Automated Detection of Keratorefractive Laser Surgeries on Optical Coherence Tomography Using Deep Learning

Purpose To report a deep learning neural network on anterior segment optical coherence tomography (AS-OCT) for automated detection of different keratorefractive laser surgeries—including laser in situ keratomileusis with femtosecond microkeratome (femto-LASIK), LASIK with mechanical microkeratome, photorefractive keratectomy (PRK), keratorefractive lenticule extraction (KLEx), and non-operated eyes—while also distinguishing between myopic and hyperopic treatments within these procedures. Methods A total of 14,948 eye scans from 2,278 eyes of 1,166 patients were used to develop a deep learning neural network algorithm with an 80/10/10 patient distribution for training, validation, and testing phases, respectively. The algorithm was evaluated for its accuracy, F1 scores, area under precision-recall curve (AUPRC), and area under receiver operating characteristic curve (AUROC). Results On the test dataset, the neural network was able to detect the different surgical classes with an accuracy of 96%, a weighted-average F1 score of 96%, and a macro-average F1 score of 96%. The neural network was further able to detect hyperopic and myopic subclasses within each surgical class, with an accuracy of 90%, weighted-average F1 score of 90%, and macro-average F1 score of 83%. Conclusions Neural networks can accurately classify a patient's keratorefractive laser history from AS-OCT scans, which may support treatment planning, intraocular lens calculations, and ectasia assessment, particularly in cases where electronic health records are incomplete. This represents a step toward transforming OCT from a diagnostic to a more comprehensive screening tool in refractive clinics. [ J Refract Surg . 2025;41(3):e248–e256.]