Automated grading of conjunctival photographs could reduce the cost and variability of trachoma prevalence surveys, but the relative value of modern pretrained visual representations, lightweight feature adaptation, and training-objective design has not been established under a common protocol. This study presents a controlled evaluation for binary classification of Trachomatous Inflammation-Follicular (TF) versus Normal using 1,546 images from the public UCSF/Lietman collection. Images are processed using the OPTED pipeline for zero-shot tarsal-conjunctiva segmentation, alignment, cropping, and standardization. We first compare six pretrained backbones using a common classification pipeline and then evaluate four lightweight adaptation mechanisms on DINOv2 ViT-B/14. Under stratified five-fold cross-validation, DINOv2 with Efficient Channel Attention (ECA) and focal-plus-center loss achieved 91.66 +/- 0.97% accuracy, 90.69 +/- 1.10% macro-F1, and 96.06 +/- 0.71% AUC. ECA introduces only five learnable parameters while matching the performance of substantially larger alternatives. Objective ablation further showed that ECA did not consistently improve plain DINOv2 across loss functions; the lowest-variance 91.66% accuracy was obtained with cross-entropy plus center loss. Overall, the fine-tuned DINOv2 representation provided most of the predictive performance, while ECA offered a highly parameter-efficient refinement whose effect depended on the training objective. The resulting workflow provides a reproducible benchmark for active trachoma image classification.
The tortuosity of corneal nerve fibers are used as indication for different diseases. Current state-of-the-art methods for grading the tortuosity heavily rely on expensive segmentation maps of these nerve fibers. In this paper, we demonstrate that self-supervised pretrained features from ImageNet are transferable to the domain of in vivo confocal microscopy. We show that DINO should not be disregarded as a deep learning model for medical imaging, although it was superseded by two later versions. After careful fine-tuning, DINO improves upon the state-of-the-art in terms of accuracy (84,25%) and sensitivity (77,97%). Our fine-tuned model focuses on the key morphological elements in grading without the use of segmentation maps.
Despite the widespread adoption of foundation models as feature extractors for medical imaging, relatively little is understood about how different pretraining strategies influence the transferability of learned representations to weakly supervised ophthalmic imaging tasks. We investigate this question in ultra-widefield (UWF) retinal imaging by evaluating foundation model representations within a patch-based multiple instance learning (MIL) framework for disease classification on UWF images. We compare Vision Transformer encoders pretrained with supervised, Masked Autoencoder (MAE), and self-distillation objectives, while keeping the downstream aggregation architecture unchanged. Within a controlled comparison of ViT-B encoders pretrained on ImageNet-1k, the choice of pretraining objective substantially influenced frozen representation transfer, with supervised and self-distillation-based models outperforming MAE. A contemporary DINOv3 model pretrained at a larger scale achieved the strongest overall performance, with a quadratic weighted kappa of 0.863 for five-class diabetic retinopathy grading, comparable with DINOv1. Attention analysis further revealed distinct patch-aggregation behaviours associated with the different pretrained representations, while partial fine-tuning substantially reduced the performance gap for MAE. These findings suggest that pretraining strategy influences both representation transferability and the subsequent aggregation of patch-level evidence within MIL, resulting in differences in downstream classification performance.
Mingya Alexa Gong, Da Ma, Lovre Antonio Budimir +7
Temporomandibular joint osteoarthritis (TMJ OA) is a prevalent degenerative condition whose osseous changes are often subtle on cone-beam CT (CBCT), making automated detection challenging. We study how well the DINO family of self-supervised vision transformers -- DINOv1, DINOv2, DINOv2+reg, and RAD-DINO (a radiology-pretrained variant) -- transfers to CBCT, asking how much backbone adaptation is needed and of what kind. We propose a simple slice-based pipeline using Vision Transformer (ViT) backbones: axial CBCT slices are encoded per-slice by a frozen or partially adapted ViT and aggregated via attention-based multiple instance learning (MIL) for patient-level binary OA/Normal classification. Through systematic ablation across unfreezing strategies and aggregation designs on a multi-source CBCT dataset, we find that partial unfreezing of the final two transformer blocks is the decisive factor, improving AUC from 0.671 (fully frozen DINOv2) to 0.902. This outperforms DINOv1 (0.867), DINOv2+reg (0.774), and a supervised ImageNet ViT-B/16 baseline (0.843). Our results provide practical guidance for adapting DINO-family foundation models in low-data medical imaging settings, showing that adaptation strategy is a stronger driver of performance than backbone choice alone.