PC-Seg: Progressive Cross-View Consistency for 3D OCT Segmentation from Sparse 2D Annotations

Reliable automated analysis of Optical Coherence Tomography (OCT) imaging is crucial for diagnosing retinal disorders but faces a critical barrier: the need for expensive, labor-intensive expert annotations. Supervised deep learning models struggle to generalize across diverse pathologies, imaging devices, and patient populations due to their restricted vocabulary of annotated abnormalities. We propose an unsupervised anomaly detection framework that learns the normative distribution of healthy retinal anatomy without lesion annotations, directly addressing annotation efficiency challenges in clinical deployment. Our approach leverages a discrete latent model trained on normal B-scans to capture OCT-specific structural patterns. To enhance clinical robustness, we incorporate retinal layer-aware supervision and structured triplet learning to separate healthy from pathological representations, improving model reliability across varied imaging conditions. During inference, anomalies are detected and localized via reconstruction discrepancies, enabling both image and pixel-level identification without requiring disease-specific labels. On the Kermany dataset (AUROC: 0.799), our method substantially outperforms VAE, VQVAE, VQGAN, and f-AnoGAN baselines. Critically, cross-dataset evaluation on Srinivasan achieves AUROC 0.884 with superior generalization, demonstrating robust domain adaptation. On the external RETOUCH benchmark, unsupervised anomaly segmentation achieves competitive Dice (0.200) and mIoU (0.117) scores, validating reproducibility across institutions.

Medical image segmentation models typically rely on large amounts of densely annotated volumetric data, limiting their scalability across tasks and imaging modalities. This work addresses the challenge of predicting entire 3D anatomical structures from extreme annotation sparsity. An annotation-efficient student-teacher framework is proposed for automatic 3D medical segmentation that requires only a set of point prompts on a single 2D slice per volume, as input. A foundation model serves as an offline teacher, utilizing the provided point prompts from the selected slice to full-volume pseudo-annotations alongside their corresponding spatial confidence scores prior to student training. To mitigate the error propagation of noisy pseudo-annotations, a task-specific 3D student network is trained using a confidence-aware optimization strategy. By leveraging the teacher's pre-computed confidence scores, this strategy explicitly excludes statically uncertain regions of the pseudo-annotations from the loss calculation, while simultaneously emphasizing regions with higher confidence. Evaluated on 3D cardiac MRI datasets, our framework outperforms state-of-the-art semi-supervised methods, improving segmentation performance by up to 43.6%. Furthermore, it drastically reduces the manual annotation burden to just a few positive point prompts per volume, while improving surface boundary precision by up to 14.7% over the teacher and successfully recovering up to 34.1% of the performance gap toward the fully supervised upper bound.

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,...