Ophthalmic Image Analysis

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42 papers5 papers in the last four weeks, up 25% on the four weeks before. 0.0% of all new papers.

Oct 15, 2026

CF-NODE: Counterfactual Spatial Node Intervention for Test-Time Adaptation Under Domain Shift, Evaluated Across Five Diabetic Retinopathy Datasets

Automated fundus-based diabetic retinopathy (DR) grading can substantially expand screening capacity, but source-trained models degrade sharply across different cameras, clinics, and patient populations. Existing test-time adaptation methods depend on entropy minimization or target information accumulated from image batches and streams. These mechanisms can reinforce confidently incorrect predictions and break down when clinical images arrive independently. We introduce CF-NODE, a novel counterfactual test-time adaptation framework for cross- domain DR grading. Instead of trusting prediction confidence or estimating a target distribution, CF-NODE asks how each prediction responds under a controlled intervention on the evidence supporting it. CF-NODE ranks internal spatial nodes using model-derived attention, feature magnitude, and node-set similarity, progressively attenuates the highest-ranked nodes, and uses the stability of the resulting expected-grade response to apply a bounded calibration of the predicted grade distribution. The framework is fully frozen and adapts every image independently using only geometric views and a fixed source-derived prior, requiring no target-derived information or model updates. We evaluate CF-NODE on five external DR datasets under repeated-seed evaluation against TENT, EATA, SAR, and T3A. CF-NODE outperforms all four methods with statistically significant improvements over the second-best method, improves AUC on every target domain, and attains the highest average AUC and macro-F1, delivering stronger grade discrimination together with more balanced recognition across DR severity levels. These results demonstrate that counterfactual intervention sensitivity provides consistent and deployment-ready domain robustness for single-image clinical inference.

Sabarish G, Deepak Parashar

Test-Time Adaptation Diabetic Retinopathy Grading Ophthalmic Image Analysis

Sep 27, 2026

FOCUS: Benchmarking Retinal Model Generalization from Foundation Vision Encoders to Multimodal LLMs

Progress in AI-based retinal image analysis has advanced with foundation models, yet evaluating their reliability remains challenging. Performance reported on a single dataset does not capture how models behave under dataset shift, across clinical definitions, or for different patient subgroups. This limitation is particularly critical in medical imaging analysis, where robustness, calibration, and fairness are essential for safe deployment. We introduce FOCUS (Foundation Ophthalmic Cross-Dataset Understanding under Shift), a cross-dataset benchmark for evaluating retinal fundus models that considers vision-only encoder models (VM), vision-language dual-encoder models (VLM), and multimodal large language models (MLLM). FOCUS harmonizes binary diabetic retinopathy, referable diabetic retinopathy, and glaucomatous optic neuropathy tasks across ten public datasets spanning diverse geographies, acquisition conditions, and label protocols. The benchmark evaluates models through a unified analysis layer that measures ranking performance, calibration, subgroup disparities, and image-quality robustness. We present a large-scale evaluation covering 532 base configurations and 228 MLLM configurations adapted through supervised fine-tuning with low-rank adaptation (LoRA). Results show that no model family consistently dominates across tasks and datasets: general VM encoders achieve the strongest average ranking performance, medical MLLMs are competitive but variable, and dual encoder VLMs benefit substantially from lightweight adaptation. Fine-tuning improves in-domain performance but exhibits heterogeneous transfer to external datasets, particularly in calibration. These findings demonstrate that retinal model evaluation is inherently multidimensional. FOCUS provides a practical framework and public benchmark to assess generalization, reliability, and robustness beyond single-dataset leaderboards

David Restrepo, Chenwei Wu, Luis Filipe Nakayama +4

CentraleSupélec, Université Paris-Saclay, France · Cancer Data Science Unit, IHU PRISM, Université Paris-Saclay, CentraleSupélec, Gustave Roussy, INSERM, France · University of Michigan, USA +4

Fairness in Medical Image Classification Ophthalmic Image Analysis Medical Image Analysis Cross-Dataset Generalization Medical Image Benchmarks Medical Image Classification+2

Sep 26, 2026

Learning When to Recur: Token-Adaptive Recursion for Imbalanced Ophthalmic Domain Incremental Learning

Domain incremental learning is essential for adapting ophthalmic deep learning models to sequential clinical domains while preserving diagnostic expertise. Existing domain incremental learning methods predominantly address the domain shift induced by style variations. However, they often overlook the severe class imbalance inherent in real-world clinical scenarios, such as clinical referral systems. Institutions in these systems encounter drastic fluctuations in class priors, resulting in label distribution shift, a critical form of domain shift that triggers severe catastrophic forgetting. To address these challenges, we propose ToRe, a rehearsal-free and parameter-efficient framework that leverages frozen ophthalmic foundation models for robust incremental adaptation. ToRe employs a parameter isolation strategy to decouple domain-specific optimization paths, thereby helping mitigate catastrophic forgetting driven by both label distribution shift and style variations. Simultaneously, it introduces token-adaptive recursion that adaptively allocates additional computational depth across tokens, allowing simple tokens to exit the recursion loop early while subjecting complex tokens, such as those associated with lesions, to deeper recursive processing. This mechanism enhances the feature representations for minority classes, thereby supporting generalization throughout the domain incremental learning process. Extensive evaluations on nine heterogeneous datasets demonstrate that ToRe consistently outperforms state-of-the-art methods in overall performance across the three benchmarks, while maintaining near-zero forgetting. Together, these results support the applicability of ToRe to dynamic and imbalanced clinical environments. The code is available at https://github.com/Nancyolo/ToRe

Nanxi Yu, Kang Li, Ye Du +3

School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, Sichuan, China · Department of Biomedical Engineering and Sports Technology, The Hong Kong Polytechnic University, Hong Kong SAR, China · School of Future Technology, South China University of Technology, Guangdong, China +1

Ophthalmic Image Analysis Domain-Incremental Learning Medical Image Analysis Class-Imbalanced Learning Vision Foundation Model Adaptation Conditional Computation

Sep 26, 2026

EyeVQA: Benchmarking Ophthalmic Vision-Language Models from Recognition to Spatial Grounding

Vision-language models (VLMs) have shown increasing potential for medical image understanding, yet their capabilities in ophthalmic imaging remain insufficiently characterized. Existing ophthalmic datasets are typically designed for individual diseases or specialized tasks, making it difficult to systematically evaluate whether VLMs can move beyond disease recognition toward comparative reasoning and fine-grained spatial grounding. We introduce EyeVQA, a unified visual question answering benchmark for comprehensive evaluation of ophthalmic VLMs. EyeVQA is constructed from 21 available ophthalmic datasets and contains 20,000 question-answer pairs spanning six disease groups and seven question types: Single-Choice, Multi-Select, Variable-Select, True-False, Ranking, Point Location, and Bounding Box. Gold answers are deterministically derived from source-provided diagnoses, severity grades, clinical findings, segmentation masks, bounding boxes, and anatomical landmarks, enabling reproducible evaluation without relying on model-generated annotations. Notably, 44.5% of the questions require reasoning across multiple images, extending evaluation beyond conventional single-image medical VQA. We benchmark fourteen representative general-purpose, scientific, and medically specialized VLMs under a unified zero-shot protocol. The best-performing model only achieves an overall score of 62.8, while substantial gaps remain in spatial grounding and cross-task generalization. These results highlight the limitations of current VLMs in comprehensive ophthalmic visual understanding and establish EyeVQA as a diagnostic benchmark for developing more reliable and spatially grounded ophthalmic multimodal models. The project page is available at https://github.com/PKUTHM/EyeVQA.

Gujie Shao, Zixun Xie, Xuechun Xing +7

VLM Evaluation Medical VQA Vision-Language Grounding Medical Image Benchmarks Ophthalmic Image Analysis

Sep 22, 2026

Interpretable AI plus Handheld, Portable Retinal Photographs: A Low-Cost Glaucoma Screening Solution for West Africa

Purpose: To develop and evaluate an interpretable artificial intelligence (AI) framework for glaucoma screening from low-cost portable, handheld retinal fundus photographs in a West African population and to compare its performance with clinical tabletop fundus imaging. Methods: We used data from a community-based study of 681 participants (1,362 eyes) in Nigeria, comprising 414 glaucoma, 478 glaucoma suspect, and 470 non-glaucoma eyes. Fundus photographs were acquired using the low-cost handheld, portable Volk Viva retinal camera and the Canon CR-2-AF tabletop camera. We fine-tuned component models separately to each device to perform vessel segmentation, cup and disc boundary segmentation, and feature extraction to detect optic nerve head features. A final classification model combined these components to classify scans as glaucoma, glaucoma suspect or non-glaucoma. Feature-weight analysis and Gradient-weighted Class Activation Mapping were used for interpretation. Results: The models performed well on both Volk Viva and Canon CR-2-AF images: Vessel segmentation: 0.98 Dice Coefficient (DC) (Volk) and 0.94 DC (Canon); Cup and disc segmentation: 0.95 DC (Volk) and 0.96 DC (Canon); Optic nerve head feature detection: area under the receiver operating characteristic curve (AUCs) of 0.83

\pm

0.03 (Volk) and 0.87

\pm

0.04 (Canon); Classification model: AUCs of 0.85

\pm

0.01 (Volk) and 0.93

\pm

0.01 (Canon). Reports for each image, present model decision confidence scores and decision-rationale visualizations to support clinical interpretation. Conclusions: Volk Viva results were reasonably comparable to Canon CR-2-AF in the component models and not far behind in classification. This shows that interpretable AI combined with low-cost, portable imaging may enhance community-level glaucoma screening, especially in settings with limited specialist access and resources.

Charis Y. N. Chiang, Tarela Sarimiye, Adeyinka Ashaye +4

Department of Ophthalmology, Emory University, Atlanta, Georgia, United States · Department of Biomedical Engineering, National University of Singapore, Singapore · Singapore Eye Research Institute, Singapore National Eye Centre, Singapore +5

Fundus Imaging Medical Diagnosis Medical Image Segmentation Glaucoma Detection Explainable Medical Image Analysis Optic Disc Segmentation+1

Aug 31, 2026

Multimodal Shared Latent Representation of Narration, Microscope and iOCT Images for Phase Recognition in Vitreoretinal Surgery

Surgical phase recognition is key to context-aware computer-assisted feedback in vitreoretinal procedures, yet the scarcity of synchronized multimodal intraoperative data, particularly microscope views and intraoperative OCT, limits approaches that aim to replicate the multimodal integration surgeons perform naturally. Surgical narration, by contrast, is abundantly available online and offers rich semantic supervision. Prior work has mainly explored pairwise contrastive learning (e.g., intraoperative OCT-microscope or microscope-narration), leaving the joint modeling of all three modalities largely unexplored. We introduce a framework that uses microscope views as a shared anchor to bridge surgical narrations and intraoperative OCT (iOCT) without requiring a fully synchronized tri-modal dataset, leveraging real microscope-narration videos and a synthetic dataset of synchronized microscope video and tool-aligned iOCT pairs. Contrastive alignment transfers structural priors from the synthetic domain to real videos lacking iOCT, and a dual-head MS-TCN++ integrates the resulting embeddings for joint macro- and micro-phase prediction. Evaluated on real vitreoretinal surgeries, our framework improves macro-phase recognition over a zero-shot baseline (mean F1 0.38 to 0.53) and provides an exploratory route to estimating fine-grained instrument-tissue measurements that are not directly observable in real microscope video alone; these micro-phase estimates are validated quantitatively on synthetic data and shown only qualitatively on real surgery. To our knowledge, this is the first work to unify microscope view, iOCT B-scans, and surgical narrations in a shared latent space for surgical phase recognition.

Onur Izmitlioglu, Shervin Dehghani, Tarek Ghannoum +2

Computer Aided Medical Procedures, Technical University of Munich, Germany · SynthesEyes GmbH, Munich, Germany · Department of Ophthalmology, LMU University Hospital, Munich, Germany

Surgical Video Understanding Multimodal Contrastive Learning Multimodal Fusion Ophthalmic Image Analysis

Aug 31, 2026

Co-Annotator: Expert-Distilled ViT and VLM for Visual and Documentation Guidance in Age-Related Macular Degeneration

Clinical AI often optimizes predictive performance without engaging how clinicians decide where to look and what to write. We present Co-Annotator, which distills expert gaze and dictation into two guidance components: a gaze-aligned Vision Transformer producing fixation-aligned areas of interest (AOIs), and an ontology-bounded vision-language model (VLM) that pre-fills editable biomarker summaries for retinal optical coherence tomography (OCT). We first collect expert gaze and dictations (US1) to train the models, significantly improving diagnostic accuracy and biomarker generation. We then deploy the system with ophthalmology residents: a controlled resident study (US2) confirmed each modality is safe and independently beneficial, with AOI guidance producing lasting perceptual efficiency gains through post-guidance carryover and VLM guidance more than doubling biomarker documentation breadth. In a combined deployment across two academic institutions (US3), providing both modalities simultaneously produced efficiency gains that substantially exceeded either modality alone: correct diagnoses per minute increased by 40% and comment editing time fell by 67%, without compromising diagnostic accuracy. Notably, neither modality improved efficiency during guidance in US2, which makes the in-guidance efficiency gain under combined guidance in US3 the more striking result. Expert-distilled multimodal guidance can remove two distinct clinical workflow bottlenecks at once (visual search overhead and documentation burden) without compromising the diagnostic accuracy clinicians already achieve.

Ziheng "Leo" Li, Benjamin Freeman, Akshay Raman +5

Columbia University

Medical Report Generation Medical Image Analysis Medical VLMs Ophthalmic Image Analysis

Aug 27, 2026

Automated 2D and 3D Segmentation of AMD and DME Lesions in OCT

Age-related macular degeneration (AMD) and diabetic macular edema (DME) are leading causes of vision loss, and optical coherence tomography (OCT) is the standard modality for detecting and monitoring the subtle lesions that drive treatment decisions. Most deep-learning segmentation work for OCT is validated only in-domain, leaving generalization to clinical data collected under different acquisition protocols largely untested. This work develops and systematically ablates four lesion-segmentation pipelines -- 2D and 3D variants for AMD and DME -- reaching Dice scores of 0.76 to 0.82 with strong volumetric and surface calibration (r vol, r surf greater than or equal to 0.97 across all four pipelines) on an in-domain validation set. The ablation process establishes a full-volume, calibration-aware adoption standard that catches mechanisms an ordinary slice-level evaluation would keep, and identifies ensemble composition as the most consistent driver of improvement. To test generalization, the models are evaluated on OLIVES, an external clinical cohort with no lesion-level ground truth, using a proxy-metric framework built around biomarker AUROC, central subfield thickness (CST) correlation, and longitudinal concordance. Predictions track clinical biomarkers outside the training distribution, though less strongly than in-domain -- evidence for, not validation of, automated lesion-burden tracking as a clinical tool.

Lucia Sundberg, Zhihao Zhao, M. Ali Nasseri

MAPS Lab, Technical University of Munich, Munich, Germany. · University of Wisconsin-Madison, Madison, Wisconsin, USA.

Ophthalmic Image Analysis Medical Image Segmentation 3D Medical Image Segmentation Optical Coherence Tomography Domain Generalization

Aug 25, 2026

Interpretable Fundus Image Classification via Ring-Based Retinal Vasculature Features

Retinal fundus photography is widely used for screening and monitoring ocular diseases, but many modern classification pipelines rely on deep latent representations and provide limited interpretability. This study develops an interpretable fundus image classification framework based on a ring-structured representation of the retinal vasculature centered on the optic disc. The method quantifies vessel geometry, color appearance, oxygenation-related vascular appearance, and vessel--background entropy within concentric retinal regions. These physiologically motivated descriptors are derived from vessel masks, image intensities, and optical-density measurements and aggregated across rings to capture spatial variation in vascular properties. Using only quantitative vascular descriptors, the proposed method achieved strong classification performance across three public fundus datasets. On HRF, it achieved 91.1% accuracy using automatically generated vessel masks, matching RETFound, a vision transformer pretrained on large-scale retinal fundus image data, under the same evaluation setting. Additional analyses suggest that pretrained image models are sensitive to acquisition-related spatial cues, including fundus scale and retinal position within the field of view, as well as broader non-vessel image characteristics. This framework may support interpretable disease classification, quantitative retinal phenotyping, and retinal biomarker discovery without requiring large task-specific training datasets.

Xiaoyan Li, Shixin Xu, Arvind Gupta +1

Computer Science, University of Toronto, 27 King’s College Cir., Toronto, M5S 1A1, Ontario, Canada. · Zu Chongzhi Center, Duke Kunshan University, No.8 Duke Ave., Kunshan, 215300, Jiangsu, China. · Mathematics and Statistics, York University, 4700 Keele St., Toronto, M3J 1P3, Ontario, Canada. +1

Ophthalmic Image Analysis Medical Image Classification Retinal Disease Classification Fundus Imaging Explainable Image Classification

Aug 19, 2026

OptiModNet: A UNet-Transformer Hybrid with Grouped-Query and Channel Attention for Optic Disc and Cup Segmentation

Precise segmentation of the optic disc and cup is critical for the early detection and diagnosis of glaucoma. However, achieving consistently high performance across datasets while maintaining low computational requirements remains a significant challenge. In glaucoma detection, low-computation methods are crucial for enabling rapid, large-scale screening and facilitating deployment in resource-limited clinical environments. While deep learning models such as UNets, Vision Transformers (ViTs), and Diffusion models have demonstrated strong segmentation performance but these methods often come with substantial computational overhead. UNets are efficient at capturing local features but are limited in modeling global contextual information. Conversely, ViTs excel at long-range dependency modeling but are computationally intensive. Hybrid architectures, such as UNetR, which combine transformer-based encoders with UNet-style decoders, have shown improved performance but while incurring additional complexity. Considering these, in this work, we propose OptiModNet, a light weight novel hybrid architecture tailored for optic disc and cup segmentation. The model integrates diverse attention mechanisms at multiple stages of the network to enhance both local and global feature representation. We include an Aggregated Pyramid Loss that supervises predictions at multiple decoder depths, to promote better gradient flow and structural consistency. We evaluate OptiModNet on the REFUGE2 dataset for both optic disc and cup segmentation tasks. Our method achieves state-of-the-art performance, exceeding existing approaches by over 2.5%, while maintaining high efficiency with only 3.73 GFLOPs and 1.93M parameters. The code is available at https://github.com/SG1947/OptiModNet.

Soumili Ghosh, Debapriya Roy, Aryan Das +1

IEM Saltlake,India · Techno Main Salt Lake, India · VIT Bhopal University, India +1

Optic Disc Segmentation Ophthalmic Image Analysis Medical Image Segmentation Medical Image Analysis U-Net Hybrid CNN-Transformer Architectures+1

Aug 18, 2026

Optic Disc Segmentation in Fundus Images: From Classical Image Processing and Deformable Models to Modern AI

Accurate localization and segmentation of the optic disc (OD) are important for retinal image analysis and glaucoma assessment, yet remain challenging due to variations in illumination, pathology, vascular interference, and poorly defined boundaries. This structured methodological review examines the evolution of OD segmentation from classical image-processing and deformable models to contemporary artificial intelligence (AI)-based approaches. A structured literature search and study-selection process was used to identify representative studies spanning major methodological developments. The review first summarizes commonly used fundus-image datasets, then organizes classical methods by principal mechanisms, including intensity and thresholding, histogram and entropy analysis, morphology, geometric and Hough-transform methods, filtering and feature operators, texture- and region-based approaches, and active-contour and level-set models. This paper pays particular attention to the assumptions, strengths, limitations, and complementary roles of these methods in OD localization and boundary delineation. Representative AI approaches are subsequently examined to illustrate the transition from handcrafted features and explicitly defined priors to learned representations, Transformer-based segmentation, boundary- and shape-aware learning, promptable segmentation, and retinal foundation models. Across these methodological generations, several core segmentation principles persist, including region-of-interest localization, multiscale representation, geometric and anatomical constraints, and boundary regularization, although their implementation has shifted from predefined operators to learned modules, losses, prompts, and pretrained representations. The review further identifies boundary ambiguity, anatomical variability, domain shift, and cross-dataset generalization as continuing challenges.

Buket D. Barkana

Biomedical Engineering Department, The University of Akron, Akron, OH 44325, USA

Optic Disc Segmentation Ophthalmic Image Analysis Medical Image Segmentation Fundus Imaging Medical Imaging Foundation Models

Aug 15, 2026

Beyond Natural-Image Foundation Models: Benchmarking Satellite Pretraining for Ophthalmic Image Analysis

Vision Foundation Models (VFMs) have emerged as a promising approach in medical imaging, producing broadly applicable systems that can be efficiently adapted across diverse imaging modalities, anatomical regions, and clinical tasks. However, VFMs require extensive training data, and their progress in medical image analysis is constrained by limited data availability, privacy concerns, and high development costs. To alleviate these constraints, medical VFMs (MedVFMs) are often built upon weights from generalist models pretrained on vast amounts of publicly available natural images, introducing a substantial distribution shift for medical task adaptation. To address this, we propose satellite imagery as a novel pretraining domain for MedVFM development and benchmarking, motivated by its closer visual alignment with medical data and its freedom from the privacy constraints that limit medical datasets. Across multiple ophthalmic imaging modalities, we compare DINOv3-SAT493m pretrained on 493 million satellite images against DINOv3-LVD1689m pretrained on 1.7 billion natural images, together with two medical specialist baselines: DINOv3-RETFound and MAE-RETFound. Our experiments show that satellite imagery is a stronger pretraining source than natural images for ophthalmic tasks, particularly on en face vascular-rich modalities. On several tasks, satellite pretraining matches or exceeds the medical specialists on high-resolution en face inputs, despite using no medical data.

Lovre Antonio Budimir, Mingya Alexa Gong, Alyssa Foong Quinney +5

Faculty of Electrical Engineering and Computing, University of Zagreb, HR · Medical Physics and Biomedical Engineering, University College London, UK · Institute of Ophthalmology, University College London, UK +4

Ophthalmic Image Analysis Medical Imaging Foundation Models Medical Image Analysis Vision Foundation Model Adaptation Medical Image Benchmarks

Aug 9, 2026

UPolarSQ: Polar Representation Learning for Optic Disc and Peripapillary Atrophy Segmentation and Quantification in Fundus Photographs

Myopia-induced posterior-pole remodeling is frequently accompanied by Optic Disc (OD) deformation and Peripapillary Atrophy (PPA), both of which provide clinically relevant structural biomarkers. In Cartesian fundus images, however, PPA often appears as an irregular and partially visible crescent adjacent to the OD, leading to fragmented segmentation and post-processing-dependent quantification. We propose UPolarSQ, a unified polar-domain framework for OD/PPA segmentation and biomarker quantification in myopic fundus images. UPolarSQ first maps an OD-centered region of interest into polar coordinates, where OD and PPA boundaries can be represented as radial profiles. It then employs UPolarSeg, a U-Net-based segmentation network enhanced with a Radial-Angular-Decoupled Module and boundary-aware auxiliary supervision to model anisotropic polar features and radial boundary transitions. Clinical biomarkers, including disc shape and PPA-width-related measurements, are deterministically extracted from the predicted polar masks, aligning segmentation and quantification within a shared geometric representation. Experiments on internal and external cohorts demonstrate that UPolarSQ improves OD/PPA segmentation and supports reliable polar-native biomarker estimation for myopic analysis.

Mengxian He, Yunyun sun, Ziyue Gao +3

Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China · Capital Medical University, Beijing, China

Medical Image Analysis Medical Image Segmentation Fundus Imaging Boundary-Aware Segmentation Optic Disc Segmentation Ophthalmic Image Analysis

Aug 7, 2026

An Agentic AI Framework Overcomes Fundamental Limitations of Large Language Models for Glaucoma Detection from Fundus Photography

Large language models (LLMs) show promise in medical image interpretation but suffer from hallucination, limited accuracy, and run-to-run inconsistency. We developed and validated an agentic AI framework integrating LLMs with specialized deep learning tools for glaucoma detection from fundus photography. The workflow had three steps: (1) LLM initial assessment; (2) function calling to invoke specialized tools for image quality (QAModel, FundaQ-8), glaucoma classification (SwinV2-Tiny), and optic disc/cup segmentation (SegFormer-B0); and (3) LLM reflection integrating the initial impression with tool outputs. Two LLMs (Gemini 2.5 Flash, GPT-5.4 mini) were evaluated on two public datasets (ORIGA, n=100; RIM-ONE-v3, n=100) under uncropped and cropped fields of view; all images were independently graded by a masked fellowship-trained glaucoma specialist. The agentic workflow improved classification accuracy by 16 to 47 percentage points across all conditions, reaching within 6 points of the specialist; on RIM-ONE-v3 the best configurations matched the specialist accuracy of 88%. LLM-alone approaches failed in two ways: GPT-5.4 mini showed positive bias (sensitivity 95-100%, specificity 0-5%), while Gemini 2.5 Flash varied stochastically between runs; the agentic workflow corrected both. Cup-to-disc ratio error fell 15-50% (MAE 0.156-0.228 to 0.104-0.132), and correlation with specialist grading rose from weak (r=0.12-0.39) to moderate-strong (r=0.59-0.84). Run-to-run consistency rose from near-random (kappa as low as -0.01) to near-perfect (kappa up to 0.96). Integrating LLMs with specialized tools addressed key limitations of LLM-alone approaches, including over-diagnosis and run-to-run variability. Gains held for both LLMs, suggesting generalizability across backbones, and may signal a shift from monolithic models toward orchestrated multi-agent systems in medical AI.

Jalil Jalili, Hossein Taghizad, Anuwat Jiravarnsirikul +8

Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, La Jolla, CA, USA. · Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, La Jolla, CA, USA · Department of Electrical and Computer Engineering, University of Quebec at Trois-Rivières, Trois-Rivières, QC, Canada +2

Tool-Using Vision-Language Agents Glaucoma Detection Medical Image Classification Medical Imaging Medical VLMs Fundus Imaging+1

Aug 7, 2026

SpecF2M: A Spectral-Aware Multi-task Network Estimating Axial Length and Refractive Error from Pediatric Fundus Photographs

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.

Mengxian He, Xinyue Liu, Yunyun Sun +5

The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong · Guangdong Laboratory of Machine Perception and Intelligent Computing, Shenzhen MSU-BIT University, China · Capital Medical University, China +1

Medical Imaging Multi-Task Learning Fundus Imaging Ophthalmic Image Analysis

Aug 6, 2026

Algorithmic statistics of retinal images

There has been a tremendous amount of image processing and machine learning research to measure and classify disease progression from live optical coherence tomography (OCT) imaging of the retina. The images considered here are large, complex, three-dimensional (3-D) and difficult to visualize effectively. Many current supervised machine learning approaches, e.g. neural networks, are non-metric meaning that any features or measurements generated can introduce systematic distortion that may be correlated with underlying non-meaningful physiological differences. Here we present a metric learning approach using the normalized compression distance (NCD) combined with anisotropic structure-enhancing filters to quantify and visualize the principal differences among a collection of 3-D retinal images. We validate the NCD-measured structural differences between pairs of images against the physician-measured change in visual field function, achieving a prediction error of

\sim

0.5 dB, more accurate than non-metric deep learning approaches. The normalized compression vectors (NCV) are proposed as a feature set measuring visual differences among a collection of 3-D microscopy images. The utility of the NCV for visualizing and measuring patterns of change is demonstrated for a human with moderate non-progressing glaucoma and for a non-human primate model using intraocular pressure setting manipulation. We conclude with a brief simulation of non-metric embedding features, e.g. from neural networks, introducing class-correlated statistical distortion.

Loan Huynh, Ronald Zambrano, Layton Aho +4

Department of Electrical and Computer Engineering, Drexel University, Philadelphia, PA, USA · Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA · School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA +2

Medical Imaging Longitudinal Medical Image Analysis Optical Coherence Tomography Metric Learning Ophthalmic Image Analysis

Jul 31, 2026

ReMoE: Report-Guided Mixture-of-Experts for Multimodal OCT/OCTA Anomaly Detection

Multimodal medical anomaly detection identifies samples deviating from normal patterns, where scarce abnormal cases make normality modeling from normal data practical. In retinal Optical Coherence Tomography (OCT) and OCT Angiography (OCTA) anomaly detection, existing unsupervised methods rely on visual feature distributions, reconstruction residuals, or encoder-decoder discrepancies, making anomaly scores depend on appearance-level deviations, while multimodal normality also contains semantic organization described in normal medical reports. To this end, we propose Report-Guided Mixture-of-Experts (ReMoE), which distills normal report semantics into an image-to-text prior student, builds modality-aware priors, and uses Report-Guided Modality Modulation (RMM) to modulate features through mixture-of-experts routing. Experiments on a private OCT/OCTA dataset with paired normal reports and a public OCTA500-3MM setting using a fixed normal report demonstrate state-of-the-art performance.

Zihan Nie, Qincheng Qiao, Muhao Xu +4

School of Mechanical Engineering, Shandong University, Jinan, China · 2Key Laboratory of High Efficiency and Clean Mechanical Manufacture, Shandong University, Ministry of Education, Jinan, China · 6Airdoc-Monash Research, Monash University, Clayton, VIC 3800, Australia +3

Mixture of Experts Optical Coherence Tomography Medical VLMs Multimodal Anomaly Detection Anomaly Detection Ophthalmic Image Analysis

Jul 20, 2026

From Pixel to Prognosis: Convolutional and GLCM Feature Fusion for Automated Four-Class Cataract Severity Classification

Objective: To develop a low-cost automated cataract severity classification system operating on standard consumer-grade colour photographs of the eye, without specialised ophthalmic hardware. Methods: A hybrid framework was designed that fuses deep features from a Convolutional Neural Network (CNN) with five handcrafted Grey-Level Co-occurrence Matrix (GLCM) and intensity descriptors - mean intensity, uniformity, standard deviation, contrast, and energy - extracted from a Hough-circle-localised pupil Region of Interest (ROI). A multi-class Support Vector Machine (SVM) with Radial Basis Function (RBF) kernel classifies each image into one of four severity grades: normal, immature, mature, or hypermature cataract. Results: The proposed fused system achieved 95.0% accuracy, 93.8% sensitivity, and 96.1% specificity on an ophthalmologist-labelled test set drawn from 300 images (75 per class) collected at an ophthalmology clinic, outperforming texture-only (88.5%) and CNN-only (91.3%) baselines and surpassing recently published deep learning approaches. Conclusion: The CNN-GLCM-SVM fusion framework provides competitive four-class cataract grading without GPU acceleration or specialised cameras, making it suitable for primary-care and telemedicine deployment in resource-limited settings.

K. Mithra, Prem Kumar Santhanam

Independent Researcher, Information and Communication Engineering, Scottsdale, AZ, USA · Seidenberg School of Computer Science and Information Systems, Pace University, New York City, NY, USA

Medical Image Classification Automated Grading Feature Fusion Ophthalmic Image Analysis

Jul 18, 2026

Can Multimodal Large Language Models Understand OCT?

Optical coherence tomography (OCT) imaging is essential for the diagnosis and treatment of retinal diseases. Although multimodal large language models (MLLMs) have demonstrated considerable potential in medical image analysis, existing benchmarks largely reduce OCT understanding to coarse-grained disease classification or isolated visual question answering, leaving the complete cognitive process from visual perception to clinical reasoning insufficiently evaluated. To address this limitation, we introduce OCT-Bench, a comprehensive benchmark dedicated to OCT image understanding. OCT-Bench comprises 10,076 high-quality multiple-choice questions constructed from 4,137 OCT images across seven public datasets. Following the real-world clinical interpretation workflow, we establish a hierarchical capability taxonomy consisting of 20 fine-grained tasks across three dimensions: Perception, Cognition, and Reasoning. These tasks cover a broad range of capabilities, including imaging attributes, retinal anatomy, lesion characteristics, spatial relationships, disease assessment, therapeutic decision-making, and prognostic management. We systematically evaluate 20 representative MLLMs, including proprietary models, open-source general-purpose models, and medical-domain models. Experimental results demonstrate that current models remain substantially short of reliable OCT understanding. Moreover, neither medical-domain adaptation nor increased model scale consistently improves performance across capability levels. OCT-Bench enables comprehensive and fine-grained evaluation of MLLMs, providing a foundation for identifying capability bottlenecks and advancing clinically grounded OCT understanding.

Baochen Fu, Wenzhi Deng, Baihao Jin +5

1Shandong University · 4Shandong Provincial Qianfoshan Hospital · University of Science and Technology of China +2

Medical Image Benchmarks Medical Imaging Medical Image Analysis Multimodal Large Language Models Medical VQA Optical Coherence Tomography+2

Jul 9, 2026

Uncertainty-Aware Multi-Source Retinal Fluid Segmentation in OCT

Measuring retinal fluid from optical coherence tomography (OCT) drives treatment decisions in macular disease, but manual annotation is slow and segmentation models trained on one scanner degrade on another. We present an attention-guided TransUNet that segments three fluid types across four independent OCT sources, combining a domain-adaptive normalisation scheme with an uncertainty estimate that flags unreliable pixels. The model reaches a mean fluid Dice of 0.78, and -- most usefully for clinicians -- its uncertainty is 1.34x higher exactly where expert graders disagree (p<10^-4), turning a raw segmentation map into an actionable clinical triage signal.

Animesh Kumar

Newcastle University, Newcastle upon Tyne NE1 7RU, United Kingdom

Domain Adaptation Medical Imaging Segmentation Uncertainty Estimation Multi-Source Domain Adaptation Optical Coherence Tomography Medical Image Segmentation+1

Jul 5, 2026

IRIS: An Intelligent Vision-Language System for Ocular Surface Diseases via Topic Tree and Scene-Driven VQA Generation

While Large Vision-Language Models (VLMs) demonstrate remarkable generic capabilities, their clinical reasoning in specialized domains like ocular surface diseases (OSDs) is severely hindered by a paucity of high-fidelity, multimodal instruction-tuning data. To dismantle this data bottleneck, we introduce IRIS, an Intelligent Recognition and Interaction System tailored for fine-grained OSD understanding via external eye photography. First, we curate IRIS-120K, the largest and most comprehensive OSD visual question-answering (VQA) dataset to date. Crucially, to overcome the semantic shallowness of conventional image-caption pairs, we propose a synergistic data generation paradigm to explicitly inject clinical priors. Our data engine operates via a dual-branch framework: 1) a Topic Finding Tree (TFT) that hierarchically anchors visual features to precise anatomical and pathological concepts, enforcing rigorous medical deduction logic; and 2) a Scene-driven strategy that synthesizes role-adaptive clinical dialogues to ensure pragmatic generalization. By explicitly aligning a compact 4B-parameter VLM on this structurally enriched corpus, IRIS achieves state-of-the-art performance, comprehensively outperforming both generalist and specialized medical VLMs with up to 34B parameters. Our findings underscore that structured knowledge injection profoundly prevails over sheer parameter scaling, unlocking the potential for resource-efficient, expert-level AI deployment on mobile edge devices for scalable OSD screening. Code, datasets, and model weights will be publicly released by this repo.

Hao Wei, Wenjin Qi, Dasen Dai +2

The Chinese University of Hong Kong, Shatin, Hong Kong, China · Westlake University, Xihu District, Hangzhou, Zhejiang Province, China

Visual Question Answering Vision-Language Models Medical VQA Medical VLMs Ophthalmic Image Analysis

Jun 30, 2026

Fully Automated High-Precision Segmentation of Retinal Atrophy and Ellipsoid Zone Thickness in OCT: A Reliable Tool for Real-World GA Monitoring

Geographic atrophy (GA) secondary to age-related macular degeneration (AMD) requires precise monitoring of relevant structural biomarkers to assess disease stage, progression, and treatment response. This paper presents a fully automated, deep learning-based framework for the high-precision, pixel-wise segmentation of key biomarkers in optical coherence tomography (OCT) imaging: retinal pigment epithelium (RPE) loss, ellipsoid zone (EZ) loss, and EZ thinning. The proposed pipeline uses three specialized semantic segmentation models to delineate RPE loss, EZ boundaries (including interruptions), and Bruch's membrane. To ensure robustness and generalizability, the models were developed on a diverse dataset of 298 SD-OCT volumes representing the full phenotypic spectrum of AMD (GA:222, intermediate AMD: 40, neovascular AMD: 17, healthy: 19) and validated on an independent external dataset (n=43). The comprehensive evaluation was further strengthened using additional datasets to assess repeatability, inter-reader reliability, the impact of B-scan density on measurement accuracy, and subgroup performance stratified by lesion size. Results demonstrated high segmentation accuracy (Dice RPE loss: 0.88, Dice EZ loss: 0.87, Pearson's r > 0.99). Total EZ thickness measurements exhibited a sub-pixel average deviation of 2.15

μm

, and segmentation reliability was confirmed by a strong reproducibility score (ICC > 0.98). By accurately and consistently quantifying outer photoreceptor degeneration and RPE loss, this fully automated framework provides a highly reliable tool for GA assessment in both clinical trials and routine real-world ophthalmic care.

Wolf-Dieter Vogl, Hlynur Skulason, Oliver Leingang +3

RetInSight GmbH, Vienna, Austria · Laboratory of Opthalmic Image Analysis (OPTIMA), Medical University of Vienna, Austria

Medical Imaging Optical Coherence Tomography Medical Image Segmentation Ophthalmic Image Analysis

Jun 24, 2026

FunPiQ: A New Benchmark for Pixel-Level Quality Assessment in Fundus Images

Color fundus photography (CFP) is the most common ophthalmic imaging modality for large-scale screening. However, it is highly susceptible to degradations, making robust fundus image quality assessment (FIQA) crucial. The criteria for what constitutes high-quality at the image level vary across clinical tasks, making FIQA dependent on expert knowledge. This motivated the development of automated methods and datasets. While existing datasets aim to standardize image-level quality, their criteria often differ. Furthermore, image-level labels preclude the quantitative evaluation of localized degradations, which is essential for trustworthy FIQA. We argue that pixel-level FIQA based on anatomical visibility represents a more task-agnostic, explainable approach. In this work, we introduce FunPiQ, the first FIQA benchmark to provide pixel-level quality annotations. In addition, we propose EFIQA-CP, an explainable-by-design (EBD) method that uses quality pseudo-labels based on anatomical visibility to train a CNN via Non-Negative Positive-Unlabeled learning. Extensive evaluations of classification methods with post-hoc explanations, anomaly detection methods, and EBD methods demonstrate the superior performance of the last and, particularly, of EFIQA-CP.

Pengwei Wang, José Morano, Virginia Mares +1

Institute of Artificial Intelligence, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria · Christian Doppler Lab for Artificial Intelligence in Retina, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria

Fundus Imaging Explainable Medical Image Analysis Image Quality Assessment Medical Image Benchmarks Medical Image Quality Assessment Ophthalmic Image Analysis

Jun 18, 2026

EFIQA: Explainable Fundus Image Quality Assessment via Anatomical Priors

Image quality control is vital for a wide range of downstream applications. Deep learning-based image quality assessment methods typically train classifiers on dataset-specific quality labels, inheriting two limitations: (1) generalization is tied to the labeling criteria of the training set and (2) these methods cannot provide spatial feedback on where the quality is degraded, lacking explainability. In this work, we propose EFIQA, a framework that requires no quality-related supervision and produces spatial quality maps by design. Rather than learning what is degradation" from human-annotated labels, EFIQA learns what should be there" by leveraging anatomical priors. For fundus photography, we instantiate this as a two-stage approach, by first training an unsupervised anomaly detector via masked anatomical inpainting to identify regions of missing vasculature, and then distilling this prior knowledge into a shallow adapter mapping features of a frozen foundation model to precise quality maps. External-dataset evaluation demonstrates that this label-free approach with minimal adaptation achieves better performance and explainability compared with supervised methods across benchmarks with different quality criteria, highlighting its potential for real-world applications.

Pengwei Wang, José Morano, Qian Wan +1

Institute of Artificial Intelligence, Center for Medical Data Science, Medical University of Vienna, Austria · Christian Doppler Lab for Artificial Intelligence in Retina, Medical University of Vienna, Austria

Fundus Imaging Explainable Medical Image Analysis Image Quality Assessment Medical Image Quality Assessment Ophthalmic Image Analysis

Jun 17, 2026

Test-Time Adaptation in Optical Coherence Tomography Using Trajectory-Aligned Time-Independent Flow

Optical coherence tomography (OCT) is essential in ophthalmology, but inconsistent image quality especially in low-cost devices hinders automated analysis. To address this, we introduce a flow-matching-based test-time adaptation method that generates high-quality surrogate images from noisy inputs. Typically, domain gaps between test and training data cause pixel distribution mismatches during the denoising process. We overcome this by matching the test image's histogram to synthetic reference trajectories, successfully aligning the input with expected distributions. Additionally, we remove the network's time conditioning to account for slight deviations in real-world noise distributions. Our approach achieves state-of-the-art performance in segmenting critical biomarkers for two stages of Age-related Macular Degeneration (AMD). Code is available: https://github.com/Veit21/tta-flow.

Veit Hucke, Thomas Pinetz, Gregor Reiter +2

Institute of Artificial Intelligence, Center for Medical Data Science, Medical University of Vienna, Austria · Comprehensive Center for Artificial Intelligence in Medicine, Medical University of Vienna, Austria · Department of Ophthalmology and Optometry, Medical University of Vienna, Austria +1

Image Denoising Medical Imaging Test-Time Adaptation Flow Matching Optical Coherence Tomography Medical Image Segmentation+1

Jun 13, 2026

EyeMVP: OCT-Informed Fundus Representation Learning via Paired CFP--OCT Pretraining

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.

Zhuo Deng, Ruiheng Zhang, Ziheng Zhang +23

Shenzhen International Graduate School, Tsinghua University, Shenzhen, China · Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China · Liangxiang Hospital of Beijing Fangshan District, Capital Medical University, Beijing, China +6

Medical Imaging Foundation Models Cross-Modal Representation Learning Fundus Imaging Medical Image Representation Learning Ophthalmic Image Analysis Retinal Disease Classification

Jun 3, 2026

HD-DinoMoE: A Class-Aware Hierarchical Dual Mixture-of-Experts Network for Scleral Anomaly Segmentation in Complex Acquisition Scenarios

Traditional Chinese Medicine (TCM) ocular inspection provides empirical cues for assessing scleral surface anomalies, but its clinical use remains subjective and difficult to quantify. To support intelligent and quantifiable ocular inspection, this study presents the TCM-inspired Artificial Intelligence Ocular Auxiliary Diagnosis System (TAO) and focuses on pixel-level scleral surface anomaly segmentation. For clinical and user-acquired images affected by multi-source distributional discrepancies, diverse anomaly morphologies, and scleral specular reflection (SSR), we propose HD-DinoMoE, a class-aware hierarchical dual mixture-of-experts network. HD-DinoMoE combines class-aware dual-stream DINOv3 feature fusion with class-specific multi-expert decoding to segment Vessels, Yellow and Black Spots, and Blood Spots. A three-stage backbone-frozen routing strategy stabilizes dual-backbone adaptation; Progressive Confidence Penalty (PCP) Loss reduces high-confidence false positives and segmentation leakage in SSR regions; and Class-Aware Adaptive Sample Weighting (CA-ASW) balances sample- and class-level training contributions. We further construct the Multi-label Scleral Anomaly Segmentation Dataset (ML-SASD), a new benchmark with Clinical, Wild, and Mix settings and pixel-wise annotations for three anomaly categories. On ML-SASD-Mix, HD-DinoMoE achieves a mean Dice of 72.11% and a mean Intersection-over-Union of 58.44%, while maintaining favorable boundary localization and specular-region false-positive control. It also shows competitive generalization on the Vessels subset of the public SBVPI dataset. These results indicate that HD-DinoMoE provides a feasible segmentation solution for TAO under complex acquisition scenarios. The code and data access information are available at https://github.com/FX-CMX/HD-DinoMoE.

Yinxiang Yu, Maoxiang Chu, Qi Niu +7

School of Electronic and Information Engineering, University of Science and Technology Liaoning, No.189 Qianshan Middle Road, Lishan District, Anshan, 114051, Liaoning, China

Medical Imaging Ophthalmic Image Analysis Mixture of Experts Medical Image Segmentation

May 13, 2026

Anatomy-Slot: Unsupervised Anatomical Factorization for Homologous Bilateral Reasoning in Retinal Diagnosis

Retinal diagnosis is inherently bilateral: clinicians compare homologous structures across eyes (e.g., optic disc asymmetry), yet most deep models operate on monocular representations. We investigate whether explicit structural correspondence improves diagnosis, and propose Anatomy-Slot to operationalize this hypothesis. Anatomy-Slot introduces an unsupervised anatomical bottleneck by decomposing patch tokens into a set of emergent, structurally-coherent slots that correspond to anatomical regions, then aligning these slots across eyes via bidirectional cross-attention. On ODIR-5K with

n=10

seeds, the method improves AUC by

4.2

points over a matched ViT-L baseline (95% CIs; Wilcoxon signed-rank test,

W=0

,

p=0.002

). Pairing disruption and stress testing under Gaussian noise provide controlled tests of correspondence dependence and robustness under corruption. We further report quantitative optic disc grounding on REFUGE and cross-attention localization analysis. Beyond the reported gains, these results indicate that object-centric anatomical correspondence offers a principled path toward interpretable diagnostic systems aligned with clinical bilateral comparison.

Yingzhe Ma, Xiao Yang, Yuguo Yin +1

University of Electronic Science and Technology of China · Peking University

Retinal Disease Classification Medical Image Analysis Medical Image Classification Explainable Medical Image Analysis Slot Attention Medical Image Grounding+1

May 4, 2026

Scientific Domain Knowledge Improves Vision-Language Fundus Models

Vision-language models hold considerable promise for ophthalmology, but it remains unclear which training data source best conveys expert domain knowledge. Existing ophthalmic models are trained on fixed text templates, medical reports, or general biomedical literature, sources that have never been compared under matched conditions. To include domain-specific literature in this comparison, we present PubMed-Ophtha, a hierarchical dataset with high domain density of 102,023 panels with their subcaptions from 15,842 open-access articles in PubMed Central. We then finetuned identical CLIP models on each source, using a general biomedical literature model as baseline, and found that domain-specific literature achieved the best average performance across 110 clinical tasks, reaching a mean linear probing AUROC of 88.63% ahead of medical reports (85.68%). Restricting the dataset to fundus images, to the image count of the medical report dataset, or to articles unrelated to the evaluation datasets did not reduce performance, indicating that the gains likely stem from domain density. We release the dataset, the finetuned models, and the full generation pipeline.

Verena Jasmin Hallitschke, Carsten Eickhoff, Philipp Berens

1Hertie Institute for AI in Brain Health, University of Tübingen, Tübingen, Germany · Institute for Applied Medical Informatics, University of Tübingen, Tübingen, Germany · 2Tübingen AI Center, Tübingen, Germany

Medical VLMs Healthcare Medical Diagnosis Vision-Language Pretraining Fundus Imaging Medical Image Benchmarks+1

May 4, 2026

Representation learning from OCT images

Optical Coherence Tomography (OCT) has become one of the most used imaging modality in ophthalmology. It provides high-resolution, non-invasive visualization of retinal microarchitecture. The automated analysis of OCT images through representation learning has emerged as a central research frontier. This has mainly been driven by the clinical need to process large acquisition volumes. The objective is to reduce the reliance on expert annotation, and improve diagnostic consistency across devices and populations. This survey provides a comprehensive and structured review of representation learning methods for retinal OCT image analysis. It covers the period from early deep learning approaches to the most recent developments in foundation models and vision-language systems. We organize the literature along a principled taxonomy of learning paradigms, encompassing supervised learning with CNN-based and transformer-based architectures, self-supervised and semi-supervised methods, generative approaches, as well as 3D volumetric modeling, multimodal representation learning, and large-scale pretrained foundation models. For each paradigm, we analyze the core methodological contributions, identify persistent limitations, and trace the connections between successive approaches. We further provide a structured overview of publicly available OCT datasets, discuss evaluation protocol considerations, and present a unified problem formulation that situates each learning paradigm within a common mathematical framework. Building on this analysis, we identify and discuss the most pressing open research directions emerging in the literature. This includes volumetric foundation model pretraining, uncertainty-aware representation learning, federated and privacy-preserving training, fairness and bias mitigation, concept-based interpretability,...

Hedi Tabia, Désiré Sidibé, Nawres Khlifa +6

IBISC Univ. Evry Université Paris-Saclay · University of Tunis El Manar · ESIEE Paris - Université Gustave Eiffel +2

Multimodal Learning Medical Imaging Foundation Models Medical Imaging Optical Coherence Tomography 3D Representation Learning Medical Image Representation Learning+2