Triple-Phase Multimodal Knowledge Aggregation Framework for Microbial Keratitis Subtype Diagnosis on Slit-Lamp Photography
Authors: Yiqing Wang, Maria A. Woodward, Ziyun Yang, N. Venkatesh Prajna, Chunming He, Leslie M. Niziol, Mercy Pawar, Ming-Chen Lu, +6 more
Organizations: Department of Biomedical Engineering, Duke University, Durham, NC, USA. · Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA. · Department of Cornea and Refractive Surgery Services, Aravind Eye Care System, Madurai, Tamil Nadu, India. · Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA. · Flaum Eye Institute, Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA. · Department of Ophthalmology, Henry Ford Hospital, Detroit, MI, USA. · Duke Eye Center, Duke University School of Medicine, Durham, NC, USA.
Abstract
Microbial keratitis requires rapid pathogen identification to guide treatment, but culture- and PCR-based diagnostics are slow and resource-intensive. We developed a triple-phase multimodal framework for bacterial-versus-fungal keratitis classification using slit-lamp photographs acquired under blue-light, sclerotic-scatter, and white-light illumination, together with clinical metadata. The model combines cross-modality contrastive learning, modality-specific fine-tuning, and feature-level multimodal ensemble learning for patient-level prediction. We evaluated the framework on a multicenter dataset of 1,645 patients and 17,158 images from India and the United States. The model achieved 85.84% accuracy, 84.46% average F1-score, and 0.885 AUC. Site-specific evaluation showed that pooled results were overly optimistic, whereas resampling- and balance-based re-evaluation provided a more realistic assessment of cross-site generalization. Under all settings, our framework remained the top-performing approach. The code is available at https://github.com/yqwang01/TPMKA and dataset access will be provided subject to University of Michigan data-sharing clearance.
Despite significant progress in Multi-modal Large Language Models (MLLMs), their clinical reasoning capacity for multi-modal diagnosis remains largely unexamined. Current benchmarks, mostly single-modality data, can't evaluate progressive reasoning and cross-modal integration essential for clinical practice. We introduce the Cross-Modality Progressive Clinical Reasoning (X-PCR) benchmark, the first comprehensive evaluation of MLLMs through a complete ophthalmology diagnostic workflow, with two reasoning tasks: 1) a six-stage progressive reasoning chain spanning image quality assessment to clinical decision-making, and 2) a cross-modality reasoning task integrating six imaging modalities. The benchmark comprises 26,415 images and 177,868 expert-verified VQA pairs curated from 51 public datasets, covering 52 ophthalmic diseases. Evaluation of 21 MLLMs reveals critical gaps in progressive reasoning and cross-modal integration. Dataset and code: https://github.com/CVI-SZU/X-PCR.
Optical microscopy enables rapid, label-free imaging of live bacteria and is the standard instrument for species identification across clinical, environmental, and industrial microbiology. Yet field samples are routinely polymicrobial and may contain organisms that were never seen during system training, and no computer-vision benchmark tests multi-label species identification from phase-contrast microscopy (PCM) of such mixtures. We introduce Phase-contrast Optical bEnchmark for Bacterial Identification (PHOEBI), a wet-lab-prepared dataset of 120,000 PCM images covering 40 combinations of six rod-shaped species, paired with a leave-combinations-out (LCO) evaluation protocol that holds out entire species combinations to mirror the practical scenario of a model trained on catalogued mixtures that must generalise to unseen ones. On LCO, every gradient-trained per-image aggregator we test drops 0.39 to 0.57 F1 from the in-distribution to the held-out split, a systematic open-world recognition failure in the aggregator, not the visual representation. A linear probe of thirteen different encoders over the same features spreads only about six percentage points of F1 across general-purpose and biomedical pretraining objectives, confirming the representation is sound. We propose three lightweight anchor-based decoders that capture per-species presence geometrically over a shared frozen tile-feature pool, scoring higher on held-out combinations than on in-distribution validation.
Skin lesion classification plays an important role in supporting the early diagnosis of skin cancer. However, automated analysis remains challenging due to class imbalance, inter-class similarity, and intra-class variability in dermoscopic images. This paper proposes a multimodal classification framework that combines Swin Transformer-based image features with structured clinical metadata to improve diagnostic performance through integrated visual-context learning. Experiments on a publicly available dataset show that the proposed model achieves a test accuracy of 92.55% and a macro F1-score of 91.33%, with strong performance across minority classes. Temperature scaling is applied as a post-hoc calibration method, resulting in a reduction in expected calibration error and improving prediction reliability, while uncertainty estimation is incorporated to further assess the confidence of model predictions. Qualitative explainability analysis further shows that the model focuses on lesion regions during inference. Therefore, the results demonstrate that multimodal fusion, combined with calibration and interpretability analysis, provides an effective and trustworthy approach for automated skin lesion classification.