FairEnc: A Fair Vision-Language Model with Fair Vision and Text Encoders for Glaucoma Detection

Vision-language models (VLMs) are increasingly used to make decisions from visual inputs. We introduce FAIRLENS, a benchmark and evaluation framework for measuring both the fairness and the validity of VLM responses in three high-stakes domains: hiring, legal, and healthcare. FAIRLENS pairs real face images spanning gender, race, and age groups with closed- and open-ended questions, giving more than 100K image-question pairs per model, and evaluates responses from four complementary views: demographic parity over adverse outcome rates, soundness, demographic association over unsupported roles and statuses, and bias in free-text generation. Soundness is the central validity criterion: a response is sound when it follows the evidence stated in the question and abstains when the image cannot support an answer. Evaluating eight VLMs, we find that the primary failure is unwarranted inference rather than unequal treatment. Models routinely infer qualifications, threat, illness, or professional role from a face instead of abstaining, and the weakest model does so on 99% of the questions its input cannot answer. These failures are most severe in legal and healthcare, where recognizing insufficient evidence matters most, and disparity metrics alone would miss them: parity gaps are small in absolute terms, yet when baseline adverse rates are low the same gap means one demographic group receives adverse labels several times as often as another, and a small gap can equally reflect a model that treats every group unsafely. Bias in free-text responses is only loosely coupled to multiple-choice accuracy, so correct structured answers do not imply safe generation. FAIRLENS shows that fair high-stakes VLM behavior requires similar treatment across groups and refusal to infer high-stakes attributes from appearance, and its question suite transfers to any face corpus with demographic annotations.

This paper presents FairNVT, a lightweight debiasing framework for pretrained transformer-based encoders that improves both representation and prediction level fairness while preserving task accuracy. Unlike many existing debiasing approaches that address these notions separately, we argue they are inherently connected: suppressing sensitive information at the representation level can facilitate fairer predictions. Our approach learns task-relevant and sensitive embeddings via lightweight adapters, applies calibrated Gaussian noise to the sensitive embedding, and fuses it with the task representation. Together with orthogonality constraints and fairness regularization, these components jointly reduce sensitive-attribute leakage in the learned embeddings and encourage fairer downstream predictions. The framework is compatible with a wide range of pretrained transformer encoders. Across three datasets spanning vision and language, FairNVT reduces sensitive-attribute attacker accuracy, improves demographic-parity and equalized-odds metrics, and maintains high task performance.

The integration of medical imaging and clinical text has enabled the emergence of generalist artificial intelligence (AI) systems for healthcare. However, pervasive biases, such as imbalanced disease prevalence, skewed anatomical region distributions, heterogeneous imaging protocols, and demographic disparities, pose significant challenges to the fairness and reliability of vision-language systems in real-world clinical settings. Here we present BiasCareVL, a bias-aware multimodal learning framework that introduces bias control directly into model design, rather than treating it as a post hoc correction. BiasCareVL incorporates adaptive uncertainty modeling with optional human-in-the-loop refinement to regulate the influence of dominant data patterns and to promote equitable reasoning under distributional imbalance. Trained on 3.44 million samples spanning over 15 imaging modalities, the framework supports diverse clinical tasks, including visual question answering, disease classification, segmentation, and report generation within a unified representation space. Across eight public benchmarks covering dermatology, oncology, radiology, and pathology, BiasCareVL consistently outperforms 20 state-of-the-art methods, with pronounced gains in clinically challenging scenarios, including over 10% accuracy improvement in multi-class skin lesion diagnosis and more than 20% Dice improvement in small tumor segmentation. Furthermore, BiasCareVL achieves diagnostic performance exceeding human accuracy with substantially reduced time requirements when evaluated with board-certified radiologists. By open-sourcing BiasCareVL, we aim to promote a transparent, reproducible, and equitable future for AI in healthcare, paving the way for general-purpose, trustworthy, and clinically reliable AI systems.