Retinal foundation models have demonstrated strong performance across a wide range of ophthalmic tasks, yet relatively little is known about how disease-related information is represented within their learned embeddings and whether this distribution influences downstream prediction performance. In this work, we use Age-related Macular Degeneration (AMD) as a case study to investigate how disease severity is represented within the embedding space of RET-CLIP, a retinal vision-language foundation model, using bilateral fundus images from the AREDS dataset, benchmarked against non-retinal encoders. We first characterize the distribution of AMD severity within the learned representation space and then evaluate how this structure influences classification performance across three clinically relevant task formulations of increasing granularity. Finally, we analyze the most influential latent dimensions combining feature attribution, statistical phenotype association, and qualitative image analyses. Our results show that RET-CLIP represents AMD severity as a continuous spectrum rather than a set of discrete categories, with healthy and advanced disease stages exhibiting clearer separation than intermediate ones. This organization was reflected in downstream performance, which decreased from a balanced accuracy of 0.844 and 0.814 for binary AMD and Late-AMD detection respectively to 0.446 for six-class grading. Furthermore, the most influential latent dimensions were statistically associated to distinct retinal phenotypes, including drusen accumulation, pigmentary alterations, and advanced retinal lesions. These findings suggest that the structure of retinal foundation-model representations influences the difficulty of clinically relevant prediction tasks and demonstrate the potential of representation-level analysis for understanding disease organization and improving interpretability.
We propose a method to predict severity of age related macular degeneration (AMD) from input optical coherence tomography (OCT) images. Although there is no standard clinical severity scale for AMD, we leverage deep learning (DL) based image registration and clustering methods to identify diseased cases and predict their severity. Experiments demonstrate our approach's disease classification performance matches state of the art methods. The predicted disease severity performs well on previously unseen data. Registration output provides better explainability than class activation maps regarding…
University of Tehran（德黑兰大学）；Noor Ophthalmology Research Center, Noor Eye Hospital（努尔眼科研究中心，努尔眼科医院）；Henry Ford Health System（亨利·福特医疗系统）
Age-related macular degeneration (AMD) is the most common cause of blindness in developed countries, especially in people over 60 years of age. The workload of specialists and the healthcare system in this field has increased in recent years mainly due to the prevalence of population aging worldwide and the chronic nature of AMD. Recent developments in deep learning have provided a unique opportunity to develop fully automated diagnosis frameworks. Considering the presence of AMD-related retinal pathologies in varying sizes in OCT images, our objective was to propose a multi-scale convolutiona…
Bruch's membrane (BM) segmentation on optical coherence tomography (OCT) is a pivotal step for the diagnosis and follow-up of age-related macular degeneration (AMD), one of the leading causes of blindness in the developed world. Automated BM segmentation methods exist, but they usually do not account for the anatomical coherence of the results, neither provide feedback on the confidence of the prediction. These factors limit the applicability of these systems in real-world scenarios. With this in mind, we propose an end-to-end deep learning method for automated BM segmentation in AMD patients.…
Centro de Investigación CITIC（CITIC研究中心）；Universidade da Coruña（拉科鲁尼亚大学）；Instituto de Investigación Biomédica de A Coruña (INIBIC)（拉科鲁尼亚生物医学研究所（INIBIC））；Hospital Clínico San Carlos（圣卡洛斯临床医院）；Instituto de Investigación Sanitaria (IdISSC)（健康研究所（IdISSC））；Centro Internacional de Oftalmología Avanzada（国际高级眼科中心）
Age-related Macular Degeneration (AMD) is the predominant cause of blindness in developed countries, specially in elderly people. Moreover, its prevalence is increasing due to the global population ageing. In this scenario, early detection is crucial to avert later vision impairment. Nonetheless, implementing large-scale screening programmes is usually not viable, since the population at-risk is large and the analysis must be performed by expert clinicians. Also, the diagnosis of AMD is considered to be particularly difficult, as it is characterized by many different lesions that, in many case…
Automated drusen segmentation in retinal optical coherence tomography (OCT) scans is relevant for understanding age-related macular degeneration (AMD) risk and progression. This task is usually performed by segmenting the top/bottom anatomical interfaces that define drusen, the outer boundary of the retinal pigment epithelium (OBRPE) and the Bruch's membrane (BM), respectively. In this paper we propose a novel multi-decoder architecture that tackles drusen segmentation as a multitask problem. Instead of training a multiclass model for OBRPE/BM segmentation, we use one decoder per target class …
University of California, Berkeley（加利福尼亚大学伯克利分校）；International Computer Science Institute（国际计算机科学研究所）；University of California, Davis（加利福尼亚大学戴维斯分校）
Many diseases are classified based on human-defined rubrics that are prone to bias. Supervised neural networks can automate the grading of retinal fundus images, but require labor-intensive annotations and are restricted to the specific trained task. Here, we employed an unsupervised network with Non-Parametric Instance Discrimination (NPID) to grade age-related macular degeneration (AMD) severity using fundus photographs from the Age-Related Eye Disease Study (AREDS). Our unsupervised algorithm demonstrated versatility across different AMD classification schemes without retraining, and achiev…
Simultaneous column-based deep learning progression analysis of atrophy associated with AMD in longitudinal OCT studies
School of Computer Science and Engineering, The Hebrew University of Jerusalem（耶路撒冷希伯来大学计算机科学与工程学院）；The Alexander Grass Center for Bioengineering, The Hebrew University of Jerusalem（耶路撒冷希伯来大学亚历山大·格拉斯生物工程中心）；Hadassah Medical Center（哈达萨医疗中心）
The presence of drusen is the main hallmark of early/intermediate age-related macular degeneration (AMD). Therefore, automated drusen segmentation is an important step in image-guided management of AMD. There are two common approaches to drusen segmentation. In the first, the drusen are segmented directly as a binary classification task. In the second approach, the surrounding retinal layers (outer boundary retinal pigment epithelium (OBRPE) and Bruch's membrane (BM)) are segmented and the remaining space between these two layers is extracted as drusen. In this work, we extend the standard U-N…
Optical coherence tomography (OCT) is a non-invasive 3D modality widely used in ophthalmology for imaging the retina. Achieving automated, anatomically coherent retinal layer segmentation on OCT is important for the detection and monitoring of different retinal diseases, like Age-related Macular Disease (AMD) or Diabetic Retinopathy. However, the majority of state-of-the-art layer segmentation methods are based on purely supervised deep-learning, requiring a large amount of pixel-level annotated data that is expensive and hard to obtain. With this in mind, we introduce a semi-supervised paradi…
School of Advanced Technologies in Medicine（医学先进技术学院）；Isfahan University of Medical Sciences（伊斯法罕医科大学）
Age-related Macular Degeneration (AMD) and Diabetic Macular Edema (DME) are the major causes of vision loss in developed countries. Alteration of retinal layer structure and appearance of exudate are the most significant signs of these diseases. With the aim of automatic classification of DME, AMD and normal subjects from Optical Coherence Tomography (OCT) images, we proposed a classification algorithm. The two important issues intended in this approach are, not utilizing retinal layer segmentation which by itself is a challenging task and attempting to identify diseases in their early stages,…
The status of retinal arteriovenous crossing is of great significance for clinical evaluation of arteriolosclerosis and systemic hypertension. As an ophthalmology diagnostic criteria, Scheie's classification has been used to grade the severity of arteriolosclerosis. In this paper, we propose a deep learning approach to support the diagnosis process, which, to the best of our knowledge, is one of the earliest attempts in medical imaging. The proposed pipeline is three-fold. First, we adopt segmentation and classification models to automatically obtain vessels in a retinal image with the corresp…
Segmentation of Retinal Low-Cost Optical Coherence Tomography Images using Deep Learning
Institute of Medical Informatics, University of Lübeck（吕贝克大学医学信息学研究所）；University of Lübeck（吕贝克大学）；Graduate School for Computing in Medicine and Life Sciences, University of Lübeck（医学与生命科学计算研究生学院，吕贝克大学）；Medical Laser Center Lübeck（吕贝克医疗激光中心）；Department of Ophthalmology, University of Kiel（基尔大学眼科部门）；Institute of Biomedical Optics, University of Lübeck（吕贝克大学生物医学光学研究所）
Comprehensive Evaluation of OCT-based Automated Segmentation of Retinal Layer, Fluid and Hyper-Reflective Foci: Impact on Clinical Assessment of Diabetic Retinopathy Severity
School of Engineering Science, Simon Fraser University（西蒙弗雷泽大学工程科学学院）；School of Medicine, Wake Forest University（威克森林大学医学院）；Sankara Nethralaya（萨卡拉眼科医院）；Department of Ophthalmology and Visual Sciences, The University of British Columbia（不列颠哥伦比亚大学眼科与视觉科学系）；School of Biomedical Engineering, The University of British Columbia（不列颠哥伦比亚大学生物医学工程学院）；Institute of Ophthalmology, University College London（伦敦大学学院眼科研究所）；Department of Medical Physics and Biomedical Engineering, University College London（伦敦大学学院医学物理与生物医学工程系）；Department of Computer Science, Memorial University of Newfoundland（新斯科舍纪念大学计算机科学系）
University of Nevada, Reno（内华达大学里诺分校）；Houston Eye Associates（休斯顿眼科协会）
Ophthalmic images may contain identical-looking pathologies that can cause failure in automated techniques to distinguish different retinal degenerative diseases. Additionally, reliance on large annotated datasets and lack of knowledge distillation can restrict ML-based clinical support systems' deployment in real-world environments. To improve the robustness and transferability of knowledge, an enhanced feature-learning module is required to extract meaningful spatial representations from the retinal subspace. Such a module, if used effectively, can detect unique disease traits and differenti…
National Institute of Technology Karnataka（卡纳塔克邦国家技术研究所）
Diabetic retinopathy (DR) is a severe complication of diabetes that can cause permanent blindness. Timely diagnosis and treatment of DR are critical to avoid total loss of vision. Manual diagnosis is time consuming and error-prone. In this paper, we propose a novel deep learning based method for automatic screening of retinal fundus images to detect and classify DR based on the severity. The method uses a dual-path configuration of deep neural networks to achieve the objective. In the first step, a modified UNet++ based retinal vessel segmentation is used to create a fundus image that emphasis…
Patch-Based and Non-Patch-Based inputs Comparison into Deep Neural Models: Application for the Segmentation of Retinal Diseases on Optical Coherence Tomography Volumes
Laboratoire LIMOS, CNRS UMR 6158（利摩日大学实验室，法国国家科研中心UMR 6158联合研究单位）；Université Clermont-Auvergne（克莱蒙奥弗涅大学）；AL Mansour University College（曼苏尔大学学院）
University of Nevada, Reno（内华达大学雷诺分校）；Houston Eye Associates（休斯顿眼科协会）
Noisy data and the similarity in the ocular appearances caused by different ophthalmic pathologies pose significant challenges for an automated expert system to accurately detect retinal diseases. In addition, the lack of knowledge transferability and the need for unreasonably large datasets limit clinical application of current machine learning systems. To increase robustness, a better understanding of how the retinal subspace deformations lead to various levels of disease severity needs to be utilized for prioritizing disease-specific model details. In this paper we propose the use of diseas…
OCTDL: Optical Coherence Tomography Dataset for Image-Based Deep Learning Methods
Friedrich-Alexander-Universität Erlangen-Nürnberg（弗里德里希-亚历山大-埃尔朗根-纽伦堡大学）；Ural Federal University Named after the First President of Russia B. N. Yeltsin（俄罗斯首任总统B.N.叶利钦命名的乌拉尔联邦大学）；Ophthalmosurgery Clinic "Professorskaya Plus"（“Professorskaya Plus”眼科诊所）；Ural State Medical University（乌拉尔国立医科大学）
Purpose: To demonstrate that retinal microvasculature per se is a reliable biomarker for Diabetic Retinopathy (DR) and, by extension, cardiovascular diseases. Methods: Deep Learning Convolutional Neural Networks (CNN) applied to color fundus images for semantic segmentation of the blood vessels and severity classification on both vascular and full images. Vessel reconstruction through harmonic descriptors is also used as a smoothing and de-noising tool. The mathematical background of the theory is also outlined. Results: For diabetic patients, at least 93.8% of DR No-Refer vs. Refer classifica…
Visulytix Ltd（Visulytix有限公司）；King’s College Hospital NHS Foundation Trust（国王学院医院NHS基金会信托）；Cardiff University（卡迪夫大学）；Ophthalmica, Ophthalmology and Microsurgery Institute（Ophthalmica眼科与显微外科研究所）
Purpose: To evaluate Pegasus-OCT, a clinical decision support software for the identification of features of retinal disease from macula OCT scans, across heterogenous populations involving varying patient demographics, device manufacturers, acquisition sites and operators. Methods: 5,588 normal and anomalous macular OCT volumes (162,721 B-scans), acquired at independent centres in five countries, were processed using the software. Results were evaluated against ground truth provided by the dataset owners. Results: Pegasus-OCT performed with AUROCs of at least 98% for all datasets in the detec…
Deep learning methods for ophthalmic diagnosis have shown considerable success in tasks like segmentation and classification. However, their widespread application is limited due to the models being opaque and vulnerable to making a wrong decision in complicated cases. Explainability methods show the features that a system used to make prediction while uncertainty awareness is the ability of a system to highlight when it is not sure about the decision. This is one of the first studies using uncertainty and explanations for informed clinical decision making. We perform uncertainty analysis of a…
FaraAI Company（法拉人工智能公司）；University of Tehran（德黑兰大学）
Optical coherence tomography (OCT) imaging is a well-known technology for visualizing retinal layers and helps ophthalmologists to detect possible diseases. Accurate and early diagnosis of common retinal diseases can prevent the patients from suffering critical damages to their vision. Computer-aided diagnosis (CAD) systems can significantly assist ophthalmologists in improving their examinations. This paper presents a new enhanced deep ensemble convolutional neural network for detecting retinal diseases from OCT images. Our model generates rich and multi-resolution features by employing the l…
Controllable retinal image synthesis using conditional StyleGAN and latent space manipulation for improved diagnosis and grading of diabetic retinopathy
Amirkabir University of Technology（阿米尔卡比尔理工大学）；Tehran Medical Sciences, Islamic Azad University（伊斯兰阿扎德大学德黑兰医学科学分校）
Benchmarking Ophthalmology Foundation Models for Clinically Significant Age Macular Degeneration Detection
Faculty of Biomedical Engineering, Technion-IIT（技术学院生物医学工程系）；Taub Faculty of Computer Science, Technion-IIT（技术学院计算机科学系）；Faculty of Mathematics, Technion-IIT（技术学院数学系）；Department of Ophthalmology, Hillel Yaffe Medical Center（希勒尔·亚法医疗中心眼科部）；The Ruth and Rappaport Faculty of Medicine, Technion-IIT（技术学院医学院）；Ophthalmology Department, São Paulo Federal University（圣保罗联邦大学眼科部）；Medical Engineering and Science, Massachusetts Institute of Technology（麻省理工学院医学工程与科学系）；The Adelson School of Medicine, Ariel University（阿里尔大学阿德勒医学学校）
