| Study characteristics |
| Patient Sampling |
Multicentre retrospective case‐control study comparing 4 convolutional neural network methods. It included 1926 images from the Pentacam (Oculus GmbH, Wetzlar, Germany) of keratoconic and healthy volunteers' eyes provided by 3 centres (UK, Iran, New Zealand). |
| Patient characteristics and setting |
Keratoconic scans were classified according to the Amsler‐ Krumeich classification. Only scans of acceptable quality were included. Control group: subjects with a BAD‐D < 1.6 SDs from normative values. |
| Index tests |
Convolutional neural network method that uses 4 colour‐coded corneal maps obtained by a Scheimpflug camera (Pentacam) |
| Target condition and reference standard(s) |
The definition of keratoconus is unclear. Unclear who performed the classification. However, cases were classified before inclusion. |
| Flow and timing |
All cases were included in the reference standard and index test. All data were included in a 2 × 2 table. |
| Comparative |
Unclear whether different AI tests were developed and interpreted blind or independently and without knowledge of the results of each other. Missing data and their causes were similar for each AI test. |
| Notes |
The study authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not‐for‐profit sectors. |
| Methodological quality |
| Item |
Authors' judgement |
Risk of bias |
Applicability concerns |
| DOMAIN 1: Patient selection |
| Was a consecutive or random sample of patients enrolled? |
No |
|
|
| Was a case‐control design avoided? |
No |
|
|
| Did the study avoid inappropriate exclusions? |
No |
|
|
| Could the selection of patients have introduced bias? |
|
High risk |
|
| Are there concerns that the included patients and setting do not match the review question? |
|
|
High |
| DOMAIN 2: Index test (All tests) |
| Were the index test results interpreted without knowledge of the results of the reference standard? |
Yes |
|
|
| If a threshold was used, was it pre‐specified? |
Unclear |
|
|
| Was the model designed in an appropriate manner? |
Yes |
|
|
| Could the conduct or interpretation of the index test have introduced bias? |
|
Low risk |
|
| Are there concerns that the index test, its conduct, or interpretation differ from the review question? |
|
|
Low concern |
| DOMAIN 3: Reference standard |
| Is the reference standard likely to correctly classify the target condition? |
Unclear |
|
|
| Were the reference standard results interpreted without knowledge of the results of the index tests? |
Yes |
|
|
| Could the reference standard, its conduct, or its interpretation have introduced bias? |
|
Unclear risk |
|
| Are there concerns that the target condition as defined by the reference standard does not match the question? |
|
|
Low concern |
| DOMAIN 4: Flow and timing |
| Did all patients receive the same reference standard? |
Yes |
|
|
| Were all patients included in the analysis? |
Yes |
|
|
| Could the patient flow have introduced bias? |
|
Low risk |
|
| DOMAIN 5: Comparative |
| Were different AI tests were developed and interpreted without knowledge of each other. |
Unclear |
|
|
| Are the proportions and reasons for missing data similar for all index tests? |
Yes |
|
|
| |
|
Unclear risk |
|
| |
|
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