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Here, we propose a methodology that advances explainable deep learning in the field of glaucoma detection and vertical cup-disc ratio (VCDR), an important risk factor. We trained and evaluated deep learning models using fundus images that underwent a certain cropping policy. We defined the crop radius as a percentage of image size, centered on the optic nerve head (ONH), with an equidistant spaced range from 10\u201360% (ONH crop policy). The inverse of the cropping mask was also applied (periphery crop policy). Trained models using original images resulted in an area under the curve (AUC) of 0.94 [95% CI 0.92\u20130.96] for glaucoma detection, and a coefficient of determination (R<jats:sup>2<\/jats:sup>) equal to 77% [95% CI 0.77\u20130.79] for VCDR estimation. Models that were trained on images with absence of the ONH are still able to obtain significant performance (0.88 [95% CI 0.85\u20130.90] AUC for glaucoma detection and 37% [95% CI 0.35\u20130.40] R<jats:sup>2<\/jats:sup> score for VCDR estimation in the most extreme setup of 60% ONH crop). Our findings provide the first irrefutable evidence that deep learning can detect glaucoma from fundus image regions outside the ONH.<\/jats:p>","DOI":"10.1038\/s41598-021-99605-1","type":"journal-article","created":{"date-parts":[[2021,10,13]],"date-time":"2021-10-13T17:43:34Z","timestamp":1634147014000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":87,"title":["Deep learning on fundus images detects glaucoma beyond the optic disc"],"prefix":"10.1038","volume":"11","author":[{"given":"Ruben","family":"Hemelings","sequence":"first","affiliation":[]},{"given":"Bart","family":"Elen","sequence":"additional","affiliation":[]},{"given":"Jo\u00e3o","family":"Barbosa-Breda","sequence":"additional","affiliation":[]},{"given":"Matthew B.","family":"Blaschko","sequence":"additional","affiliation":[]},{"given":"Patrick","family":"De Boever","sequence":"additional","affiliation":[]},{"given":"Ingeborg","family":"Stalmans","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2021,10,13]]},"reference":[{"issue":"11","key":"99605_CR1","doi-asserted-by":"publisher","first-page":"2081","DOI":"10.1016\/j.ophtha.2014.05.013","volume":"121","author":"Y-C Tham","year":"2014","unstructured":"Tham, Y.-C. et al. 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