the MSND if we train the models on a
relatively larger dataset. To this end, we added an additional
experiments - with radial areas on every 5◦ ACAs of an
eye, yielding 72 ACA segments for each single eye, resulting
in total of 72 × 66 = 4, 752 samples with annotations.
We generated label the same for all three consecutive 5◦ ACAs
as the original 15◦ ACAs. Then we train the HV-Net and
MSDN models again on these augmented data. Our HV-Net
achieves better performance than MSDN with relatively larger
margin in terms of Acc, Sen and AUC (P < 0.0001, Delong’s
test), as illustrated in Table V, which demonstrates that our
264
model has potential in classification on the large-scale data.
It is worth noting that this additional experiment is only for
the validation of data augmentation purpose.
B. Analysis on Failure Cases
We further analyze the failed classification cases. Fig. 8
shows some failed appositional and synechial ACA classifi-
cation samples, by our HV-Net and MSDN. Based on our
observation on cases shown in Fig. 8, we found that proposed
model pays more attention to the dark-to-light change feature:
for some particular samples with appositional angles but have
not very obvious light and dark changes, they tend to be
classified as synechial angles by HV-Net. This leads to a
higher classification accuracy of HV-Net for synechial angles,
which can also be observed from Fig. 7 (E) and (F). It also
shows that our proposed use of the light-dark change as one
of the classification features is feasible, and it is reasonable to
believe that our model will be able to extract light-dark change
representations more accurately as more training samples are
added in the future work.
C. Conclusion
In this work, we designed a specific approach and strategies
to solve the above mentioned issues. We introduced a 2D-
3D Hybrid Variation-aware Network (HV-Net), that utilizes
both 2D slices and 3D iris representations to obtain 2D cross-
sectional appearance and 3D iris geometrical characteristics,
respectively. Here, a Variation-aware Block (VAB) is intro-
duced to obtain an accurate characterization of configurational
changes in angle and iris shape. To obtain the geometrical
characteristics of the iris and provide global shape information,
we propose an automated framework for 3D iris surface
reconstruction and quantification from AS-OCT imagery. Fur-
thermore, we employ an annealing strategy to optimize the
model to encourage the sub-networks to map the inputs into
more conducive spaces for the extraction of dark-to-light
variation representations, while retaining discrimination of the
learned features.
The paired-images acquired in different illumination condi-
tions were used in this study, and such data acquisition was
inspired by the clinical examination of dynamic gonioscopy,
so as to achieve a similar effect to that provided by dynamic
gonioscopy: the appositional angle will open a particular
angle when under pressure, while the synechial angle will
not, due to progression to permanent contacts. We combined
multiple features (i.e., 2D, 3D, and dark-to-light variation
features) to empower the classification system the vital ability
to distinguish between appositional and synechial angles. The
effectiveness of our proposed method has been extensively
evaluated using a dataset comprising imagery of 66 individual
eyes, that is consisting of 1584 paired samples acquired under
different illumination conditions. Compared with several state-
of-the-art methods, our proposed method has demonstrated
better classification performance.
Our algorithm achieves good results in the automatic clas-
sification of the open-appositional-synechial ACA sub-types
in the private dataset, demonstrating the potential for clinical
application. However, more exploration is still needed to
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IEEE TRANSACTIONS ON MEDICAL IMAGING, VOL. 41, NO. 2, FEBRUARY 2022
Fig. 8. Example of failed classifications between appositional and
synechial angle closure cases of our HV-Net and MSDN. 0 and 1 repre-
sent appositional and synechial ACA respectively. Red (×) means wrong
classification, green () means correct classification.
apply it in real clinical scenarios. At present, there is no
other way but gonioscopy to determine synechia, our work
is the first attempt to explicitly use light-dark paired data
to stimulate the dynamic gonioscopy examination, aiming to
distinguish appositional and synechial ACAs, and ablation
experiments show the effectiveness of this idea, indicating that
this perspective is worth further exploration. We will include
more samples in the future to further improve accuracy and
generalizability with a view to future expansion to clinical and
commercial applications. In addition, as shown in Table III,
these approaches have a low sensitivity-high specificity, which
may stem from the similarity between two closed-angle groups
and the data imbalance. For the current model, the synechial
angle tends to be misclassified into the appositional angle.
However, the system is used to assist the physician in the
diagnosis, and the physician can make further observations on
the appositional angle judged by the model to avoid the missed
diagnosis. In addition, physicians can also adjust the sensitivity
and specificity of the model by adjusting the threshold value
according to the actual needs.
Eyes with a large PAS extent are at higher risk for pro-
gression and are also more likely to have associated optic
neuropathy [48], [49]. In future work, we will collect more
clinical data, especially synechial samples, so as to optimize
the proposed network and further validate the generalization
performance of our model on an external dataset from different
countries or devices.
R EFERENCES
[1] P. Foster and G. Johnson, “Glaucoma in China: How big is the problem?”
Brit. J. Ophthalmol., vol. 85, no. 11, pp. 1277–1282, 2001.
[2] P. J. Foster, R. Buhrmann, H. A. Quigley, and G. J. Johnson, “The def-
inition and classification of glaucoma in prevalence surveys,” Brit. J.
Ophthalmol., vol. 86, no. 2, pp. 238–243, 2002.
HAO et al.: HV-NET FOR ANGLE-CLOSURE ASSESSMENT IN AS-OCT
[3] R. Thomas, T. Arun, J. Muliyil, and R. George, “Outcome of laser
peripheral iridotomy in chronic primary angle closure glaucoma,”
Ophthalmic Surg., Lasers Imag. Retina, vol. 30, no. 7, pp. 547–553,
Jul. 1999.
[4] H. Fu et al., “AGE challenge: Angle closure glaucoma evaluation in
anterior segment optical coherence tomography,” Med. Image Anal.,
vol. 66, Dec. 2020, Art. no. 101798.
[5] H.-K. Cho, D. Ahn, and C. Kee, “Evaluation of circumferential angle
closure using iridotrabecular contact index after laser iridotomy by
swept-source optical coherence tomography,” Acta Ophthalmol., vol. 95,
no. 3, pp. e190–e196, May 2017.
[6] Z. D. Soh, S. Thakur, S. Majithia, M. E. Nongpiur, and C.-Y. Cheng,
“Iris and its relevance to angle closure disease: A review,” Brit. J.
Ophthalmol., vol. 105, no. 1, pp. 3–8, Jan. 2021.
[7] H. Yang, P. Yu, S. Cringle, X. Sun, and D.-Y. Yu, “Iridal vasculature
and the vital roles of the iris,” J. Nature Sci., vol. 1, no. 8, p. e157,
2015.
[8] B. Wang et al., “Quantitative iris parameters and association with narrow
angles,” Ophthalmology, vol. 117, no. 1, pp. 11–17, Jan. 2010.
[9] J. Huang, Z. Wang, Z. Wu, Z. Li, K. Lai, and J. Ge, “Comparison
of ocular biometry between eyes with chronic primary angle-closure
glaucoma and their fellow eyes with primary angle-closure or primary
angle-closure suspect,” J. Glaucoma, vol. 24, no. 4, pp. 323–327, 2015.
[10] C. Zheng et al., “In vivo analysis of vectors involved in pupil constriction
in Chinese subjects with angle closure,” Investig. Ophthalmol. Vis. Sci.,
vol. 53, no. 11, pp. 6756–6762, 2012.
[11] C. K. S. Leung et al., “Dynamic analysis of dark-light changes of the
anterior chamber angle with anterior segment OCT,” Investig. Ophthal-
mol. Vis. Sci., vol. 48, no. 9, pp. 4116–4122, 2007.
[12] C. Y. L. Cheung et al., “Dynamic analysis of iris configuration with
anterior segment optical coherence tomography,” Investig. Ophthalmol.
Vis. Sci., vol. 51, no. 8, pp. 4040–4046, 2010.
[13] J. Tian, P. Marziliano, M. Baskaran, H. T. Wong, and T. Aung,
“Automatic anterior chamber angle assessment for HD-OCT images,”
IEEE Trans. Biomed. Eng., vol. 58, no. 11, pp. 3242–3249,
Nov. 2011.
[14] Y. Xu et al., “Automated anterior chamber angle localization and
glaucoma type classification in OCT images,” in Proc. 35th Annu. Int.
Conf. IEEE Eng. Med. Biol. Soc. (EMBC), Jul. 2013, pp. 7380–7383.
[15] S. Ni Ni, J. Tian, P. Marziliano, and H.-T. Wong, “Anterior chamber
angle shape analysis and classification of glaucoma in SS-OCT images,”
J. Ophthalmol., vol. 2014, pp. 1–12, Aug. 2014.
[16] H. Fu et al., “Segmentation and quantification for angle-closure glau-
coma assessment in anterior segment OCT,” IEEE Trans. Med. Imag.,
vol. 36, no. 9, pp. 1930–1938, Sep. 2017.
[17] H. Fu et al., “Multi-context deep network for angle-closure glau-
coma screening in anterior segment OCT,” in Proc. MICCAI. Cham,
Switzerland: Springer, 2018, pp. 356–363.
[18] P. Amil et al., “Unsupervised feature extraction of anterior chamber
OCT images for ordering and classification,” Sci. Rep., vol. 9, no. 1,
p. 1157, Dec. 2019.
[19] H. Fu et al., “Angle-closure detection in anterior segment OCT based
on multilevel deep network,” IEEE Trans. Cybern., vol. 50, no. 7,
pp. 3358–3366, Jul. 2020.
[20] P. Li, L. Geng, W. Zhu, F. Shi, and X. Chen, “Automatic angle-closure
glaucoma screening based on the localization of scleral spur in anterior
segment OCT,” in Proc. IEEE 17th Int. Symp. Biomed. Imag. (ISBI),
Apr. 2020, pp. 1387–1390.
[21] M. M. Ferreira, G. P. Esteve, G. B. Junior, J. D. S. de Almeida,
A. C. de Paiva, and R. Veras, “Multilevel CNN for angle closure glau-
coma detection using AS-OCT images,” in Proc. Int. Conf. Syst., Signals
Image Process. (IWSSIP), Jul. 2020, pp. 105–110.
[22] H. Hao et al., “Angle-closure assessment in anterior segment OCT
images via deep learning,” Med. Image Anal., vol. 69, Apr. 2021,
Art. no. 101956.
[23] J. Hao et al., “Reconstruction and quantification of 3D iris surface for
angle-closure glaucoma detection in anterior segment OCT,” in Proc.
MICCAI. Cham, Switzerland: Springer, 2020, pp. 704–714.
[24] J. Console, L. Sakata, T. Aung, D. Friedman, and M. He, “Quantitative
analysis of anterior segment optical coherence tomography images:
The Zhongshan Angle Assessment Program,” Brit. J. Ophthalmol.,
vol. 92, no. 12, pp. 1612–1616, 2008.
[25] Y. Zhao et al., “Retinal vascular network topology reconstruction and
artery/vein classification via dominant set clustering,” IEEE Trans. Med.
Imag., vol. 39, no. 2, pp. 341–356, Feb. 2020.
Authorized licensed use limited to: BEIHANG UNIVERSITY. Downloaded on February 24,2022 at 07:44:18 UTC from IEEE Xplore. Restrictions apply.
265
[26] Y. Ma et al., “ROSE: A retinal OCT-angiography vessel segmentation
dataset and new model,” IEEE Trans. Med. Imag., vol. 40, no. 3,
pp. 928–939, Mar. 2021.
[27] Y. Zhao et al., “Automated tortuosity analysis of nerve fibers in
corneal confocal microscopy,” IEEE Trans. Med. Imag., vol. 39, no. 9,
pp. 2725–2737, Sep. 2020.
[28] B. Y. Xu, M. Chiang, S. Chaudhary, S. Kulkarni, A. A. Pardeshi,
and R. Varma, “Deep learning classifiers for automated detection of
gonioscopic angle closure based on anterior segment OCT images,”
Amer. J. Ophthalmol., vol. 208, pp. 273–280, Dec. 2019.
[29] D. Williams, Y. Zheng, P. G. Davey, F. Bao, M. Shen, and A. Elsheikh,
“Reconstruction of 3D surface maps from anterior segment optical
coherence tomography images using graph theory and genetic algo-
rithms,” Biomed. Signal Process. Control, vol. 25, pp. 91–98, Mar. 2016.
[30] M. Corsini, P. Cignoni, and R. Scopigno, “Efficient and flexible sampling
with blue noise properties of triangular meshes,” IEEE Trans. Vis.
Comput. Graphics, vol. 18, no. 6, pp. 914–924, Jun. 2012.
[31] Y. Zhao et al., “Region-based saliency estimation for 3D shape analysis
and understanding,” Neurocomputing, vol. 197, pp. 1–13, Jul. 2016.
[32] K. He, X. Zhang, S. Ren, and J. Sun, “Deep residual learning for
image recognition,” in Proc. IEEE Conf. Comput. Vis. Pattern Recognit.
(CVPR), Jun. 2016, pp. 770–778.
[33] K. Simonyan and A. Zisserman, “Very deep convolutional networks
for large-scale image recognition,” 2014, arXiv:1409.1556. [Online].
Available: http://arxiv.org/abs/1409.1556
[34] S. Xingjian, Z. Chen, H. Wang, D.-Y. Yeung, W.-K. Wong, and
W.-C. Woo, “Convolutional lstm network: A machine learning approach
for precipitation nowcasting,” in Proc. NIPS, 2015, pp. 802–810.
[35] Z. Cui, R. Ke, Z. Pu, and Y. Wang, “Deep bidirectional and uni-
directional LSTM recurrent neural network for network-wide traf-
fic speed prediction,” 2018, arXiv:1801.02143. [Online]. Available:
http://arxiv.org/abs/1801.02143
[36] R. Q. Charles, H. Su, M. Kaichun, and L. J. Guibas, “PointNet:
Deep learning on point sets for 3D classification and segmentation,”
in Proc. IEEE Conf. Comput. Vis. Pattern Recognit. (CVPR), Jul. 2017,
pp. 652–660.
[37] R. Hadsell, S. Chopra, and Y. LeCun, “Dimensionality reduction by
learning an invariant mapping,” in Proc. CVPR, 2006, pp. 1735–1742.
[38] J. Cheng et al., “Speckle reduction in 3D optical coherence tomography
of retina by A-scan reconstruction,” IEEE Trans. Med. Imag., vol. 35,
no. 10, pp. 2270–2279, Oct. 2016.
[39] H. Hao et al., “Anterior chamber angles classification in anterior segment
OCT images via multi-scale regions convolutional neural networks,”
in Proc. 41st Annu. Int. Conf. IEEE Eng. Med. Biol. Soc. (EMBC),
Jul. 2019, pp. 849–852.
[40] Y. Xu et al., “Anterior chamber angle classification using multiscale
histograms of oriented gradients for glaucoma subtype identification,”
in Proc. Annu. Int. Conf. IEEE Eng. Med. Biol. Soc., Aug. 2012,
pp. 3167–3170.
[41] J. A. K. Suykens and J. Vandewalle, “Least squares support vector
machine classifiers,” Neural Process. Lett., vol. 9, no. 3, pp. 293–300,
Jun. 1999.
[42] X. Xia, C. Xu, and B. Nan, “Inception-v3 for flower classification,”
in Proc. 2nd Int. Conf. Image, Vis. Comput. (ICIVC), Jun. 2017,
pp. 783–787.
[43] F. Chollet, “Xception: Deep learning with depthwise separable convo-
lutions,” in Proc. IEEE Conf. Comput. Vis. Pattern Recognit. (CVPR),
Jul. 2017, pp. 1251–1258.
[44] D. Tran, L. Bourdev, R. Fergus, L. Torresani, and M. Paluri, “Learning
spatiotemporal features with 3D convolutional networks,” in Proc. IEEE
Int. Conf. Comput. Vis. (ICCV), Dec. 2015, pp. 4489–4497.
[45] S. Xie, C. Sun, J. Huang, Z. Tu, and K. Murphy, “Rethinking spatiotem-
poral feature learning: Speed-accuracy trade-offs in video classification,”
in Proc. ECCV, 2018, pp. 305–321.
[46] J. Carreira and A. Zisserman, “Quo vadis, action recognition? A new
model and the kinetics dataset,” in Proc. IEEE Conf. Comput. Vis.
Pattern Recognit. (CVPR), Jul. 2017, pp. 6299–6308.
[47] J. M. Johnson and T. M. Khoshgoftaar, “Survey on deep learning with
class imbalance,” J. Big Data, vol. 6, no. 1, pp. 1–54, Dec. 2019.
[48] R. Thomas, “Five year risk of progression of primary angle closure
suspects to primary angle closure: A population based study,” Brit. J.
Ophthalmol., vol. 87, no. 4, pp. 450–454, Apr. 2003.
[49] K. K. Ramani, B. Mani, R. J. George, and V. Lingam, “Follow-up of
primary angle closure suspects after laser peripheral iridotomy using
ultrasound biomicroscopy and A-scan biometry for a period of 2 years,”
J. Glaucoma, vol. 18, no. 7, pp. 521–527, 2009.