The relentless growth of large-scale artificial intelligence (AI) has created unprecedented demand for computational power, straining the energy, bandwidth, and scaling limits of conventional electronic platforms. Electronic-photonic integrated circuits (EPICs) have emerged as a compelling platform for next-generation AI systems, offering inherent advantages in ultra-high bandwidth, low latency, and energy efficiency for computing and interconnection. Beyond performance, EPICs also hold unique promises for sustainability. Fabricated in relaxed process nodes with fewer metal layers and lower defect densities, photonic devices naturally reduce embodied carbon footprint (CFP) compared to advanced digital electronic integrated circuits, while delivering orders-of-magnitude higher computing performance and interconnect bandwidth. To further advance the sustainability of photonic AI systems, we explore how electronic-photonic design automation (EPDA) and cross-layer co-design methodologies can amplify these inherent benefits. We present how advanced EPDA tools enable more compact layout generation, reducing both chip area and metal layer usage. We will also demonstrate how cross-layer device-circuit-architecture co-design unlocks new sustainability gains for photonic hardware: ultra-compact photonic circuit designs that minimize chip area cost, reconfigurable hardware topology that adapts to evolving AI workloads, and intelligent resilience mechanisms that prolong lifetime by tolerating variations and faults. By uniting intrinsic photonic efficiency with EPDA- and co-design-driven gains in area efficiency, reconfigurability, and robustness, we outline a vision for lifelong-sustainable electronic-photonic AI systems. This perspective highlights how EPIC AI systems can simultaneously meet the performance demands of modern AI and the urgent imperative for sustainable computing.

Visual impairment represents a major global health challenge, with multimodal imaging providing complementary information that is essential for accurate ophthalmic diagnosis. This comprehensive survey systematically reviews the latest advances in multimodal deep learning methods in ophthalmology up to the year 2025. The review focuses on two main categories: task-specific multimodal approaches and large-scale multimodal foundation models. Task-specific approaches are designed for particular clinical applications such as lesion detection, disease diagnosis, and image synthesis. These methods utilize a variety of imaging modalities including color fundus photography, optical coherence tomography, and angiography. On the other hand, foundation models combine sophisticated vision-language architectures and large language models pretrained on diverse ophthalmic datasets. These models enable robust cross-modal understanding, automated clinical report generation, and decision support. The survey critically examines important datasets, evaluation metrics, and methodological innovations including self-supervised learning, attention-based fusion, and contrastive alignment. It also discusses ongoing challenges such as variability in data, limited annotations, lack of interpretability, and issues with generalizability across different patient populations. Finally, the survey outlines promising future directions that emphasize the use of ultra-widefield imaging and reinforcement learning-based reasoning frameworks to create intelligent, interpretable, and clinically applicable AI systems for ophthalmology.

Current artificial intelligence models for medical imaging are predominantly single modality and single disease. Attempts to create multimodal and multi-disease models have resulted in inconsistent clinical accuracy. Furthermore, training these models typically requires large, labour-intensive, well-labelled datasets. We developed MerMED-FM, a state-of-the-art multimodal, multi-specialty foundation model trained using self-supervised learning and a memory module. MerMED-FM was trained on 3.3 million medical images from over ten specialties and seven modalities, including computed tomography (CT), chest X-rays (CXR), ultrasound (US), pathology patches, color fundus photography (CFP), optical coherence tomography (OCT) and dermatology images. MerMED-FM was evaluated across multiple diseases and compared against existing foundational models. Strong performance was achieved across all modalities, with AUROCs of 0.988 (OCT); 0.982 (pathology); 0.951 (US); 0.943 (CT); 0.931 (skin); 0.894 (CFP); 0.858 (CXR). MerMED-FM has the potential to be a highly adaptable, versatile, cross-specialty foundation model that enables robust medical imaging interpretation across diverse medical disciplines.

Artificial intelligence (AI) shows remarkable potential in medical imaging diagnostics, yet most current models require retraining when applied across different clinical settings, limiting their scalability. We introduce GlobeReady, a clinician-friendly AI platform that enables fundus disease diagnosis that operates without retraining, fine-tuning, or the needs for technical expertise. GlobeReady demonstrates high accuracy across imaging modalities: 93.9-98.5% for 11 fundus diseases using color fundus photographs (CPFs) and 87.2-92.7% for 15 fundus diseases using optic coherence tomography (OCT) scans. By leveraging training-free local feature augmentation, GlobeReady platform effectively mitigates domain shifts across centers and populations, achieving accuracies of 88.9-97.4% across five centers on average in China, 86.3-96.9% in Vietnam, and 73.4-91.0% in Singapore, and 90.2-98.9% in the UK. Incorporating a bulit-in confidence-quantifiable diagnostic mechanism further enhances the platform's accuracy to 94.9-99.4% with CFPs and 88.2-96.2% with OCT, while enabling identification of out-of-distribution cases with 86.3% accuracy across 49 common and rare fundus diseases using CFPs, and 90.6% accuracy across 13 diseases using OCT. Clinicians from countries rated GlobeReady highly for usability and clinical relevance (average score 4.6/5). These findings demonstrate GlobeReady's robustness, generalizability and potential to support global ophthalmic care without technical barriers.

While being very successful in solving many downstream tasks, the application of deep neural networks is limited in real-life scenarios because of their susceptibility to domain shifts such as common corruptions, and adversarial attacks. The existence of adversarial examples and data corruption significantly reduces the performance of deep classification models. Researchers have made strides in developing robust neural architectures to bolster decisions of deep classifiers. However, most of these works rely on effective adversarial training methods, and predominantly focus on overall model robustness, disregarding class-wise differences in robustness, which are critical. Exploiting weakly robust classes is a potential avenue for attackers to fool the image recognition models. Therefore, this study investigates class-to-class biases across adversarially trained robust classification models to understand their latent space structures and analyze their strong and weak class-wise properties. We further assess the robustness of classes against common corruptions and adversarial attacks, recognizing that class vulnerability extends beyond the number of correct classifications for a specific class. We find that the number of false positives of classes as specific target classes significantly impacts their vulnerability to attacks. Through our analysis on the Class False Positive Score, we assess a fair evaluation of how susceptible each class is to misclassification.

Integrating deep learning into medical imaging is poised to greatly advance diagnostic methods but it faces challenges with generalizability. Foundation models, based on self-supervised learning, address these issues and improve data efficiency. Natural domain foundation models show promise for medical imaging, but systematic research evaluating domain adaptation, especially using self-supervised learning and parameter-efficient fine-tuning, remains underexplored. Additionally, little research addresses the issue of catastrophic forgetting during fine-tuning of foundation models. We adapted the DINOv2 vision transformer for retinal imaging classification tasks using self-supervised learning and generated two novel foundation models termed DINORET and BE DINORET. Publicly available color fundus photographs were employed for model development and subsequent fine-tuning for diabetic retinopathy staging and glaucoma detection. We introduced block expansion as a novel domain adaptation strategy and assessed the models for catastrophic forgetting. Models were benchmarked to RETFound, a state-of-the-art foundation model in ophthalmology. DINORET and BE DINORET demonstrated competitive performance on retinal imaging tasks, with the block expanded model achieving the highest scores on most datasets. Block expansion successfully mitigated catastrophic forgetting. Our few-shot learning studies indicated that DINORET and BE DINORET outperform RETFound in terms of data-efficiency. This study highlights the potential of adapting natural domain vision models to retinal imaging using self-supervised learning and block expansion. BE DINORET offers robust performance without sacrificing previously acquired capabilities. Our findings suggest that these methods could enable healthcare institutions to develop tailored vision models for their patient populations, enhancing global healthcare inclusivity.

Artificial intelligence (AI) is vital in ophthalmology, tackling tasks like diagnosis, classification, and visual question answering (VQA). However, existing AI models in this domain often require extensive annotation and are task-specific, limiting their clinical utility. While recent developments have brought about foundation models for ophthalmology, they are limited by the need to train separate weights for each imaging modality, preventing a comprehensive representation of multi-modal features. This highlights the need for versatile foundation models capable of handling various tasks and modalities in ophthalmology. To address this gap, we present EyeFound, a multimodal foundation model for ophthalmic images. Unlike existing models, EyeFound learns generalizable representations from unlabeled multimodal retinal images, enabling efficient model adaptation across multiple applications. Trained on 2.78 million images from 227 hospitals across 11 ophthalmic modalities, EyeFound facilitates generalist representations and diverse multimodal downstream tasks, even for detecting challenging rare diseases. It outperforms previous work RETFound in diagnosing eye diseases, predicting systemic disease incidents, and zero-shot multimodal VQA. EyeFound provides a generalizable solution to improve model performance and lessen the annotation burden on experts, facilitating widespread clinical AI applications for retinal imaging.

Robot co-design, where the morphology of a robot is optimized jointly with a learned policy to solve a specific task, is an emerging area of research. It holds particular promise for soft robots, which are amenable to novel manufacturing techniques that can realize learned morphologies and actuators. Inspired by nature and recent novel robot designs, we propose to go a step further and explore the novel reconfigurable robots, defined as robots that can change their morphology within their lifetime. We unify morphology change, locomotion, and environment interaction in the same action space, and introduce an appropriate, coarse-to-fine curriculum that enables us to discover policies that accomplish fine-grained control of the resulting robots. We also introduce Ditto-Gym, a comprehensive RL benchmark for reconfigurable soft robots that require fine-grained morphology changes to accomplish the tasks. Finally, we evaluate our proposed coarse-to-fine algorithm on DittoGym and demonstrate robots that learn to change their morphology several times within a sequence, uniquely enabled by our RL algorithm. More results are available at https://dittogym.github.io. Over millions of years, morphologies of species change as a function of evolutionary pressures (Minelli, 2003; Raff, 2012). In robotics, this process of evolution has inspired the task of robot co-design: the joint optimization of a robot's morphology and a control policy that best enable the robot to accomplish a given task (Gupta et al., 2022; Wang et al.; Ha, 2019; Yuan et al., 2021). Yet, in nature, creatures do not only change their morphology over millions of years as a function of evolution. Almost all living beings go through a process of morphology changes even in their lifetime. These changes can be dramatic in magnitude, like when a mighty tree grows from a tiny sapling, but they can also be dramatic in form, like across the many examples of metamorphosis, where frogs, for instance, go through a water-dwelling stage with a tail for propulsion, to then lose their tail and grow legs to live on land (Rose, 2005; Hofmann et al., 2003).

The early detection of glaucoma is essential in preventing visual impairment. Artificial intelligence (AI) can be used to analyze color fundus photographs (CFPs) in a cost-effective manner, making glaucoma screening more accessible. While AI models for glaucoma screening from CFPs have shown promising results in laboratory settings, their performance decreases significantly in real-world scenarios due to the presence of out-of-distribution and low-quality images. To address this issue, we propose the Artificial Intelligence for Robust Glaucoma Screening (AIROGS) challenge. This challenge includes a large dataset of around 113,000 images from about 60,000 patients and 500 different screening centers, and encourages the development of algorithms that are robust to ungradable and unexpected input data. We evaluated solutions from 14 teams in this paper, and found that the best teams performed similarly to a set of 20 expert ophthalmologists and optometrists. The highest-scoring team achieved an area under the receiver operating characteristic curve of 0.99 (95% CI: 0.98-0.99) for detecting ungradable images on-the-fly. Additionally, many of the algorithms showed robust performance when tested on three other publicly available datasets. These results demonstrate the feasibility of robust AI-enabled glaucoma screening.

This paper attacks an emerging challenge of multi-modal retinal disease recognition. Given a multi-modal case consisting of a color fundus photo (CFP) and an array of OCT B-scan images acquired during an eye examination, we aim to build a deep neural network that recognizes multiple vision-threatening diseases for the given case. As the diagnostic efficacy of CFP and OCT is disease-dependent, the network's ability of being both selective and interpretable is important. Moreover, as both data acquisition and manual labeling are extremely expensive in the medical domain, the network has to be relatively lightweight for learning from a limited set of labeled multi-modal samples. Prior art on retinal disease recognition focuses either on a single disease or on a single modality, leaving multi-modal fusion largely underexplored. We propose in this paper Multi-Modal Multi-Instance Learning (MM-MIL) for selectively fusing CFP and OCT modalities. Its lightweight architecture (as compared to current multi-head attention modules) makes it suited for learning from relatively small-sized datasets. For an effective use of MM-MIL, we propose to generate a pseudo sequence of CFPs by over sampling a given CFP. The benefits of this tactic include well balancing instances across modalities, increasing the resolution of the CFP input, and finding out regions of the CFP most relevant with respect to the final diagnosis. Extensive experiments on a real-world dataset consisting of 1,206 multi-modal cases from 1,193 eyes of 836 subjects demonstrate the viability of the proposed model.