Deep Learning Applications in OCT and OCT Angiography for Retinal Disease Diagnosis: A Review
Keywords:
Classification, Deep learning, Optical coherence tomography, Retinal diseaseAbstract
Retinal diseases are among the most pressing global health challenges for which novel diagnostic approaches are urgently needed. Optical Coherence Tomography (OCT) and OCT Angiography (OCTA) are novel imaging techniques that provide high-resolution visualization of retinal microvascular abnormalities. Nonetheless, interpreting complex OCT/OCTA images requires extensive knowledge and experience, prompting the need for automated analysis using deep learning technology. This review provides a critical overview of recent progress in deep learning applications for various OCT and OCTA data analysis, including the model training paradigms, optimization techniques, and image processing applications. Three hundred seventy-three articles were found based on the keywords “retinal disease”, “OCT” or “OCTA”, and “deep learning” in literature searches. Following title, abstract, and keyword screening, 170 articles were reviewed in full text for eligibility, with 27 studies included in the final review. Selected articles were reviewed to determine the dataset used, the employed deep learning and image preprocessing methods, and the evaluated performance metrics. This paper summarizes the applications of deep learning in improving the performance of retinal disease classification and identifies future directions for enhancing the reliability of AI-based models. Finally, this review outlines the challenges associated with current research and existing strategies, and suggests future directions to enhance the medical relevance of deep-learning diagnostic systems.References
[1] T. W. Hsu, Y. M. Bai, S. J. Tsai, T. J. Chen, C. S. Liang and M. H. Chen, Risk of retinal disease in patients with bipolar disorder: a nationwide cohort study, Psychiatry and Clinical Neurosciences, 76, 2022, 106–113.
[2] Q. Tang, X. Li, J. Wang, Y. Zhang, X. Wang, Y. Liu, J. Zhou and Y. Chen, Study on the Interaction between the characteristics of retinal microangiopathy and risk factors for cerebral small vessel disease, Contrast Media and Molecular Imaging, 2022, 1-12.
[3] World Health Organization, Blindness and vision impairment. https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment, 2023 (accessed 05.01.2024.
[4] T. Y. Wong and T. E. Tan, The diabetic retinopathy ‘pandemic’ and evolving global strategies: The 2023 Friedenwald lecture, Investigative Ophthalmology & Visual Science, 64, 2023.
[5] C. J. T. Ong, M. Y. Z. Wong, K. X. Cheong, J. Zhao, K. Y. C. Teo and T. E. Tan, Optical coherence tomography angiography in retinal vascular disorders, Diagnostics, 13, 2023, 1–20.
[6] Y. Hirano, N. Suzuki, T. Tomiyasu, R. Kurobe, Y. Yasuda, Y. Esaki, T. Yasukawa, M. Yoshida and Y. Ogura, Multimodal imaging of microvascular abnormalities in retinal vein occlusion, Journal of Clinical Medicine, 10, 2021, 405.
[7] C. Iovino, C. M. Iodice, D. Pisani, L. Damiano, V. Di Iorio, F. Testa and F. Simonelli, Clinical applications of optical coherence tomography angiography in inherited retinal diseases: An up-to-date review of the literature, Journal of Clinical Medicine, 12, 2023, 3170.
[8] L. von der Emde, M. Saßmannshausen, O. Morelle, G. Rennen, F. G. Holz, M. W. M. Wintergerst and T. Ach, Reliability of retinal layer annotation with a novel, high-resolution optical coherence tomography device: a comparative study, Bioengineering, 10, 2023, 438.
[9] R. K. Meleppat, C. R. Fortenbach, Y. Jian, E. S. Martinez, K. Wagner, B. S. Modjtahedi, M. J. Motta, D. L. Ramamurthy, I. R. Schwab and R. J. Zawadzki, In vivo imaging of retinal and choroidal morphology and vascular plexuses of vertebrates using swept-source optical coherence tomography, Translational Vision Science & Technology, 11, 2022, 11.
[10] Y. Nakamichi, Gradient mapping of multi-timescale optical coherence tomography angiography signals for enhancing signal-to-noise ratio of flow detection, Journal of Biomechanical Science and Engineering, 18, 2023, 1–11.
[11] T. Rabinovitch, V. Yehezkeli, D. Goldenberg, A. Loewenstein and E. Moisseiev, Evaluation of accuracy and agreement of optical coherence tomography angiography interpretation of common retinal findings and diagnoses, Ophthalmologica, 244, 2021, 141–149.
[12] B. Chawla and R. Singh, Recent advances and challenges in the management of retinoblastoma, Indian Journal of Ophthalmology, 65, 2017, 133–139.
[13] M. S. Ramakrishnan, J. L. Kovach, C. C. Wykoff, A. M. Berrocal and Y. S. Modi, American society of retina specialists clinical practice guidelines on multimodal imaging for retinal disease, Journal of VitreoRetinal Diseases, 8, 2024, 234–246.
[14] A. Invernizzi, M. Pellegrini, E. Cornish, K. Y. C. Teo, M. Cereda and J. Chhablani, Imaging the choroid: From indocyanine green angiography to optical coherence tomography angiography, Asia-Pacific Journal of Ophthalmology, 9, 2020, 335–348.
[15] K. Agarwal, A. Vinekar, P. Chandra, T. R. Padhi, S. Nayak, S. Jayanna, B. Panchal, S. Jalali and T. Das, Imaging the pediatric retina: An overview, Indian Journal of Ophthalmology, 69, 2021, 812–823.
[16] J. J. Pieczynski, P. Kuklo and A. Grzybowski, The role of telemedicine, in-home testing and artificial intelligence to alleviate an increasingly burdened healthcare system: Diabetic retinopathy, Ophthalmology and Therapy, 10, 2021, 445–464.
[17] N. Govindaswamy, D. Ratra, D. Dalan, S. Doralli, A. A. Tirumalai, R. Nagarajan, T. Mochi, N. Shetty and A. Sinha Roy, Vascular changes precede tomographic changes in diabetic eyes without retinopathy and improve artificial intelligence diagnostics, Journal of Biophotonics, 13, 2020, e202000107.
[18] X. Yao, M. N. Alam, D. Le and D. Toslak, Quantitative optical coherence tomography angiography: A review, Experimental Biology and Medicine, 245, 2020, 301–312.
[19] S. Sivasubramaniam and S. P. Balamurugan, Early detection and prediction of heart disease using wearable devices and deep learning algorithms, Multimedia Tools and Applications, 84, 2025, 6187–6201.
[20] T. Liu, Y. Hu, Z. Liu, Z. Jiang, X. Ling, X. Zhu and W. Li, Deep learning-based DCE-MRI automatic segmentation in predicting lesion nature in BI-RADS category 4, Journal of Imaging Informatics in Medicine, 38, 2025, 2053–2062.
[21] J. Kaur, S. Bhatti, K. Tan, O. R. Popoola, M. A. Imran, R. Ghannam, Q. H. Abbasi and H. T. Abbas, Contextual beamforming: exploiting location and AI for enhanced wireless telecommunication performance, APL Machine Learning, 2, 2024, 016113.
[22] T. Miftahushudur, H. M. Sahin, B. Grieve and H. Yin, A survey of methods for addressing imbalance data problems in agriculture applications, Remote Sensing, 17, 2025, 454.
[23] M. H. Akpinar, A. Sengur, O. Faust, L. Tong, F. Molinari and U. R. Acharya, Artificial intelligence in retinal screening using oct images: A review of the last decade (2013–2023), Computer Methods and Programs in Biomedicine, 254, 2024, 108253.
[24] A. Hayati, M. R. Abdol Homayuni, R. Sadeghi, H. Asadigandomani, M. Dashtkoohi, S. Eslami and M. Soleimani, Advancing diabetic retinopathy screening: A systematic review of artificial intelligence and optical coherence tomography angiography innovations, Diagnostics, 15, 2025, 737.
[25] B. Hassan, H. Raja, T. Hassan, M. U. Akram, H. Raja, A. A. Abd-Alrazaq, S. Yousefi and N. Werghi, A comprehensive review of artificial intelligence models for screening major retinal diseases, Artificial Intelligence Review, 57, 2024, 1.
[26] C. Lam, Y. L. Wong, Z. Tang, X. Hu, T. X. Nguyen, D. Yang, S. Zhang, J. Ding, S. K. H. Szeto, A. R. Ran and C. Y. Cheung, Performance of artificial intelligence in detecting diabetic macular edema from fundus photography and optical coherence tomography images: A systematic review and meta-analysis, Diabetes Care, 47, 2024, 304–319.
[27] M. Ennab and H. Mcheick, Enhancing interpretability and accuracy of AI models in healthcare: a comprehensive review on challenges and future directions, Frontiers in Robotics and AI, 11, 2024, 1444763.
[28] M. El Habib Daho, Y. Li, R. Zeghlache, Y. C. Atse, H. Le Boité, S. Bonnin, D. Cosette, P. Deman, L. Borderie, C. Lepicard and R. Tadayoni, Improved automatic diabetic retinopathy severity classification using deep multimodal fusion of UWF-CFP and OCTA images, International Workshop on Ophthalmic Medical Image Analysis, Cham, Switzerland, 2023, 11–20.
[29] N. Ban, A. Shinojima, K. Negishi and T. Kurihara, Drusen in AMD from the perspective of cholesterol metabolism and hypoxic response, Journal of Clinical Medicine, 13, 2024, 2608.
[30] M. Kropp, O. Golubnitschaja, A. Mazurakova, L. Koklesova, N. Sargheini, T. K. S. Vo, E. de Clerck, J. Polivka Jr., P. Potuznik, J. Polivka, I. Stetkarova, P. Kubatka and G. Thumann, Diabetic retinopathy as the leading cause of blindness and early predictor of cascading complications—Risks and mitigation, EPMA Journal, 14, 2023, 21–42.
[31] G. Nkrumah, M. Paez-Escamilla, S. R. Singh, M. A. Rasheed, D. Maltsev, A. Guduru and J. Chhablani, Biomarkers for central serous chorioretinopathy, Therapeutic Advances in Ophthalmology, 12, 2020, 2515841420950846.
[32] C. Desai, O. K. Radhakrishnan, N. J. Cardoza, K. Mohankumar and M. Mohan, A study conducted in western Maharashtra to evaluate the risk factors for diabetic macular edema in patients with type 2 diabetes mellitus, Indian Journal of Clinical and Experimental Ophthalmology, 2021.
[33] G. Nagamani and T. Sudhakar, An improved dynamic-layered classification of retinal diseases, IAES International Journal of Artificial Intelligence, 13, 2024, 417–429.
[34] M. Adhi and M. Reinoso, Spontaneous regression and quiescence of choroidal neovascularization secondary to traumatic choroidal rupture depicted on OCT angiography, European Journal of Ophthalmology, 2021, 11206721211059030.
[35] Z. G. Lu, A. May, B. Dinh, V. Lin, F. Su, C. Tran, H. Adivikolanu, R. Ehlen, B. Che, Z. H. Wang, D. H. Shaw, S. Borooah and P. X. Shaw, The interplay of oxidative stress and ARMS2-HTRA1 genetic risk in neovascular AMD, Vessel Plus, 5, 2021, 4.
[36] Z. Tang, Y. Ju, X. Dai, N. Ni, Y. Liu, D. Zhang, H. Gao, H. Sun, J. Zhang and P. Gu, HO-1-mediated ferroptosis as a target for protection against retinal pigment epithelium degeneration, Redox Biology, 43, 2021, 101971.
[37] C. Farinha, M. L. Cachulo, R. Coimbra, D. Alves, S. Nunes, I. Pires, J. P. Marques, J. Costa, A. Martins, I. Sobral, P. Barreto, I. Laíns, J. Figueira, L. Ribeiro, J. Cunha-Vaz and R. Silva, Age-related macular degeneration staging by color fundus photography vs. multimodal imaging—epidemiological implications (The Coimbra Eye Study—Report 6), Journal of Clinical Medicine, 9, 2020, 1329.
[38] M. Kiruthika and G. Malathi, A comprehensive review on early detection of drusen patterns in age-related macular degeneration using deep learning models, Photodiagnosis and Photodynamic Therapy, 51, 2025, 104454.
[39] M. Belmouhand, S. P. Rothenbuehler, J. Bjerager, S. Dabbah, J. B. Hjelmborg, I. C. Munch, C. Dalgård and M. Larsen, Heritability and risk factors of incident small and large drusen in the Copenhagen twin cohort eye study: A 20-year follow-up, Ophthalmologica, 245, 2022, 421–430.
[40] S. Yang, Z. Gao, H. Qiu, C. Zuo, L. Mi, H. Xiao and X. Liu, Low-reflectivity drusen with overlying RPE damage revealed by spectral-domain OCT: Hint for the development of age-related macular degeneration, Frontiers in Medicine, 8, 2021, 706502.
[41] A. Grzybowski, D. P. Rao, P. Brona, K. Negiloni, T. Krzywicki and F. M. Savoy, Diagnostic accuracy of automated diabetic retinopathy image assessment softwares: IDx-DR and medios artificial intelligence, Ophthalmic Research, 66, 2023, 1286–1292.
[42] M. Karabeg, G. Petrovski, S. N. Hertzberg, M. G. Erke, D. S. Fosmark, G. Russell, M. C. Moe, V. Volke, V. Raudonis, R. Verkauskiene, J. Sokolovska, I. K. Haugen and B. E. Petrovski, A pilot cost-analysis study comparing AI-based EyeArt® and ophthalmologist assessment of diabetic retinopathy in minority women in Oslo, Norway, International Journal of Retina and Vitreous, 10, 2024, 40.
[43] M. Li and C. Wan, The use of deep learning technology for the detection of optic neuropathy, Quantitative Imaging in Medicine and Surgery, 12, 2022, 2129–2143.
[44] M. Hafner, S. G. Priglinger, B. von Livonius and M. J. Gerhardt, Quantitative comparison of a novel swept-source optical coherence tomography angiography device with three established systems, Scientific Reports, 15, 2025, 20129.
[45] J. I. Lim, C. D. Regillo, S. R. Sadda, E. Ipp, M. Bhaskaranand, C. Ramachandra, K. Solanki, H. Dubiner, G. Levy-Clarke, R. Pesavento and M. D. Sherman, Artificial intelligence detection of diabetic retinopathy: Subgroup comparison of the EyeArt system with ophthalmologists' dilated examinations, Ophthalmology Science, 3(1), 2023, 100228.
[46] J. Lin and M. D. Smucker, How do users find things with PubMed? Towards automatic utility evaluation with user simulations, Proceedings of the 31st Annual International ACM SIGIR Conference on Research and Development in Information Retrieval, Singapore, 2008, 19–26.
[47] M. Marocchi, L. Abbott, Y. Rong, S. Nordholm and G. Dwivedi, Abnormal heart sound classification and model interpretability: a transfer learning approach with deep learning, Journal of Vascular Diseases, 2, 2023, 438–459.
[48] F. Y. Shih and H. Patel, Deep learning classification on optical coherence tomography retina images, International Journal of Pattern Recognition and Artificial Intelligence, 34, 2020, 2052002.
[49] D. Le, M. Alam, C. K. Yao, J. I. Lim, Y. T. Hsieh, R. V. P. Chan, D. Toslak and X. Yao, Transfer learning for automated OCTA detection of diabetic retinopathy, Translational Vision Science & Technology, 9, 2020, 35.
[50] N. B. Khalaf, H. K. Aljobouri and M. S. Najim, Identification and classification of retinal diseases by using deep learning models, 2023 International Conference on Smart Applications, Communications and Networking (SmartNets), Istanbul, Türkiye, 2023, 1–5.
[51] Y. Wang, M. Lucas, J. Furst, A. A. Fawzi and D. Raicu, Explainable deep learning for biomarker classification of OCT images, 2020 IEEE 20th International Conference on Bioinformatics and Bioengineering (BIBE), Cincinnati, OH, USA, 2020, 204–210.
[52] I. Khalil, A. Mehmood, H. Kim and J. Kim, OCTNet: A modified multi-scale attention feature fusion network with InceptionV3 for retinal OCT image classification, Mathematics, 12, 2024, 3003.
[53] K. Gencer, G. Gencer, T. H. Ceran, A. E. Bilir and M. Doğan, Photodiagnosis with deep learning: A GAN and autoencoder-based approach for diabetic retinopathy detection, Photodiagnosis and Photodynamic Therapy, 53, 2025, 104552.
[54] A. O. Asia, Z. Cai, A. Alasri and A. ELrashidi, Multimodel deep transfer learning and hybrid BiLSTM-AM-DCN with Walrus optimization algorithm for multiclass retinal disease classification in OCT images, Egyptian Informatics Journal, 34, 2026, 100988.
[55] P. Sekar, K. S. Suba Raja and R. Krishnaraj, DRCNN-Lesion Proxy: A hybrid CNN with lesion-inspired feature simulation for diabetic retinopathy severity classification, Scientific Reports, 15, 2025, 37954.
[56] U. S. Khan and S. U. R. Khan, Boost diagnostic performance in retinal disease classification utilizing deep ensemble classifiers based on OCT, Multimedia Tools and Applications, 84, 2025, 21227–21247.
[57] Q. Zhang, Z. Liu, J. Li and G. Liu, Identifying diabetic macular edema and other retinal diseases by optical coherence tomography image and multiscale deep learning, Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 2020, 4787–4800.
[58] D. Kermany, K. Zhang and M. Goldbaum, Large dataset of labeled optical coherence tomography (OCT) and chest X-ray images, Version 3, Mendeley Data, 2018.
[59] A. M. Ismail, F. E. Abd El-Samie, O. A. Omer and A. S. Mubarak, Ensemble transfer learning networks for disease classification from retinal optical coherence tomography images, Journal of Optics, 2024, 1–16.
[60] A. Adel, M. M. Soliman, N. E. M. Khalifa and K. Mostafa, Automatic classification of retinal eye diseases from optical coherence tomography using transfer learning, 2020 16th International Computer Engineering Conference (ICENCO), Cairo, Egypt, 2020, 37–42.
[61] P. T. Mooney, Retinal OCT images (Kermany2018), Kaggle Dataset, 2018. https://www.kaggle.com/datasets/paultimothymooney/kermany2018 (accessed 19.12.2025.
[63] H. Yang, L. Chen, J. Cao and J. Wang, HRS-Net: A hybrid multiscale network model based on convolution and transformers for multiclass retinal disease classification, IEEE Access, 12, 2024, 144219–144229.
[65] L. Hamid, A. Elnokrashy, E. H. Abdelhay and M. M. Abdelsalam, A deep learning LSTM-based approach for AMD classification using OCT images, Neural Computing and Applications, 36, 2024, 19531–19547.
[64] Ö. F. Aydın, F. B. Tek and Y. Turkan, Retinal disease classification from bimodal OCT and OCTA using a CNN–ViT hybrid architecture, 2025 10th International Conference on Computer Science and Engineering (UBMK), Instanbul, Türkiye, 2025, 260–264.
[66] J. Kim and L. Tran, Ensemble learning based on convolutional neural networks for the classification of retinal diseases from optical coherence tomography images, 2020 IEEE 33rd International Symposium on Computer-Based Medical Systems (CBMS), Rochester, MN, USA, 2020, 532–537.
[67] Y. Mori and N. Modi, Enhancing OCT image classification for retinal disease diagnosis: a novel approach using squeeze-and-excitation ResNet, 2024 IEEE 3rd World Conference on Applied Intelligence and Computing (AIC), Gwalior, India, 2024, 940–945.
[62] A. Laouarem, C. Kara-Mohamed, E. B. Bourennane and A. Hamdi-Cherif, HTC-Retina: A hybrid retinal diseases classification model using transformer-convolutional neural network from optical coherence tomography images, Computers in Biology and Medicine, 178, 2024, 108726.
[68] K. G. Lee, S. J. Song, S. Lee, H. G. Yu, D. I. Kim and K. M. Lee, A deep learning-based framework for retinal fundus image enhancement, PLoS ONE, 18, 2023, e0282416.
[69] K. S. Swarnalatha, U. A. Nayak, N. A. Benny, H. B. Bharath, D. Shetty and S. D. Kumar, Detection of diabetic retinopathy using convolution neural network, Emerging Research in Computing, Information, Communication and Applications: Proceedings of ERCICA 2022, Singapore: Springer Nature Singapore, 2022, 427–439.
[70] P. Zang, L. Gao, T. T. Hormel, J. Wang, Q. You, T. S. Hwang and Y. Jia, DcardNet: Diabetic retinopathy classification at multiple levels based on structural and angiographic optical coherence tomography, IEEE Transactions on Biomedical Engineering, 68, 2020, 1859–1870.
[71] A. Roy, R. Abdullah, F. Ahmed, S. Mashfi, S. H. Khan and D. Z. Karim, RetNet: retinal disease detection using convolutional neural network, 2023 International Conference on Electrical, Computer and Communication Engineering (ECCE), Chittagong, Bangladesh, 2023, 1–6.
[72] G. Altan, DeepOCT: An explainable deep learning architecture to analyze macular edema on OCT images, Engineering Science and Technology, an International Journal, 34, 2022, 101091.
[73] A. M. Alqudah, AOCT-NET: a convolutional network automated classification of multiclass retinal diseases using spectral-domain optical coherence tomography images, Medical & Biological Engineering & Computing, 58, 2020, 41–53.
[74] M. Opoku, B. A. Weyori, A. F. Adekoya and K. Adu, CLAHE-CapsNet: efficient retina optical coherence tomography classification using capsule networks with contrast limited adaptive histogram equalization, PLoS ONE, 18, 2023, e0288663.
[75] X. Huang, Z. Ai, H. Wang, C. She, J. Feng, Q. Wei, B. Hao, Y. Tao, Y. Lu and F. Zeng, GABNet: Global attention block for retinal OCT disease classification, Frontiers in Neuroscience, 17, 2023, 1143422.
[76] X. Wang, F. Tang, H. Chen, C. Y. Cheung and P. A. Heng, Deep semisupervised multiple instance learning with self-correction for DME classification from OCT images, Medical Image Analysis, 83, 2023, 102673.
[77] X. Wang, F. Tang, H. Chen, L. Luo, Z. Tang, A. R. Ran, C. Y. Cheung and P. A. Heng, UD-MIL: Uncertainty-driven deep multiple instance learning for OCT image classification, IEEE Journal of Biomedical and Health Informatics, 24, 2020, 3431–3442.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Jalaluddin Muhammad-Sukki, Audrey Huong, Ser Lee Loh, Firdaus Muhammad-Sukki, Xavier Ngu

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:Authors hold and retain copyright, and grant the journal right of first publication, with the work after publication simultaneously licensed under a Creative Commons Attribution 4.0 License CC BY that permits any use, reproduction and distribution of the work and article without further permission provided that the original work is properly cited.
Authors are permitted and encouraged to post their work online in institutional repositories, website and other social media before and after publication, as it can lead to productive exchanges, as well as earlier and greater citation of published work.





