Community vision screening plays a crucial role in identifying individuals with vision loss and preventing avoidable blindness, particularly in rural communities where access to eye care services is limited. Currently, there is a pressing need for a simple and efficient process to screen and refer individuals with significant eye disease-related vision loss to tertiary eye care centers for further care. An ideal solution should seamlessly and readily integrate with existing workflows, providing comprehensive initial screening results to service providers, thereby enabling precise patient referrals for timely treatment. This paper introduces the Enhancing Community Vision Screening (ECVS) solution, which addresses the aforementioned concerns with a novel and feasible solution based on simple, non-invasive retinal photography for the detection of pathology-based visual impairment. Our study employs four distinct deep learning models: RETinal photo Quality Assessment (RETQA), Pathology Visual Impairment detection (PVI), Eye Disease Diagnosis (EDD) and Visualization of Lesion Regions of the eye (VLR). We conducted experiments on over 10 datasets, totaling more than 80,000 fundus photos collected from various sources. The models integrated into ECVS achieved impressive AUC scores of 0.98 for RETQA, 0.95 for PVI, and 0.90 for EDD, along with a DICE coefficient of 0.48 for VLR. These results underscore the promising capabilities of ECVS as a straightforward and scalable method for community-based vision screening.

However, existing fair FL methods ignore the specific characteristics of medical FL applications, i.e., domain shift among the datasets from different hospitals. In this work, we propose Fed-LWR to improve performance fairness from the perspective of feature shift, a key issue influencing the performance of medical FL systems caused by domain shift. Specifically, we dynamically perceive the bias of the global model across all hospitals by estimating the layer-wise difference in feature representations between local and global models. To minimize global divergence, we assign higher weights to hospitals with larger differences. The estimated client weights help us to re-aggregate the local models per layer to obtain a fairer global model. We evaluate our method on two widely used federated medical image segmentation benchmarks. The results demonstrate that our method achieves better and fairer performance compared with several state-of-the-art fair FL methods.

Background: Pneumothorax is an acute thoracic disease caused by abnormal air collection between the lungs and chest wall. To address the opaqueness often associated with deep learning (DL) models, explainable artificial intelligence (XAI) methods have been introduced to outline regions related to pneumothorax diagnoses made by DL models. However, these explanations sometimes diverge from actual lesion areas, highlighting the need for further improvement. Method: We propose a template-guided approach to incorporate the clinical knowledge of pneumothorax into model explanations generated by XAI methods, thereby enhancing the quality of these explanations. Utilizing one lesion delineation created by radiologists, our approach first generates a template that represents potential areas of pneumothorax occurrence. This template is then superimposed on model explanations to filter out extraneous explanations that fall outside the template's boundaries. To validate its efficacy, we carried out a comparative analysis of three XAI methods with and without our template guidance when explaining two DL models in two real-world datasets. Results: The proposed approach consistently improved baseline XAI methods across twelve benchmark scenarios built on three XAI methods, two DL models, and two datasets. The average incremental percentages, calculated by the performance improvements over the baseline performance, were 97.8% in Intersection over Union (IoU) and 94.1% in Dice Similarity Coefficient (DSC) when comparing model explanations and ground-truth lesion areas. Conclusions: In the context of pneumothorax diagnoses, we proposed a template-guided approach for improving AI explanations. We anticipate that our template guidance will forge a fresh approach to elucidating AI models by integrating clinical domain expertise.

Visual perimetry is an important eye examination that helps detect vision problems caused by ocular or neurological conditions. During the test, a patient's gaze is fixed at a specific location while light stimuli of varying intensities are presented in central and peripheral vision. Based on the patient's responses to the stimuli, the visual field mapping and sensitivity are determined. However, maintaining high levels of concentration throughout the test can be challenging for patients, leading to increased examination times and decreased accuracy. In this work, we present RLPeri, a reinforcement learning-based approach to optimize visual perimetry testing. By determining the optimal sequence of locations and initial stimulus values, we aim to reduce the examination time without compromising accuracy. Additionally, we incorporate reward shaping techniques to further improve the testing performance. To monitor the patient's responses over time during testing, we represent the test's state as a pair of 3D matrices. We apply two different convolutional kernels to extract spatial features across locations as well as features across different stimulus values for each location. Through experiments, we demonstrate that our approach results in a 10-20% reduction in examination time while maintaining the accuracy as compared to state-of-the-art methods. With the presented approach, we aim to make visual perimetry testing more efficient and patient-friendly, while still providing accurate results.

Pneumothorax is a medical emergency caused by abnormal accumulation of air in the pleural space - the potential space between the lungs and chest wall. On 2D chest radiographs, pneumothorax occurs within the thoracic cavity and outside of the mediastinum and we refer to this area as "lung+ space". While deep learning (DL) has increasingly been utilized to segment pneumothorax lesions in chest radiographs, many existing DL models employ an end-to-end approach. These models directly map chest radiographs to clinician-annotated lesion areas, often neglecting the vital domain knowledge that pneumothorax is inherently location-sensitive. We propose a novel approach that incorporates the lung+ space as a constraint during DL model training for pneumothorax segmentation on 2D chest radiographs. To circumvent the need for additional annotations and to prevent potential label leakage on the target task, our method utilizes external datasets and an auxiliary task of lung segmentation. This approach generates a specific constraint of lung+ space for each chest radiograph. Furthermore, we have incorporated a discriminator to eliminate unreliable constraints caused by the domain shift between the auxiliary and target datasets. Our results demonstrated significant improvements, with average performance gains of 4.6%, 3.6%, and 3.3% regarding Intersection over Union (IoU), Dice Similarity Coefficient (DSC), and Hausdorff Distance (HD). Our research underscores the significance of incorporating medical domain knowledge about the location-specific nature of pneumothorax to enhance DL-based lesion segmentation.

Metasurfaces have widespread applications in fifth-generation (5G) microwave communication. Among the metasurface family, free-form metasurfaces excel in achieving intricate spectral responses compared to regular-shape counterparts. However, conventional numerical methods for free-form metasurfaces are time-consuming and demand specialized expertise. Alternatively, recent studies demonstrate that deep learning has great potential to accelerate and refine metasurface designs. Here, we present XGAN, an extended generative adversarial network (GAN) with a surrogate for high-quality free-form metasurface designs. The proposed surrogate provides a physical constraint to XGAN so that XGAN can accurately generate metasurfaces monolithically from input spectral responses. In comparative experiments involving 20000 free-form metasurface designs, XGAN achieves 0.9734 average accuracy and is 500 times faster than the conventional methodology. This method facilitates the metasurface library building for specific spectral responses and can be extended to various inverse design problems, including optical metamaterials, nanophotonic devices, and drug discovery.

Composed image retrieval (CIR) is the task of retrieving specific images by using a query that involves both a reference image and a relative caption. Most existing CIR models adopt the late-fusion strategy to combine visual and language features. Besides, several approaches have also been suggested to generate a pseudo-word token from the reference image, which is further integrated into the relative caption for CIR. However, these pseudo-word-based prompting methods have limitations when target image encompasses complex changes on reference image, e.g., object removal and attribute modification. In this work, we demonstrate that learning an appropriate sentence-level prompt for the relative caption (SPRC) is sufficient for achieving effective composed image retrieval. Instead of relying on pseudo-word-based prompts, we propose to leverage pretrained V-L models, e.g., BLIP-2, to generate sentence-level prompts. By concatenating the learned sentence-level prompt with the relative caption, one can readily use existing text-based image retrieval models to enhance CIR performance. Furthermore, we introduce both image-text contrastive loss and text prompt alignment loss to enforce the learning of suitable sentence-level prompts. Experiments show that our proposed method performs favorably against the state-of-the-art CIR methods on the Fashion-IQ and CIRR datasets. The source code and pretrained model are publicly available at https://github.com/chunmeifeng/SPRC

Failure to recognize samples from the classes unseen during training is a major limitation of artificial intelligence in the real-world implementation for recognition and classification of retinal anomalies. We established an uncertainty-inspired open-set (UIOS) model, which was trained with fundus images of 9 retinal conditions. Besides assessing the probability of each category, UIOS also calculated an uncertainty score to express its confidence. Our UIOS model with thresholding strategy achieved an F1 score of 99.55%, 97.01% and 91.91% for the internal testing set, external target categories (TC)-JSIEC dataset and TC-unseen testing set, respectively, compared to the F1 score of 92.20%, 80.69% and 64.74% by the standard AI model. Furthermore, UIOS correctly predicted high uncertainty scores, which would prompt the need for a manual check in the datasets of non-target categories retinal diseases, low-quality fundus images, and non-fundus images. UIOS provides a robust method for real-world screening of retinal anomalies.

Federated learning (FL) is a distributed learning paradigm that enables multiple clients to learn a powerful global model by aggregating local training. However, the performance of the global model is often hampered by non-i.i.d. distribution among the clients, requiring extensive efforts to mitigate inter-client data heterogeneity. Going beyond inter-client data heterogeneity, we note that intra-client heterogeneity can also be observed on complex real-world data and seriously deteriorate FL performance. In this paper, we present a novel FL algorithm, i.e., FedIns, to handle intra-client data heterogeneity by enabling instance-adaptive inference in the FL framework. Instead of huge instance-adaptive models, we resort to a parameter-efficient fine-tuning method, i.e., scale and shift deep features (SSF), upon a pre-trained model. Specifically, we first train an SSF pool for each client, and aggregate these SSF pools on the server side, thus still maintaining a low communication cost. To enable instance-adaptive inference, for a given instance, we dynamically find the best-matched SSF subsets from the pool and aggregate them to generate an adaptive SSF specified for the instance, thereby reducing the intra-client as well as the inter-client heterogeneity. Extensive experiments show that our FedIns outperforms state-of-the-art FL algorithms, e.g., a 6.64\% improvement against the top-performing method with less than 15\% communication cost on Tiny-ImageNet. Our code and models will be publicly released.

Localizing anatomical landmarks are important tasks in medical image analysis. However, the landmarks to be localized often lack prominent visual features. Their locations are elusive and easily confused with the background, and thus precise localization highly depends on the context formed by their surrounding areas. In addition, the required precision is usually higher than segmentation and object detection tasks. Therefore, localization has its unique challenges different from segmentation or detection. In this paper, we propose a zoom-in attentive network (ZIAN) for anatomical landmark localization in ocular images. First, a coarse-to-fine, or "zoom-in" strategy is utilized to learn the contextualized features in different scales. Then, an attentive fusion module is adopted to aggregate multi-scale features, which consists of 1) a co-attention network with a multiple regions-of-interest (ROIs) scheme that learns complementary features from the multiple ROIs, 2) an attention-based fusion module which integrates the multi-ROIs features and non-ROI features. We evaluated ZIAN on two open challenge tasks, i.e., the fovea localization in fundus images and scleral spur localization in AS-OCT images. Experiments show that ZIAN achieves promising performances and outperforms state-of-the-art localization methods. The source code and trained models of ZIAN are available at https://github.com/leixiaofeng-astar/OMIA9-ZIAN.