Brain and Optic Nerve Study with Artificial Intelligence (BONSAI): The Final Outcomes

The timely and accurate detection of optic disc abnormalities, in particular papilledema, is a key part of the clinical examination; however, few physicians confidently perform ophthalmoscopy. Our goal was to develop an artificial intelligence deep learning system (AI-DLS) capable of distinguishing "normal optic nerves", "papilledema" (optic disc edema from proven intracranial hypertension), and "other optic nerve abnormalities" on standard digital fundus photographs from a large, multiethnic, worldwide, patient population. This classification was chosen to provide a low-cost, non-invasive test that facilitates identification of patients less (those with normal optic nerves) or more (those with papilledema) likely to have neurologic disorders associated with high morbidity/mortality in emergency settings.