Standardized Corneal Topography-Driven AI for Orthokeratology Fitting: A Hybrid Deep/Machine Learning Approach With Enhanced Generalizability

Purpose: The purpose of this study was to develop a standardized artificial intelligence (AI) system integrating corneal topography images and numerical parameters for optimizing orthokeratology (OK) lens fitting. Methods: Retrospective data from 1153 patients (2341 eyes) with Euclid OK lenses were analyzed. Five hundred nineteen eyes (393 patients) with treatment zone decentration ≤1 mm were included for model training. A device-agnostic corneal topography reconstruction pipeline generated standardized tangential curvature maps. A hybrid model combined deep learning (ResNet for image features) and machine learning (using numerical parameters) to predict alignment curve (AC) and cylinder power (CP), with numerical regression for AC and classification regression for CP. Multitask learning addressed AC-CP biomechanical coupling. Results: Numerical parameter-based models achieved optimal axial AC prediction (mean absolute error [MAE] = 0.290, R² = 0.917), and CP prediction (accuracy [ACC] = 0.798, area under the curve [AUC] = 0.791). The image-based deep learning model using baseline corneal topography alone attained acceptable AC prediction (MAE = 0.248, R² = 0.850), yet demonstrated suboptimal CP classification accuracy (ACC = 0.674, AUC = 0.621). Hybrid modeling achieved breakthrough performance in AC prediction (MAE = 0.136, R² = 0.973) and superior CP classification (ACC = 0.898, AUC = 0.896). Conclusions: This system standardizes corneal topography across devices, addressing a critical barrier to generalizability in existing AI models, significantly enhancing fitting precision and generalizability for myopia control applications. Translational Relevance: The device-agnostic design in the present study allows seamless integration into diverse clinical settings. The hybrid AI framework achieves near-expert accuracy, offering a scalable solution to access to high-quality OK lens fitting.