To develop generative adversarial networks (GANs) that synthesize realistic anterior segment optical coherence tomography (AS-OCT) images and evaluate deep learning (DL) models that are trained on real and synthetic datasets for detecting angle closure.
The GAN architecture was adopted and trained on the dataset with AS-OCT images collected from the Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, synthesizing open- and closed-angle AS-OCT images. A visual Turing test with two glaucoma specialists was performed to assess the image quality of real and synthetic images. DL models, trained on either real or synthetic datasets, were developed. Using the clinicians’ grading of the AS-OCT images as the reference standard, we compared the diagnostic performance of open-angle vs. closed-angle detection of DL models and the AS-OCT parameter, defined as a trabecular-iris space area 750 µm anterior to the scleral spur (TISA750), in a small independent validation dataset.
The GAN training included 28,643 AS-OCT anterior chamber angle (ACA) images. The real and synthetic datasets for DL model training have an equal distribution of open- and closed-angle images (all with 10,000 images each). The independent validation dataset included 238 open-angle and 243 closed-angle AS-OCT ACA images. The image quality of real versus synthetic AS-OCT images was similar, as assessed by the two glaucoma specialists, except for the scleral spur visibility. For the independent validation dataset, both DL models achieved higher areas under the curve compared with TISA750. Two DL models had areas under the curve of 0.97 (95% confidence interval, 0.96-0.99) and 0.94 (95% confidence interval, 0.92-0.96).
The GAN synthetic AS-OCT images appeared to be of good quality, according to the glaucoma specialists. The DL models, trained on all-synthetic AS-OCT images, can achieve high diagnostic performance.
The GANs can generate realistic AS-OCT images, which can also be used to train DL models.

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