Disentangling Co-Occurring Retinal Pathologies with Saliency-Guided Sparse Expert Routing

AI models for multimodal medical imaging must balance modality-specific specialization with cross-modal shared representations, a trade-off that pure Mixture-of-Experts (MoE) architectures currently fail to satisfy. Expert-based routing improves in-domain learning but may sacrifice cross-modal signals, which appear particularly important for rare (low-prevalence) pathologies in our experiments. To resolve this, we introduce Generalist-Specialist-MoE (GS-MoE), a two-branch (MoE) architecture that couples a cross-modal generalist model with distinct modality-specific specialists (experts) via domain-constrained feature fusion. On RadImageNet (1.35M images, 165 pathologies, three modalities), GS-MoE recovers detection of six low-prevalence pathologies on which every baseline scores F1 $=$ 0, with per-class gains up to +0.60 F1. It attains this while even slightly exceeding dense and specialist-only MoE aggregate baselines (MCC 0.770), while using ${\sim}53\%$ fewer active parameters at inference than the strongest investigated dense model.

Mixture-of-Experts (MoE) networks promise favorable accuracy-compute trade-offs, yet practical vision deployments are hindered by expert collapse and limited end-to-end efficiency gains. We study when sparse top-$k$ routing with hard capacity constraints helps in vision classification, evaluated under multi-seed protocols on four benchmarks (CIFAR-10/100, Tiny-ImageNet, ImageNet-1K). We observe a \emph{compute-leverage pattern}: positive accuracy gaps require a substantial fraction $ρ$ of total FLOPs to be routed; at ImageNet scale this is necessary but not sufficient, as multi-expert routing ($k \geq 2$) is additionally required. Two controlled experiments isolate these factors. A hidden-size sweep on CIFAR-10 yields both predicted sign reversals across standard and depthwise backbones, ruling out backbone family as the active variable. An ImageNet-1K ablation that varies only top-$k$ -- holding architecture, initialization, and $ρ$ fixed -- reverses the gap from positive to negative across all five seeds. A per-sample variant of Soft MoE that softmaxes over experts rather than the batch rescues CIFAR-100 above the dense baseline, identifying batch-axis dispatch as the dominant failure mode in per-sample CNN settings. Code and aggregate results: https://github.com/libophd/sparse-moe-vision-rho.

Foundation models are used to extract transferable representations from large amounts of unlabeled data, typically via self-supervised learning (SSL). However, many of these models rely on architectures that offer limited interpretability, a critical issue in high-stakes domains such as medical imaging. We propose \model, a foundation model that is interpretable-by-design via a BagNet backbone whose small receptive fields generate class evidence maps that are faithful to the model's decision-making process. Additionally, \model{} incorporates a $2D$ projection layer during pretraining that enables direct visualization of the representation space, providing a dataset-level view of the learned structure including meaningful clinical clusters as well as potential spurious correlations. We trained \model{} on over 800,000 color fundus photographs from various sources to learn generalizable representations for different downstream tasks. Our model achieves performance comparable to RETFound, which has $16\times$ more parameters, while providing interpretable predictions on out-of-distribution data. These results suggest that large-scale SSL pretraining paired with inherent interpretability can lead to robust representations for retinal imaging. Code and pretrained models are available at \href{https://anonymous.4open.science/r/dual-ifm-3D5A/README.md}{www.anonymous.4open.science/dual-IFM}.