Using machine learning to predict post-operative depth of focus after cataract surgery with implantation of Tecnis Symfony

To predict post-operative depth of focus (DoF) using machine learning techniques after cataract surgery with Tecnis Symfony implantation and determine associated impact factors.This was a retrospective cohort study among patients receiving Tecnis Symfony implantation, an extended-range-of-vision intraocular lens, during October 2016-January 2020 at Daqing Oilfield General Hospital, China. Four different predictive models were used to predict good post-operative DoF (⩾2.5 D): Extreme Gradient Boost (XGBoost), random forest (RF), LASSO penalized regression, and multivariable logistic regression (MLR). Apriori algorithm was employed to further explore the association between patient attributes and DoF.A total of 182 unique cases (143 patients) were included. The XGBoost model produced the best predictive accuracy compared to RF, LASSO, and MLR models. Overall performance of the best fitting XGBoost model was as follows: accuracy = 70.3%, AUC = 80.2%, sensitivity = 65.5%, and specificity = 87.5%. The Apriori algorithm identified six preoparative attributes with substantial effects on good post-operative DoF: low anterior chamber depth (ACD) (1.9 to <2.5 mm), smaller pupil size (1.7 to <2.5 mm), low-to-mid axial length (21 to <23 mm), minimum astigmatism degree (-0.2 to 0 diopter), low IOP (9 to <12 mmHg), and medium lens target refractive error (-0.5 to <-0.25 diopter).Machine Learning models were able to predict good post-operative DoF among cataract patients receiving a Tecnis Symfony ocular lens implantation. The accuracy of the model was above 70%. The Apriori algorithm identified six preoperative attributes with a strong association with post-operative DoF.