TAPE: A two-stage parameter-efficient adaptation framework for foundation models in OCT-OCTA analysis

Retinal vessel segmentation in multi-domain deployment requires a source model to adapt to domains that differ in imaging conditions and annotation conventions. Conventional parameter-efficient fine-tuning reduces target-specific storage, but its highly restricted adaptation subspace can be insufficient for reconstructing thin, connected vascular structures. We therefore ask how target-specific capacity should be allocated so that topology-aware supervision remains effective under a strict per-domain parameter budget. Based on this principle, we propose TAPDecoderFT, a topology-responsive, role-structured adaptation framework. Specifically, TAPDecoderFT shares a fixed source parameter state across deployment domains, uses low-rank residuals for target-specific private/fusion feature mixing, and retains a trainable dense-reconstruction path comprising the decoder, output head, and refinement module. To promote structurally faithful predictions, the compact target state is jointly optimized with a region-overlap and topology-aware objective that encourages centerline continuity and thin-branch recovery. It improves both DSC and clDice over GenericLoRA-r4 and narrow TAP-r4 in all six directions and is comparable to full fine-tuning.

Optical Coherence Tomography (OCT) has become one of the most used imaging modality in ophthalmology. It provides high-resolution, non-invasive visualization of retinal microarchitecture. The automated analysis of OCT images through representation learning has emerged as a central research frontier. This has mainly been driven by the clinical need to process large acquisition volumes. The objective is to reduce the reliance on expert annotation, and improve diagnostic consistency across devices and populations. This survey provides a comprehensive and structured review of representation learning methods for retinal OCT image analysis. It covers the period from early deep learning approaches to the most recent developments in foundation models and vision-language systems. We organize the literature along a principled taxonomy of learning paradigms, encompassing supervised learning with CNN-based and transformer-based architectures, self-supervised and semi-supervised methods, generative approaches, as well as 3D volumetric modeling, multimodal representation learning, and large-scale pretrained foundation models. For each paradigm, we analyze the core methodological contributions, identify persistent limitations, and trace the connections between successive approaches. We further provide a structured overview of publicly available OCT datasets, discuss evaluation protocol considerations, and present a unified problem formulation that situates each learning paradigm within a common mathematical framework. Building on this analysis, we identify and discuss the most pressing open research directions emerging in the literature. This includes volumetric foundation model pretraining, uncertainty-aware representation learning, federated and privacy-preserving training, fairness and bias mitigation, concept-based interpretability,...

The advent of vision foundation models, notably the Segment Anything Model (SAM), has catalyzed significant advancements in natural image segmentation. However, their direct transfer to medical imaging remains severely bottlenecked by profound domain gaps, such as cross-modality and cross-center shifts. Existing Parameter-Efficient Fine-Tuning (PEFT) methods facilitate the adaptation of SAM to medical domains; nevertheless, they frequently suffer from performance degradation under severe distribution shifts. This vulnerability primarily stems from the implicit entanglement of heterogeneous frequency components within a shared low-rank subspace, which directly exacerbates sub-optimal structural alignment and localized boundary blurring. To overcome this representational bottleneck, we propose the Fourier-Adaptive Nonlinear Low-Rank Adaptor (FAN-LoRA), a novel frequency-decoupled fine-tuning architecture. FAN-LoRA explicitly separates the optimization space by employing a B-spline-driven low-pass branch for global structural alignment, synergistically coupled with a discrete Fourier high-pass branch for local textural compensation. Extensive experiments across three challenging cross-modality and cross-center benchmarks demonstrate that FAN-LoRA consistently outperforms state-of-the-art PEFT baselines. Compared to the strongest competitors, our method achieves consistent improvements in average Dice scores and notable reductions in boundary errors, while maintaining a compact module size without compromising computational efficiency.