Through BrokenEyes: How Eye Disorders Impact Face Detection?

Vision-language models hold considerable promise for ophthalmology, but it remains unclear which training data source best conveys expert domain knowledge. Existing ophthalmic models are trained on fixed text templates, medical reports, or general biomedical literature, sources that have never been compared under matched conditions. To include domain-specific literature in this comparison, we present PubMed-Ophtha, a hierarchical dataset with high domain density of 102,023 panels with their subcaptions from 15,842 open-access articles in PubMed Central. We then finetuned identical CLIP models on each source, using a general biomedical literature model as baseline, and found that domain-specific literature achieved the best average performance across 110 clinical tasks, reaching a mean linear probing AUROC of 88.63% ahead of medical reports (85.68%). Restricting the dataset to fundus images, to the image count of the medical report dataset, or to articles unrelated to the evaluation datasets did not reduce performance, indicating that the gains likely stem from domain density. We release the dataset, the finetuned models, and the full generation pipeline.

Glaucoma is a progressive optic neuropathy characterized by irreversible damage to the optic nerve, making timely diagnosis critical to prevent permanent vision loss. Although deep learning has demonstrated promising performance in automated glaucoma detection, existing approaches often overlook feature refinement, suffer from class imbalance, and rely on individual classifiers that limit prediction robustness. To address these challenges, this paper proposes a hybrid glaucoma detection framework that integrates attention-enhanced deep feature extraction with heterogeneous ensemble learning. Specifically, deep representations are extracted using InceptionV3 and subsequently refined by incorporating the Convolutional Block Attention Module (CBAM) to enhance discriminative retinal features. To improve classification robustness, the extracted features are classified using multiple machine learning models together with Single-Level Ensemble (SLE) and Double-Level Ensemble (DLE) strategies, while SMOTE combined with Tomek Links (SMOTE+TL) is employed to alleviate class imbalance. Furthermore, a systematic comparison of handcrafted, deep, and attention-enhanced deep feature representations is conducted. Experimental evaluation on two public retinal fundus datasets demonstrates that deep feature-based methods consistently outperform handcrafted feature-based methods, while the proposed attention-enhanced framework achieves the best overall performance. Furthermore, Grad-CAM visualizations confirm that the proposed model focuses on clinically relevant retinal regions, providing interpretable evidence on the model's prediction process.

Progress in AI-based retinal image analysis has accelerated with the adoption of foundation models, yet evaluating their real-world reliability remains challenging. Performance reported on a single dataset does not capture how models behave under dataset shift, across clinical definitions, or for different patient subgroups. This limitation is particularly critical in medical imaging, where robustness, calibration, and fairness are essential for safe deployment. We introduce FOCUS (Foundation Ophthalmic Cross-Dataset Understanding under Shift), a cross-dataset benchmark evaluating retinal fundus models across vision-only encoder models (VM), vision-language dual-encoder models (VLM), and multimodal large language models (MLLM). FOCUS harmonizes binary diabetic retinopathy, referable diabetic retinopathy, and glaucomatous optic neuropathy tasks across ten public datasets spanning diverse geographies, acquisition conditions, and label protocols. The benchmark evaluates models through a unified analysis layer that measures ranking performance, calibration, subgroup disparities, and image-quality robustness. We present a large-scale evaluation covering 532 base configurations and 228 MLLM configurations adapted via LoRA fine-tuning. Results show no model family consistently dominates across tasks and datasets: general VM encoders achieve the strongest average ranking performance, medical MLLMs are competitive but variable, and dual-encoder VLMs benefit substantially from lightweight adaptation. Fine-tuning improves in-domain performance but exhibits heterogeneous transfer to external datasets, particularly in calibration. FOCUS provides a practical framework and public benchmark to assess generalization, reliability, and robustness beyond single-dataset leaderboards.