Sowmya Kamath, S.Reji, S.Vaibhava Lakshmi, V.Supreetha, S.Gawas, P.Mayya, V.Hazarika, M.2026-02-032025Healthcare Technology Letters, 2025, 12, 1, pp. -https://doi.org/10.1049/htl2.70051https://idr.nitk.ac.in/handle/123456789/20566Fungal keratitis (FK) is a severe ocular infection that can lead to significant vision problems or blindness if not diagnosed and treated promptly. Early and accurate detection of FK is essential for effective management. Traditional diagnostic methods are often time-consuming and require specialized laboratory resources. Recently, advances in artificial intelligence and computer vision have enabled automated diagnosis of FK using slit-lamp images. In this article, a comprehensive evaluation of state-of-the-art techniques adopted for classifying FK using in vivo confocal microscopy (IVCM) images is presented. Detailed experiments and performance evaluation of various machine learning models are systematically performed, with a focus on evaluating the effect of diverse techniques for image processing, data augmentation, hyperparameters and model finetuning to assess each model's strengths and limitations. Experiments revealed that applying green channel preprocessing with a 12-feature set achieved 99% accuracy using Random Forest, highlighting its effectiveness in FK detection, while complex techniques like histogram modelling reduced accuracy to 64%. Robust models like AdaBoost and RUSBoost maintained high F1-scores, demonstrating adaptability to imbalanced medical datasets, and to real-world clinical scenarios. © 2025 The Author(s). Healthcare Technology Letters published by John Wiley & Sons Ltd on behalf of The Institution of Engineering and Technology.Computer aided diagnosisData handlingDiseasesLearning systemsMachine learningAutomated diagnosisBiomedical imagingDiagnostic methodsEffective managementImages processingIn-vivoMachine learning approachesMedical images processingMicroscopy imagesVision problemsMedical image processingadaptive boostingarea under the curveArticleclinical articleconfocal microscopydata augmentationdiagnostic accuracydisease classificationfeature extractionGaussian Naive Bayeshumanimage enhancementimage processingin vivo studyinformation processingk nearest neighborkeratomycosislogistic regression analysismachine learningrandom forestrandom undersampling boostingreceiver operating characteristicretrospective studysensitivity and specificitysupport vector machine