Augmentation Strategy for DINO in Glaucoma Classification

Despite the growing number of public datasets, annotated medical images remain scarce. Supervised learning methods achieve strong performance on many benchmarks, however require large amounts of labeled data, which are costly and time-consuming to obtain in the medical domain. To address this limitation, contrastive self-supervised learning (SSL) has emerged as a promising alternative for learning useful representations from unlabeled data. In this work, we investigate two SSL frameworks, SimSiam and SimCLR, for retinal disease classification from fundus images. We focus on understanding how augmentation strategies and training parameters influence representation learning under resource-constrained settings. Given limited data and computational capacity, we explore the feasibility of training SSL models with small batch sizes incorporated with retinal-specific augmentation techniques. Through a series of experiments, we assess the quality of learned representations via linear evaluation and fine-tuning across downstream tasks, including multi-disease classification and diabetic retinopathy grading. Our results show that tailoring augmentation strategies to the characteristics of retinal images plays a critical role in improving performance. Even under constrained settings, lightweight SSL frameworks can learn transferable representations that reduce dependence on large annotated datasets and achieve competitive results.

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.

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.