Accurate medical image segmentation is often hindered by noisy labels in training data, due to the challenges of annotating medical images. Prior research works addressing noisy labels tend to make class-dependent assumptions, overlooking the pixel-dependent nature of most noisy labels. Furthermore, existing methods typically apply fixed thresholds to filter out noisy labels, risking the removal of minority classes and consequently degrading segmentation performance. To bridge these gaps, our proposed framework, Collaborative Learning with Curriculum Selection (CLCS), addresses pixel-dependent noisy labels with class imbalance. CLCS advances the existing works by i) treating noisy labels as pixel-dependent and addressing them through a collaborative learning framework, and ii) employing a curriculum dynamic thresholding approach adapting to model learning progress to select clean data samples to mitigate the class imbalance issue, and iii) applying a noise balance loss to noisy data samples to improve data utilization instead of discarding them outright. Specifically, our CLCS contains two modules: Curriculum Noisy Label Sample Selection (CNS) and Noise Balance Loss (NBL). In the CNS module, we designed a two-branch network with discrepancy loss for collaborative learning so that different feature representations of the same instance could be extracted from distinct views and used to vote the class probabilities of pixels. Besides, a curriculum dynamic threshold is adopted to select clean-label samples through probability voting. In the NBL module, instead of directly dropping the suspiciously noisy labels, we further adopt a robust loss to leverage such instances to boost the performance.

Deep learning based image enhancement models have largely improved the readability of fundus images in order to decrease the uncertainty of clinical observations and the risk of misdiagnosis. However, due to the difficulty of acquiring paired real fundus images at different qualities, most existing methods have to adopt synthetic image pairs as training data. The domain shift between the synthetic and the real images inevitably hinders the generalization of such models on clinical data. In this work, we propose an end-to-end optimized teacher-student framework to simultaneously conduct image enhancement and domain adaptation. The student network uses synthetic pairs for supervised enhancement, and regularizes the enhancement model to reduce domain-shift by enforcing teacher-student prediction consistency on the real fundus images without relying on enhanced ground-truth. Moreover, we also propose a novel multi-stage multi-attention guided enhancement network (MAGE-Net) as the backbones of our teacher and student network. Our MAGE-Net utilizes multi-stage enhancement module and retinal structure preservation module to progressively integrate the multi-scale features and simultaneously preserve the retinal structures for better fundus image quality enhancement. Comprehensive experiments on both real and synthetic datasets demonstrate that our framework outperforms the baseline approaches. Moreover, our method also benefits the downstream clinical tasks.