The Role of Artificial Intelligence in the Diagnosis of Ocular Surface Squamous Neoplasia: a systematic review and meta-analysis
DOI:
https://doi.org/10.71413/anhkzh25Keywords:
Artificial intelligence, Deep learning, Machine learning, Ocular surface Neoplasia, OSSNAbstract
Relevance:
Ocular Surface Squamous Neoplasia (OSSN) is the most common malignancy of the ocular surface; timely non-invasive detection can preserve vision. This systematic review and diagnostic meta-analysis revealed that AI-based models performed with high accuracy in diagnosing OSSN. Future research requires comprehensive prospective studies, along with improvements in methodology to strengthen AI-based diagnosis.
Abstract:
This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) guidelines. We systematically searched four databases, PubMed, Web of Science, Embase, and Scopus, to explore the use of AI in diagnosing OSSN. The QUADAS-2 tool was used to find the risk of bias across the included studies. A diagnostic meta-analysis was conducted to determine the pooled sensitivity and specificity of AI models used in various studies to diagnose the OSSN. The summary receiver operating curve (SROC) was drawn to calculate the area under the curve (AUC).
A total of 51 studies were found, and 6 studies were included in this systematic review, and four studies were eligible to be included in the diagnostic meta-analysis. All the included studies had at least one significant bias in methodology, leading to an overall high risk of bias. The diagnostic meta-analysis showed a pooled sensitivity of 95.5 % (95% CI: 67.5 to 99.5) and a specificity of 96.4 % (95% CI: 87.7 to 99.0). The summary receiver operating curve (SROC) revealed high accuracy (0.95) of AI models in diagnosing OSSN.
AI-based models demonstrated high sensitivity and specificity in the diagnosis of ocular surface squamous neoplasia. AI can reliably diagnose OSSN with both deep learning and machine learning models.
References
Cicinelli MV, Marchese A, Bandello F, Modorati G. Clinical Management of Ocular Surface Squamous Neoplasia: A Review of the Current Evidence. Ophthalmol Ther. 2018 Dec;7(2):247–62. DOI: https://doi.org/10.1007/s40123-018-0140-z
Grossniklaus HE, Green WR, Luckenbach M, Chan CC. Conjunctival Lesions in Adults: A Clinical and Histopathologic Review. Cornea. 1987;6(2):78–116. DOI: https://doi.org/10.1097/00003226-198706020-00002
Tunc M, Char DH, Crawford B, Miller T. Intraepithelial and invasive squamous cell carcinoma of the conjunctiva: analysis of 60 cases. British Journal of Ophthalmology. 1999 Jan 1;83(1):98–103. DOI: https://doi.org/10.1136/bjo.83.1.98
McKelvie PA. Squamous cell carcinoma of the conjunctiva: a series of 26 cases. British Journal of Ophthalmology. 2002 Feb 1;86(2):168–73. DOI: https://doi.org/10.1136/bjo.86.2.168
Shields CL, Demirci H, Karatza E, Shields JA. Clinical survey of 1643 melanocytic and nonmelanocytic conjunctival tumors. Ophthalmology. 2004 Sep;111(9):1747–54. DOI: https://doi.org/10.1016/j.ophtha.2004.02.013
Gichuhi S, Sagoo MS. Squamous cell carcinoma of the conjunctiva. Community Eye Health. 2016;29(95):52–3.
Kaliki S, Wagh RD, Vempuluru VS, Kapoor AG, Jakati S, Mishra DK, et al. Ocular surface squamous neoplasia with orbital tumour extension: risk factors and outcomes. Eye. 2023 Feb;37(3):446–52. DOI: https://doi.org/10.1038/s41433-022-01955-1
Mittal R, Rath S, Vemuganti GK. Ocular surface squamous neoplasia – Review of etio-pathogenesis and an update on clinico-pathological diagnosis. Saudi Journal of Ophthalmology. 2013 Jul;27(3):177–86. DOI: https://doi.org/10.1016/j.sjopt.2013.07.002
Gichuhi S, Ohnuma S ichi, Sagoo MS, Burton MJ. Pathophysiology of ocular surface squamous neoplasia. Experimental Eye Research. 2014 Dec;129:172–82. DOI: https://doi.org/10.1016/j.exer.2014.10.015
Lan X, Xie Z, Fang X, Luo S, Xiao X, Lin Y, et al. Ocular surface squamous neoplasia: Growth, diagnosis, and treatment. European Journal of Ophthalmology. 2025 Apr 24;11206721251337166.
Nguena MB, Van Den Tweel JG, Makupa W, Hu VH, Weiss HA, Gichuhi S, et al. Diagnosing Ocular Surface Squamous Neoplasia in East Africa. Ophthalmology. 2014 Feb;121(2):484–91. DOI: https://doi.org/10.1016/j.ophtha.2013.09.027
Greenfield JA, Scherer R, Alba D, De Arrigunaga S, Alvarez O, Palioura S, et al. Detection of Ocular Surface Squamous Neoplasia Using Artificial Intelligence With Anterior Segment Optical Coherence Tomography. American Journal of Ophthalmology. 2025 May;273:182–91. DOI: https://doi.org/10.1016/j.ajo.2025.02.019
Reynolds J, Pfeiffer M, Ozgur O, Esmaeli B. Prevalence and severity of ocular surface Neoplasia in African nations and need for early interventions. J Ophthalmic Vis Res. 2016;11(4):415. DOI: https://doi.org/10.4103/2008-322X.194139
Yeasmin MN, Al Amin M, Joti TJ, Aung Z, Azim MA. Advances of AI in image-based computer-aided diagnosis: A review. Array. 2024 Sep;23:100357. DOI: https://doi.org/10.1016/j.array.2024.100357
Hashemian H, Peto T, Ambrósio Jr R, Lengyel I, Kafieh R, Muhammed Noori A, et al. Application of Artificial Intelligence in Ophthalmology: An Updated Comprehensive Review. JOVR. 2024 Sep 16;19(3):354–67. DOI: https://doi.org/10.18502/jovr.v19i3.15893
Sinha S, Ramesh PV, Nishant P, Morya AK, Prasad R. Novel automated non-invasive detection of ocular surface squamous neoplasia using artificial intelligence. World J Methodol [Internet]. 2024 Jun 20 [cited 2025 Jun 10];14(2). DOI: https://doi.org/10.5662/wjm.v14.i2.92267
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;n71. DOI: https://doi.org/10.1136/bmj.n71
Kozma K, Jánki ZR, Bilicki V, Csutak A, Szalai E. Artificial intelligence to enhance the diagnosis of ocular surface squamous neoplasia. Sci Rep. 2025 Mar 20;15(1):9550. DOI: https://doi.org/10.1038/s41598-025-94876-4
Ramezani F, Azimi H, Delfanian B, Amanollahi M, Saeidian J, Masoumi A, et al. Classification of ocular surface diseases: Deep learning for distinguishing ocular surface squamous neoplasia from pterygium. Graefes Arch Clin Exp Ophthalmol [Internet]. 2025 Apr 5 [cited 2025 Jun 10] DOI: https://doi.org/10.1007/s00417-025-06804-x
Rehman O, Gujar R, Kumawat R, Pandey R, Gupta C, Tiwari S, et al. Deep Learning-Based Detection of Ocular Surface Squamous Neoplasia from Ocular Surface Images. Ocul Oncol Pathol. 2025 Jan 24;1–13. DOI: https://doi.org/10.1159/000543766
Habibalahi A, Bala C, Allende A, Anwer AG, Goldys EM. Novel automated non invasive detection of ocular surface squamous neoplasia using multispectral autofluorescence imaging. The Ocular Surface. 2019 Jul;17(3):540–50. DOI: https://doi.org/10.1016/j.jtos.2019.03.003
Habibalahi A, Allende A, Michael J, Anwer AG, Campbell J, Mahbub SB, et al. Pterygium and Ocular Surface Squamous Neoplasia: Optical Biopsy Using a Novel Autofluorescence Multispectral Imaging Technique. Cancers (Basel). 2022 Mar 21;14(6):1591. DOI: https://doi.org/10.3390/cancers14061591
Yoo TK, Choi JY, Kim HK, Ryu IH, Kim JK. Adopting low-shot deep learning for the detection of conjunctival melanoma using ocular surface images. Computer Methods and Programs in Biomedicine. 2021 Jun;205:106086. DOI: https://doi.org/10.1016/j.cmpb.2021.106086
Li Z, Qiang W, Chen H, Pei M, Yu X, Wang L, et al. Artificial intelligence to detect malignant eyelid tumors from photographic images. npj Digit Med. 2022 Mar 2;5(1):23. DOI: https://doi.org/10.1038/s41746-022-00571-3
Xu W, Jin L, Zhu PZ, He K, Yang WH, Wu MN. Implementation and Application of an Intelligent Pterygium Diagnosis System Based on Deep Learning. Front Psychol. 2021 Oct 22;12:759229. DOI: https://doi.org/10.3389/fpsyg.2021.759229
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