Longitudinal Retinal Vascular Remodeling in Myopic Children Treated with Orthokeratology or Defocus Lenses: A Two-Year Comparative Study

Spherical Equivalent Refraction (SER) and Axial Length (AL) are core indicators for pediatric myopia screening, yet their measurements require dedicated biometry and cycloplegic refraction. Fundus photography offers an accessible imaging modality, as myopia-related posterior-pole changes are visible in 45$^\circ$ fundus images. However, these cues are often low-contrast, spatially diffuse, and multi-scale. Moreover, AL, Sphere (SPH), and Cylinder (CYL) share partially overlapping but non-identical anatomical correlates. We propose SpecF2M, a spectral-aware multi-task network for estimating AL and SER components from pediatric fundus photographs. SpecF2M integrates a deterministic anatomy-guided enhancement module, a hybrid spatial--spectral backbone combining MixCNN and Hybrid Spectral Learning (HSL) blocks, and an expert-routing head for component-level estimation of AL, SPH, and CYL. On a pediatric cohort of 4,359 eligible child visits and 6,966 fundus images, SpecF2M outperforms controlled CNN/ViT baselines for AL and SPH estimation, achieving MAEs of 0.5347 mm and 0.7062 D, respectively. Component-level analysis further reveals asymmetric task coupling, where CYL exhibits weaker association with fundus-derived myopic patterns than AL/SPH. These results support fundus-based, screening-oriented estimation of pediatric myopia indicators, while external validation remains necessary before deployment.

Long-term visual acuity (VA) outcomes after anti-VEGF therapy are central to patient counseling, expectation setting, and follow-up planning in diabetic macular edema (DME). However, in clinical practice, physicians must often estimate long-term visual trajectories based only on early post-treatment findings, making reliable prognostication difficult. Although prior OCT-based learning approaches have largely focused on short-term response or single-endpoint prediction, modeling VA trajectories across multiple future time points from early longitudinal observations remains insufficiently explored. In this study, we assembled a real-world cohort of 188 anti-VEGF--treated DME patients with paired baseline and month-1 OCT scans, along with tabular OCT-derived biomarkers and non-imaging clinical variables. Using only these early data, we formulate a multi-horizon VA forecasting problem aimed at predicting visual outcomes at 3, 6, 12, 18, and 24 months, reflecting clinically meaningful follow-up intervals. We propose ReVA, a response-aware multimodal framework that integrates structural features from baseline and month-1 OCT with the tabular variables to capture baseline disease status and early treatment response. ReVA uses spatial attention to preserve localized prognostic imaging features and a dependency-aware tabular encoder to model interactions among clinical variables. These multimodal representations are fused to predict patient-specific long-term visual acuity trajectories. The proposed framework achieves MAE $=0.1246$, RMSE $=0.1621$, and $R^2=0.6064$ for 24-month VA prediction, with consistent performance across all forecast horizons. Our findings show that incorporating early treatment-response signals enables clinically meaningful long-term visual acuity forecasting, supporting data-driven decision support for routine anti-VEGF management.

Automatic extraction of retinal vascular biomarkers from color fundus images (CFI) is crucial for large-scale studies of the retinal vasculature. We present VascX, an open-source Python toolbox that extracts biomarkers from CFI artery-vein segmentations. VascX starts from vessel segmentation masks, extracts their skeletons, builds undirected and directed vessel graphs, and resolves vessel segments into longer vessels. A comprehensive set of biomarkers is derived, including vascular density, central retinal equivalents (CREs), and tortuosity. Spatially localized biomarkers may be calculated over grids placed relative to the fovea and optic disc. VascX is released via GitHub and PyPI with comprehensive documentation and examples. Our test-retest reproducibility analysis on repeat imaging of the same eye by different devices shows that most VascX biomarkers have moderate to excellent agreement (ICC > 0.5), with important differences in the level of robustness of different biomarkers. Our analyses of biomarker sensitivity to image perturbations and heuristic parameter values support these differences and further characterize VascX biomarkers. Ultimately, VascX provides an explainable and easily modifiable feature-extraction toolbox that complements segmentation to produce reliable retinal vascular biomarkers. Our graph-based biomarker computation stages support reproducible, region-aware measurements suited for large-scale clinical and epidemiological research. By enabling easy extraction of existing biomarkers and rapid experimentation with new ones, VascX supports oculomics research. Its robustness and computational efficiency facilitate scalable deployment in large databases, while open-source distribution lowers barriers to adoption for ophthalmic researchers and clinicians.