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      Author Response: Factors in Color Fundus Photographs That Can Be Used by Humans to Determine Sex of Individuals

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          Abstract

          We thank Dr Dieck and co-authors 1 for the comments on our paper. 2 They performed an important experiment. In that, ophthalmologists were told about some features of the difference in the fundus image of men and women in advance and judged the sex of each eye from her/his fundus photograph. As a result, the correct judgment rate was only around 60%. The first author of our paper, Takehiro Yamashita, also did judgment using the same software and the accuracy rate was about the same (personal communication with Dr Nikolas Pontikos). On the other hand, Poplin et al. reported that deep learning artificial intelligence (AI) gave a far better judgment rate of 97%. 3 In the statistics, it has been considered important to eliminate elements that have a small effect in order to avoid statistical errors including multicollinearity (e.g. stepwise analysis). However, in terms of discrimination, it can be said that inserting multiple elements is superior even if one element alone has no significant effect. Thus, comprehensive judgment using many factors by AI may be getting more useful and popular for predicting the results. Most importantly, what the present study means would not be just the development of AI algorism discriminating between sexes. We believe this means the appearance of completely new way of research. Namely, AI came up with a theme that humans had never thought of, and then humans find out the truth by analyzing that theme. When this method spreads in the future, it will be discovered that previously unanticipated factors are important for the certain phenomena more easily and rapidly. These studies show that AI can be a new teacher for humans in research.

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          Factors in Color Fundus Photographs That Can Be Used by Humans to Determine Sex of Individuals

          Purpose Artificial intelligence (AI) can identify the sex of an individual from color fundus photographs (CFPs). However, the mechanism(s) involved in this identification has not been determined. This study was conducted to determine the information in CFPs that can be used to determine the sex of an individual. Methods Prospective observational cross-sectional study of 112 eyes of 112 healthy volunteers. The following characteristics of CFPs were analyzed: the color of peripapillary area expressed by the mean values of red, green, and blue intensities, and the tessellation expressed by the tessellation fundus index (TFI). The optic disc ovality ratio, papillomacular angle, retinal artery trajectory, and retinal vessel angles were also quantified. Their differences between the sexes were assessed by Mann-Whitney U tests. Regularized binomial logistic regression was used to select the decisive factors. In addition, its discriminative performance was evaluated through the leave-one-out cross validation. Results The mean age of 76 men and 36 women was 25.8 years. The regularized binomial logistic regression delivered the optimal model for sex selected variables of peripapillary temporal green and blue intensities, temporal TFI, supratemporal TFI, optic disc ovality ratio, artery trajectory, and supratemporal retinal artery angle. With this approach, the discrimination accuracy rate was 77.9%. Conclusions Human-assessed characteristics of CFPs are useful in investigating the new theme proposed by AI, the sex of an individual. Translational Relevance This is the first report to approach the thinking process of AI by humans and can be a new approach to medical AI research.
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            Factors in color fundus photographs that can be used by humans to determine sex of individuals

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              Author and article information

              Journal
              Transl Vis Sci Technol
              Transl Vis Sci Technol
              tvst
              TVST
              Translational Vision Science & Technology
              The Association for Research in Vision and Ophthalmology
              2164-2591
              05 June 2020
              June 2020
              : 9
              : 7
              : 11
              Affiliations
              [1]Department of Ophthalmology, Kagoshima University, Kagoshima, Japan
              Author notes
              Correspondence: Taiji Sakamoto, Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. 8-35-1, Sakuragaoka, Kagoshima-shi, Kagoshima 890-0075, Japan. e-mail: tsakamot@ 123456m3.kufm ,
              Article
              TVST-20-2526
              10.1167/tvst.9.7.11
              7414789
              0fbc95ea-5c51-4d57-b8f9-1c8cc777356f
              Copyright 2020 The Authors

              This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

              History
              : 20 April 2020
              : 18 April 2020
              Page count
              Pages: 1
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