Two for One: Privileged Learning for Resource-Constrained Screening

Color fundus photography (CFP) is the mainstay of large-scale retinal screening, but its diagnostic capacity is limited by the lack of depth-resolved structure, which optical coherence tomography (OCT) provides yet is less accessible at population scale. We present EyeMVP, a cross-modal retinal foundation model that uses paired CFP--OCT pretraining to learn OCT-informed CFP representations while requiring only CFP at inference. Pretrained on 674,893 same-eye same-day CFP--OCT triples from 112,642 patients across eight hospitals, EyeMVP uses cross-modal masked reconstruction to enrich CFP features with OCT-associated supervision, and combines source-constrained cross-attention with CFP-derived structural masks to accommodate the non-aligned geometry of en-face CFP and cross-sectional OCT. Across 15 dataset-level settings spanning classification and segmentation, under both full-data and few-shot regimes, EyeMVP performs on par with or better than representative retinal foundation models, with consistent gains on macular and optic-nerve tasks; it attains AUROCs of 0.923 for macular edema and 0.867 for myopic macular schisis, two conditions poorly resolved in CFP. In an exploratory reader study, EyeMVP surpasses junior and intermediate ophthalmologists but not seniors on macular edema, while exceeding all groups on myopic macular schisis. These results indicate that cross-modal reconstruction can enrich CFP representations with OCT-associated supervision, offering a practical route to stronger CFP-based screening.

Purpose: Early screening for eye diseases is critical in low- and middle-income countries where access to care is limited. We investigate whether a confidence-guided, multi-image diabetic retinopathy diagnosis framework can integrate image filtering with confidence-aware predictions for reliable screening at capture. Methods: We develop a multi-image fusion method that aggregates retinal views to improve confidence and balanced accuracy. Our method uses confidence to identify unreliable predictions, prompting retakes when needed. We compare: (1) a cascaded image-quality and disease diagnosis pipeline using a single image per patient, (2) confidence-based prediction, and (3) our confidence-based multi-image fusion pipeline. All methods are evaluated using a RETFoundGreen backbone on the mBRSET (n = 1,234) and BRSET (n = 7,599) datasets. Results: At 70% coverage, our method achieves 91% balanced accuracy on mBRSET and 97% on BRSET, improvements of ~12% and ~6%, respectively, over cascade filtering. The image-quality cascade reaches sensitivities of 61% on mBRSET and 86% on BRSET, whereas our framework reaches 94% and 96%, respectively, at 50% coverage. Conclusions: Human-annotated quality labels are weakly associated with diagnostic performance, and confidence-based filtering consistently outperforms image quality-based cascaded pipelines. Translational Relevance: Using confidence-based multi-image fusion, patients receive more reliable predictions, reducing incorrect diagnoses during screening. The lightweight backbone and single inference pass per image make the framework compatible with low-latency mobile screening systems in resource-limited settings.

Retinal diseases remain among the leading preventable causes of visual impairment worldwide. Automated screening based on fundus image analysis has the potential to expand access to early detection, particularly in underserved populations. This paper presents a reproducible deep learning pipeline for binary retinal disease risk classification from publicly available fundus photographs. We implement and compare a baseline convolutional neural network with a transfer learning approach using a pretrained VGG16 backbone and evaluate generalization on held-out data. To address class imbalance, we apply class weighting and report standard classification metrics including accuracy, precision, recall, F1-score, confusion matrices, and ROC-AUC. The VGG16 transfer learning model achieves 90.8% test accuracy with a weighted F1-score of 0.90, substantially outperforming the baseline CNN (83.1% accuracy). Results indicate that transfer learning improves discrimination compared to a baseline CNN, while also revealing remaining challenges in sensitivity to minority disease cases. We discuss practical limitations related to dataset characteristics, class imbalance, and threshold selection, and provide guidance for reproducibility and future improvements for clinically reliable screening