Diabetic Retinopathy Grading

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Aug 8, 2026cs.CV

PARAGraph: Pathology-Anatomy-Aware Hierarchical Graph for Diabetic Retinopathy Grading

Diabetic retinopathy (DR) remains a leading cause of vision loss among working-age adults worldwide, making reliable severity grading clinically important. Despite strong performance, most deep models formulate DR grading as image-level classification and do not explicitly model clinically grounded evidence, such as lesion types and spatial relations. In this paper, we propose PARAGraph, a Pathology-Anatomy-Aware Hierarchical Graph framework for DR grading. PARAGraph represents each image as a three-level hierarchical graph with lesion-level nodes, intermediate category and region nodes, and global anatomical and semantic nodes. To incorporate medical priors into nodes, we construct an optic disc-fovea-anchored coordinate frame that provides a scale- and rotation-normalized retinal reference system. Within this frame, lesion nodes are encoded with category, normalized area, and anatomical coordinates. To mitigate noisy lesion segmentation, PARAGraph uses a dual-fusion strategy that introduces global visual context into a graph semantic node and a decision-level prediction branch, improving robustness when lesion evidence is unreliable. Extensive experiments on Messidor-2, APTOS, and DDR show that PARAGraph achieves consistent DR grading performance over state-of-the-art methods. Interpretability and robustness analyses further demonstrate that its predictions are clinically grounded, closely associated with lesion evidence and robust to lesion segmentation noise.

Ziyang Zhang, Yuankai Huo, Yalin Zheng +1

Vanderbilt University, USA · University of Liverpool, UK

Graph Neural Networks Diabetic Retinopathy Grading Medical Image Classification Explainable Medical Image Analysis

Aug 1, 2026cs.CV

Representation Transfer of Foundation Models for Ultra-Widefield Retinal Imaging

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

Institute of Ophthalmology, University College London, London, United Kingdom · Wake Forest University School of Medicine, Winston-Salem, NC, USA · Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Blacksburg, VA, USA +5

Medical Imaging Foundation Models Diabetic Retinopathy Grading Vision Foundation Model Adaptation

Jul 28, 2026cs.LG

OrthKD: Extracting Generalized Clinical Knowledge from Heterogeneous Teachers for Lightweight Deployment

Deploying diabetic retinopathy (DR) screening models in primary care requires edge-efficient systems that remain accurate, safe, and reliable under domain shift. Multi-teacher knowledge distillation (KD) is a natural compression strategy, but existing approaches largely assume that all teachers provide equally trustworthy supervision. In our setting, this assumption fails: a strong CNN teacher (EfficientNet-B3, 0.876 QWK) and a weaker Transformer teacher (Swin-Base, 0.830 QWK) are complementary, yet the Transformer's logits can still mislead the student. We therefore propose OrthKD, a selective-trust distillation framework that transfers full supervision from the strong CNN, uses feature-only distillation from the weak ViT, and enforces orthogonality between teacher-specific student projections to encourage complementary rather than redundant evidence. This design preserves local lesion precision, injects global structural context, and improves robustness to distribution shift. On 132,049 retinal images, a 5.4M-parameter MobileNetV3 student reaches 0.885 QWK on EyePACS and improves zero-shot Messidor-2 performance from 0.507 to 0.728 QWK, while also achieving strong referral AUC and calibration. These results show that selectively distilling heterogeneous teachers can enable practical DR screening on resource-constrained devices.

Yi Xu, Cheng Chen, Mufan Cao

Tongji University, Shanghai, China

Diabetic Retinopathy Grading Selective Knowledge Distillation Cross-Architecture Knowledge Distillation Multi-Teacher Knowledge Distillation Knowledge Distillation Cross-Dataset Generalization+1

Jul 22, 2026eess.IV

PRISM-DR: Per-lesion Retinal Inference with Specialist Models for Diabetic Retinopathy

Diabetic retinopathy is a leading cause of preventable blindness; its early lesions are small, low contrast, and easily missed in manual screening. Most automated detectors handle the four non-proliferative DR lesions: microaneurysms, hemorrhages, hard exudates, and soft exudates, with a single multi-class model, even though these lesions differ sharply in size, color, morphology, and prevalence, so a shared model favors common, easy classes over rare, difficult ones. We present PRISM-DR, a lesion-specific pipeline that trains one single-class detector per lesion, each with its own configuration. From a raw fundus image, the pipeline applies region of interest cropping, fundus-specific preprocessing, four parallel YOLO detectors, tiling, per-lesion ensembling of five cross-validation folds, and an inter-lesion suppression step that resolves overlaps by physical lesion size and clinical priority rather than confidence. Per lesion, the best of five YOLO generations is selected, and augmentation is tuned by Bayesian optimization. Trained on IDRiD with stratified five-fold cross-validation, the system reaches a test mAP50 of 0.527 and F1 of 0.529, highest AP50 on hard exudates with 0.561. Without fine-tuning, the models transfer well where the imaging scale is close to IDRiD and degrade as field of view and resolution depart. These modest absolute results reflect a small single-source training set and a difficult task; however, treating each lesion as a separate detection problem is a practical alternative to a single multi-class model.

Zübeyr Özeren, Tansel Uyar

Department of Biomedical Engineering, Baskent University, Ankara, Türkiye · Department of Biomedical Engineering, Ankara University, Ankara, Türkiye

Diabetic Retinopathy Grading Medical Image Anomaly Detection Object Detection

Jul 6, 2026cs.CV

Causal-RetiGraph: Cross-Cohort Retinal Support and Same-Subject Pathway Analysis for Diabetic Retinopathy

Diabetic retinopathy (DR) is a local retinal lesion process and a visible manifestation of systemic microvascular injury. Modern retinal AI can grade images accurately, but often leaves unanswered how local lesion evidence, retinal vascular structure, and systemic disease pathways are connected. This paper introduces \emph{Causal-RetiGraph}, a compact biomedical informatics framework that links retinal graph phenotypes with NHANES-anchored pathway modelling. The retinal-image fold constructs an interpretable

X1234

phenotype from vessel maps, lesion evidence, image embeddings, and AutoMorph biomarkers through spatial

X_{12}

and Jacobian

X_{34}

branches. The NHANES fold models systemic exposures, covariates, a same-subject retinal mediator family

R^*

, and downstream outcome families.

X1234

is used for retinal support and pathway prioritisation, while

R^*

is used for participant-level pathway summaries. On the retinal fold,

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achieves 0.9055 binary DR accuracy and 0.9711 AUROC, with graded DR QWK of 0.8312. The results show that lesion and biomarker streams improve contextual retinal representation under scarce and imbalanced data. In NHANES, HbA1c, urine albumin, pulse pressure, fasting glucose, and systolic blood pressure are the strongest binary DR anchors. Participant-level pathway analysis identifies glycaemic--renal and glycaemic--haemodynamic pathways as the clearest mediator-style signals. These results suggest that retinal graph phenotypes can help prioritise systemic pathways in DR while preserving the distinction between image-derived support and same-subject mediation.

Inam Ullah, Imran Razzak, Shoaib Jameel

University of Southampton Southampton, United Kingdom · Mohamed bin Zayed University of Artificial Intelligence United Arab Emirates

Causal Mediation Analysis Diabetic Retinopathy Grading Explainable Medical Image Analysis Multimodal Graph Learning Causal Inference

Jul 4, 2026eess.IV

Cross-Modal Fusion of OCT and OCT angiography enface for Improved Diagnostics of Diabetic Retinopathy

Diabetic retinopathy (DR) is a leading cause of vision impairment worldwide, highlighting the need for accurate and accessible screening tools. Optical Coherence Tomography (OCT) provides high-resolution structural information of the retina, whereas OCT angiography (OCTA) offers complementary vascular information that is highly relevant for DR diagnosis. In this study, we propose a cross-modal fusion of OCT B-scans with single-channel en face OCTA using a bidirectional cross-modal attention network for automated DR classification. Two independent datasets, OCT500 and UIC, comprising 730 subjects in total, were utilized to evaluate performance under within-dataset, combined-dataset, and cross-dataset generalization settings. A ConvNeXt V2 model trained solely on OCT images served as the unimodal baseline. In addition to ground-truth (GT) OCTA, we explored the use of translated (TR) OCTA generated from OCT scans, eliminating the requirement for dedicated OCTA hardware. Experimental results demonstrate that cross-modal fusion consistently outperforms unimodal OCT classification across all evaluation scenarios. Fusion with GT OCTA improved classification accuracy and discriminative performance, while TR OCTA achieved comparable or superior results in most settings. Furthermore, TR OCTA improved sensitivity and cross-dataset generalization, indicating enhanced robustness to domain shifts. These findings demonstrate that attention-based OCT-OCTA en face fusion provides clinically meaningful improvements for DR detection and suggest that computationally generated OCTA can serve as a practical, low-cost alternative to hardware-acquired OCTA, enabling broader deployment of high-performance retinal screening systems in resource-limited clinical environments.

Rashadul Hasan Badhon, Atalie Carina Thompson, Jennifer I. Lim +2

Diabetic Retinopathy Grading Optical Coherence Tomography Cross-Modal Attention Multimodal Fusion

Jul 3, 2026eess.IV

Model Confidence-Guided Multi-Image Fusion of Fundus Images for Diabetic Retinopathy Diagnosis

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.

Ananya Raghu, Anisha Raghu, Alice S. Tang +3

Massachusetts Institute of Technology, Cambridge, MA, USA · Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA · Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University, Baltimore, MD, USA +3

Multi-Source Image Fusion Selective Prediction Diabetic Retinopathy Grading Fundus Imaging

Jun 30, 2026cs.CV

Uncertainty-Aware Last-Layer Adaptation of RETFound for Referable Diabetic Retinopathy Screening Under Dataset Shift

This paper presents a safety-centered empirical evaluation of uncertainty-aware last-layer adaptation for referable diabetic retinopathy screening using RETFound, a self-supervised vision-transformer retinal foundation model used here as a frozen feature encoder, and the public APTOS 2019 and DDR diabetic retinopathy fundus image datasets. We compare a cached-feature softmax head, post-hoc temperature scaling, variational Bayesian last-layer heads, a diagonal Laplace last-layer approximation, and an SNGP-style cached-feature head. On APTOS, uncertainty-aware operating points improved sensitivity and selective-referral behavior. The strongest APTOS selective-referral result deferred approximately 20 percent of cases and reduced accepted-case false negatives to zero while preserving high accepted-case specificity. However, threshold tuning also reduced false negatives at high false-positive cost, so false-negative reduction alone was not unique to Bayesian modeling. On DDR, native Bayesian heads qualitatively reproduced the APTOS direction but with weaker tradeoffs, while the APTOS-trained SNGP checkpoint transferred poorly and failed to provide useful external selective-referral behavior. These results highlight the value of safety-centered evaluation beyond aggregate accuracy: uncertainty-aware last-layer heads can improve internal safety-oriented operating points, but trustworthy retinal screening claims require explicit safety-coverage evaluation and second-dataset validation under shift.

Karim Mardhani

University of Colorado Boulder Boulder, CO, USA

Bayesian Neural Networks Distribution Shift Robustness Selective Prediction Diabetic Retinopathy Grading Vision Foundation Model Adaptation

Jun 23, 2026eess.IV

A Dual Edge Spatial Jacobian Image Graph for Interpretable Diabetic Retinopathy Grading

Automated diabetic retinopathy (DR) grading from colour fundus photographs can achieve strong predictive performance, but clinical interpretation requires more than an image-level label. It requires understanding how lesion evidence is distributed around retinal vessels and how this evidence relates to quantitative vascular biomarkers. We present a dual-edge spatial-Jacobian image graph for interpretable DR grading. Each fundus image is represented as a graph node with four aligned evidence streams: AutoMorph vessel information (

X_1

), DR-XAI-style lesion evidence maps (

X_2

), a 128-dimensional lesion-based contrastive image embedding (

X_3

), and AutoMorph morphometric biomarkers (

X_4

). The spatial edge branch (

X_{12}

) encodes vessel-lesion geometry, while the Jacobian branch (

X_{34}

) models embedding-biomarker sensitivity. Lightweight two-token attention fuses both edge families into a final image graph. On 2,910 matched non-augmented APTOS images, the full graph achieves 0.8076 accuracy, 0.8312 quadratic weighted kappa, 0.5915 macro-F1, and 0.9330 adjacent-grade accuracy; referable DR reaches 0.9055 accuracy and 0.9711 AUROC. The framework is positioned as an explainable representation-learning tool for lesion-biomarker hypothesis generation, rather than as a deployment-ready clinical classifier. The code is available at https://github.com/Inamullah-Colab/dual-edge-dr-graph-xai.

Inam Ullah, Imran Razzak, Shoaib Jameel

University of Southampton Southampton, United Kingdom · Mohamed bin Zayed University of Artificial Intelligence Abu Dhabi, United Arab Emirates

Graph Representation Learning Diabetic Retinopathy Grading Fundus Imaging Explainable Medical Image Analysis Medical Image Representation Learning

May 13, 2026cs.CV

Bridging the Rural Healthcare Gap: A Cascaded Edge-Cloud Architecture for Automated Retinal Screening

Diabetic Retinopathy (DR) is one of the leading causes of preventable blindness, yet rural regions often lack the specialists and infrastructure needed for early detection. Although cloud-based deep learning systems offer high accuracy, they face significant challenges in these settings due to high latency, limited bandwidth, and high data transmission costs. To address these challenges, we propose a two-tier edge-cloud cascade on the public APTOS 2019 Blindness Detection dataset. Tier 1 runs a lightweight MobileNetV3-small model on a local clinic device to perform a binary triage between Referable DR (Classes 2-4) and Non-referable DR (Classes 0-1). Tier 2 runs a RETFoundDINOv2 model in the cloud for ordinal severity grading, but only on the subset of images flagged as referable by Tier 1. On a stratified APTOS test split of 733 images, Tier 1 reaches 98.99% sensitivity and 84.37% specificity at a validation-tuned high-sensitivity threshold. The default cascade forwards 49.52% of test images to Tier 2, reducing cloud calls by 50.48% relative to using a cloud-based model for all images. In the deployed 4-class output space (Class 0-1 / Class 2 / Class 3 / Class 4), the cascade obtains 80.49% accuracy and 0.8167 quadratic weighted kappa; the cloud-only baseline obtains 80.76% accuracy and 0.8184 quadratic weighted kappa. On APTOS, the cascade cuts cloud use by about half with a modest drop in grading performance. Index Terms: Diabetic Retinopathy, Edge-Cloud Cascade, MobileNetV3-small, RETFound-DINOv2, Retinal Screening, tele-ophthalmology

Nishi Doshi, Shrey Shah

University of Southern California · Los Angeles, USA

Diabetic Retinopathy Grading Edge-Cloud Computing On-Device Inference

May 12, 2026cs.CV

Diabetic Retinopathy Classification using Downscaling Algorithms and Deep Learning

Diabetic Retinopathy (DR) is an art and science of recording and classifying the retinal images of a diabetic patient. DR classification deals with classifying retinal fundus image into five stages on the basis of severity of diabetes. One of the major issue faced while dealing with DR classification problem is the large and varying size of images. In this paper we propose and explore the use of several downscaling algorithms before feeding the image data to a Deep Learning Network for classification. For improving training and testing; we amalgamate two datasets: Kaggle and Indian Diabetic Retinopathy Image Dataset. Our experiments have been performed on a novel Multi Channel Inception V3 architecture with a unique self crafted preprocessing phase. We report results of proposed approach using accuracy, specificity and sensitivity, which outperform the previous state of the art methods. Index Terms: Diabetic Retinopathy, Downscaling Algorithms, Multichannel CNN Architecture, Deep Learning

Nishi Doshi, Urvi Oza, Pankaj Kumar

Diabetic Retinopathy Grading Convolutional Neural Networks

May 10, 2026eess.IV

Cross-Modal Semantic-Enhanced Diffusion Framework for Diabetic Retinopathy Grading

Automated grading of diabetic retinopathy (DR) faces several critical challenges: subtle inter-grade visual distinctions in fine-grained lesion patterns, distributional discrepancies induced by heterogeneous imaging devices and acquisition conditions, and the inherent inability of purely visual approaches to exploit clinical semantic knowledge. In this paper, we propose CLIP-Guided Semantic Diffusion (CGSD), a DR grading framework that synergistically integrates vision-language pretraining with diffusion probabilistic modeling. We adopt a domain-specific vision-language model tailored for DR grading as the semantic guidance module and adapt it to the target domain via Low-Rank Adaptation (LoRA), effectively bridging the distributional gap between the pretrained model and the target dataset with only a minimal number of trainable parameters. Building on this foundation, we construct a cross-modal semantic conditioning vector by computing the dot product between image features and the text description features of each DR grade, yielding a joint representation that simultaneously encodes visual content and clinical-grade semantics. This vector serves as the conditioning signal for the diffusion denoising network, replacing the structurally complex dual-branch visual prior employed in existing diffusion-based classification methods. Experiments on the APTOS 2019 dataset demonstrate that the proposed approach achieves an accuracy of 87.5% and a macro-averaged F1 score of 0.731, outperforming a variety of representative methods. Ablation studies further validate the independent contribution of each constituent module.

Yiqun Wang

Beijing Jiaotong University · School of Software Engineering Beijing Jiaotong University Beijing, China

Diabetic Retinopathy Grading Medical VLMs Image Classification Multimodal Diffusion Models

May 8, 2026eess.IV

FQPDR: Federated Quantum Neural Network for Privacy-preserving Early Detection of Diabetic Retinopathy

Diabetic Retinopathy (DR) is a common complication of diabetes that can lead to blindness of people. Detecting DR at the earliest stage is essential to prevent irreversible eye damage. Microaneurysm dots are the first signs of DR. As the dots are tiny and of low contrast, detecting mild DR is a very challenging task. Federated learning (FL) preserves data privacy, which is a major concern for medical image processing. FL is a collaborative learning method, which shares only the model parameters with a server, without sharing the patient data to a central server. Inspired by classical FL, we propose a federated learning-based quantum neural network (federated QNN) for this task. We implemented the models with limited samples and few learnable parameters from the E-ophtha and Retina MNIST datasets. The crossevaluation efficiency of the proposed federated quantum neural network system for privacy-preserving early detection of diabetic retinopathy (FQPDR) in Kaggle dataset images indicates the robustness of the light weight learning models. FQPDR performances are inspiring while considering existing non-FL and FL methods.

Debashis De, Mahua Nandy Pal, Dipankar Hazra

Department of Computer Science and Engineering, Maulana Abul Kalam Azad University of Technology, West Bengal · Department of Computer Science and Engineering, MCKV Institute of Engineering, West Bengal · Department of Computer Science and Engineering, OmDayal Group of Institutions, West Bengal

Diabetic Retinopathy Grading Quantum Machine Learning Privacy-Preserving ML Quantum Neural Networks Federated Learning

May 7, 2026cs.CV

Retina-RAG: Retrieval-Augmented Vision-Language Modeling for Joint Retinal Diagnosis and Clinical Report Generation

Diabetic Retinopathy (DR) is a leading cause of preventable blindness among working-age adults worldwide, yet most automated screening systems are limited to image-level classification and lack clinically structured reporting. We propose Retina-RAG, a low-cost modular framework that jointly performs DR severity grading, macular edema (ME) detection, and report generation. The architecture decouples a high-performance retinal classifier and a parameter-efficient vision-language model (Qwen2.5-VL-7B-Instruct) adapted via Low-Rank Adaptation (LoRA), enabling flexible component integration. A retrieval-augmented generation (RAG) module injects curated ophthalmic knowledge together with structured classifier outputs at inference time to improve diagnostic consistency and reduce hallucinations. Retina-RAG achieves an F1-score of 0.731 for DR grading and 0.948 for ME detection, substantially outperforming zero-shot Qwen (0.096, 0.732) and MMed-RAG (0.541, 0.641) on a retinal disease detection dataset with captions. For report generation, Retina-RAG attains ROUGE-L 0.438 and SBERT similarity 0.884, exceeding all baselines. The full framework operates on a single consumer-grade GPU, demonstrating that clinically structured retinal AI can be achieved with modest computational resources.

Abdelrahman Zaian, Sheethal Bhat, Mohamed Abdalkader +1

Friedrich-Alexander-Universität, Germany

Multimodal RAG Medical Report Generation Medical Image Analysis Diabetic Retinopathy Grading Medical VLMs

Apr 25, 2026cs.CV

From Pixels to Explanations: Interpretable Diabetic Retinopathy Grading with CNN-Transformer Ensembles, Visual Explainability and Vision-Language Models

The quality of diabetic retinopathy (DR) screening relies on the ability to correctly grade severity; however, many deep-learning (DL) classifiers cannot be easily interpreted in the clinical context. This study presents a methodology that combines strong discriminative models with multimodal explanations, converting retinal pixels into clinically interpretable outputs. Using the APTOS 2019 benchmark, we evaluated six representative CNN- and transformer-based backbones under a controlled protocol with stratified five-fold cross-validation. We then compared ensembling strategies (hard voting, weighted soft voting, stacking) and investigated a hybrid class-level fusion variant to exploit grade-specific advantages. For interpretability, we produced Grad-CAM++ visual attribution maps and short textual rationales using vision-language models (VLMs) conditioned on the fundus image and classifier outputs under conservative prompting constraints. Modern CNN backbones (ResNet-50 and ConvNeXt-Tiny) provided the strongest single-model baselines, with cross-validated QWK up to 0.919 and 0.914, respectively. Ensembling improved ordinal agreement, and weighted soft voting was the most consistent across folds (QWK 0.934 +/- 0.017). Hybrid class-level fusion was competitive but did not yield a statistically reliable improvement over standard fusion in paired fold comparisons (Holm-adjusted p >= 1.000). For explanation quality, Grad-CAM++ offered plausible but coarse localization, and VLM rationales were generally grade-consistent. Quantitatively, VLM variants showed a trade-off between clinical completeness and template-level semantic similarity (coverage 0.700 vs. BERTScore 0.072), while image-text alignment was comparable (CLIPScore approximately 0.34).

Pir Bakhsh Khokhar, Carmine Gravino, Fabio Palomba +2

Department of Informatics, University of Salerno, Via Giovanni Paolo II, 132, Fisciano, 84084, Salerno, Italy · Department of Information Security and Communication Technology (IIK), Norwegian University of Science and Technology, Gjøvik, 2815, Norway

Diabetic Retinopathy Grading Deep Ensembles Explainable Medical Image Analysis

Apr 19, 2026cs.CV

Robust Diabetic Retinopathy Grading Using Dual-Resolution Attention-Based Deep Learning with Ordinal Regression

Diabetic retinopathy (DR) is a leading cause of vision impairment worldwide, and automated grading systems play a crucial role in large-scale screening programs. However, deep learning models often exhibit degraded performance when deployed across datasets acquired under different imaging conditions. This study presents a robust dual-resolution deep learning framework for DR grading that integrates attention-based feature fusion with ordinal regression to improve cross-dataset generalization. The proposed method employs two parallel EfficientNet backbones operating at different spatial resolutions to capture complementary retinal features. A learnable attention mechanism adaptively fuses multi-resolution representations, while an ordinal regression formulation based on the cumulative link model (CORAL) explicitly accounts for the ordered nature of DR severity levels. To mitigate domain discrepancies between datasets, a preprocessing strategy combining circular cropping, contrast enhancement, and histogram matching is applied. The model was trained on the APTOS 2019 dataset and evaluated on both an internal validation split and an external Messidor-2 test set. Experimental results demonstrate strong grading performance, achieving a quadratic weighted kappa (QWK) of 0.88 on the APTOS validation set and 0.68 on the unseen Messidor-2 dataset, indicating improved robustness for cross-dataset DR grading applications.

Afshan Hashmi

Tuwaiq Academy, Tuwaiq Research and Development Centre, Riyadh, Saudi Arabia

Diabetic Retinopathy Grading Multi-Scale Feature Fusion Cross-Dataset Generalization

Feb 23, 2025cs.CV

Interpretable Retinal Disease Prediction Using Biology-Informed Heterogeneous Graph Representations

Interpretability is crucial for utilizing machine learning models as clinical decision support tools for medical diagnostics. However, most state-of-the-art image classifiers based on neural networks are not interpretable. As a result, clinicians often resort to known biomarkers to guide diagnosis, although biomarker-based classification often suffers from drastic information loss compared to raw medical images. This work proposes a method that preserves the rich imaging information while simultaneously enhancing the interpretability of predictions for diabetic retinopathy staging from optical coherence tomography angiography (OCTA) images. The core contribution of our method is a novel biology-informed heterogeneous graph representation that models retinal vessel segments, intercapillary areas, and the foveal avascular zone (FAZ) in a human-interpretable way. This graph representation allows us to frame diabetic retinopathy staging as a graph-level classification task, which we solve using an established, efficient graph neural network architecture. We compare our method against established methods, including classical biomarker-based classifiers, convolutional neural networks (CNNs), and vision transformers in predicting the clinically assigned DR stage based on color fundus photography images. We find stage agreement rates of our method and alternative vision model based classifiers saturating at AUC-ROC values of 84%. Crucially, we use our biology-informed graph to provide explanations of great detail. Our approach surpasses existing methods in precisely localizing and identifying abnormal vessels and non-perfusion areas. Our approach sets the stage for the interpretable identification of patients who require special attention due to their traceable microvascular changes, only observable using the details of OCTA images.

Laurin Lux, Alexander H. Berger, Maria Romeo Tricas +8

Munich Center for Machine Learning (MCML), Munich, Germany · School of Medicine and Health, TUM University Hospital, Munich, Germany · School of Computation, Information and Technology, TUM, Munich, Germany

Medical Imaging Diabetic Retinopathy Grading Explainable Medical Image Analysis