Clinical practitioners use all available data modalities for diagnosing and treating eye diseases like Diabetic Retinopathy (DR) or Diabetic Macular Edema (DME).

Diabetic macular edema (DME) significantly contributes to visual impairment in diabetic patients. Treatment responses to intravitreal therapies vary, highlighting the need for patient stratification to predict therapeutic benefits and enable personalized strategies. To our knowledge, this study is the first to explore pre-treatment stratification for predicting DME treatment responses. To advance this research, we organized the 2nd Asia-Pacific Tele-Ophthalmology Society (APTOS) Big Data Competition in 2021. The competition focused on improving predictive accuracy for anti-VEGF therapy responses using ophthalmic OCT images. We provided a dataset containing tens of thousands of OCT images from 2,000 patients with labels across four sub-tasks. This paper details the competition's structure, dataset, leading methods, and evaluation metrics. The competition attracted strong scientific community participation, with 170 teams initially registering and 41 reaching the final round. The top-performing team achieved an AUC of 80.06%, highlighting the potential of AI in personalized DME treatment and clinical decision-making.

Diabetic Macular Edema (DME), a prevalent complication among diabetic patients, constitutes a major cause of visual impairment and blindness. Although deep learning has achieved remarkable progress in medical image analysis, traditional DME diagnosis still relies on extensive annotated data and subjective ophthalmologist assessments, limiting practical applications. To address this, we present RURANET++, an unsupervised learning-based automated DME diagnostic system. This framework incorporates an optimized U-Net architecture with embedded Spatial and Channel Squeeze & Excitation (SCSE) attention mechanisms to enhance lesion feature extraction. During feature processing, a pre-trained GoogLeNet model extracts deep features from retinal images, followed by PCA-based dimensionality reduction to 50 dimensions for computational efficiency. Notably, we introduce a novel clustering algorithm employing multi-projection heads to explicitly control cluster diversity while dynamically adjusting similarity thresholds, thereby optimizing intra-class consistency and inter-class discrimination. Experimental results demonstrate superior performance across multiple metrics, achieving maximum accuracy (0.8411), precision (0.8593), recall (0.8411), and F1-score (0.8390), with exceptional clustering quality. This work provides an efficient unsupervised solution for DME diagnosis with significant clinical implications.

Diabetic macular edema (DME) is a severe complication of diabetes, characterized by thickening of the central portion of the retina due to accumulation of fluid. DME is a significant and common cause of visual impairment in diabetic patients. Center-involved DME (ci-DME) is the highest risk form of disease because fluid extends close to the fovea which is responsible for sharp central vision. Earlier diagnosis or prediction of ci-DME may improve treatment outcomes. Here, we propose an ensemble method to predict ci-DME onset within a year, after using synthetic ultra-wide field color fundus photography (UWF-CFP) images provided by the DIAMOND Challenge during development. We adopted a variety of baseline state-of-the-art classification networks including ResNet, DenseNet, EfficientNet, and VGG with the aim of enhancing model robustness. The best performing models were Densenet-121, Resnet-152 and EfficientNet-b7, and these were assembled into a definitive predictive model. The final ensemble model demonstrates a strong performance with an Area Under Curve (AUC) of 0.7017, an F1 score of 0.6512, and an Expected Calibration Error (ECE) of 0.2057 when deployed on the synthetic test dataset. Results from our ensemble model were superior/comparable to previous recorded results in highly curated settings using conventional fundus photography/ultra-wide field fundus photography. Optimal sensitivity in previous studies (using humans or computers to diagnose) ranges from 67.3%-98%, specificity from 47.8%-80%. Therefore, our method can be used safely and effectively in a range of settings may facilitate earlier diagnosis, better treatment decisions, and improved prognostication in ci-DME.

Retinal images and vasculature reflect the body's micro-and macrovascular health. They can be used to diagnose DM complications, including diabetic retinopathy (DR), neuropathy, nephropathy, and atherosclerotic cardiovascular disease, as well as forecast the risk of cardiovascular events. Artificial intelligence (AI)-enabled systems developed for high-throughput detection of DR using digitized retinal images have become clinically adopted. Beyond DR screening, AI integration also holds immense potential to address challenges associated with the holistic care of the patient with DM. In this work, we aim to comprehensively review the literature for studies on AI applications based on retinal images related to DM diagnosis, prognostication, and management. We will describe the findings of holistic AI-assisted diabetes care, including but not limited to DR screening, and discuss barriers to implementing such systems, including issues concerning ethics, data privacy, equitable access, and explainability. With the ability to evaluate the patient's health status vis a vis DM complication as well as risk prognostication of future cardiovascular complications, AIassisted retinal image analysis has the potential to become a central tool for modern personalized medicine in patients with DM.

Data leakage is a sneaky issue that often plagues machine learning models. The term leakage refers to test data leaking into the training set. It happens when the model is trained on data that it shouldn't have access to during training, leading to overfitting and poor performance on unseen data. It's like training a student for a test using the test answers -- they'll do great on that specific test, but not so well on others. The goal of machine learning is to create models that can generalize and make accurate predictions on new, unseen data.

Clinical diagnosis of the eye is performed over multifarious data modalities including scalar clinical labels, vectorized biomarkers, two-dimensional fundus images, and three-dimensional Optical Coherence Tomography (OCT) scans. Clinical practitioners use all available data modalities for diagnosing and treating eye diseases like Diabetic Retinopathy (DR) or Diabetic Macular Edema (DME). Enabling usage of machine learning algorithms within the ophthalmic medical domain requires research into the relationships and interactions between all relevant data over a treatment period. Existing datasets are limited in that they neither provide data nor consider the explicit relationship modeling between the data modalities. In this paper, we introduce the Ophthalmic Labels for Investigating Visual Eye Semantics (OLIVES) dataset that addresses the above limitation. This is the first OCT and near-IR fundus dataset that includes clinical labels, biomarker labels, disease labels, and time-series patient treatment information from associated clinical trials. The dataset consists of 1268 near-IR fundus images each with at least 49 OCT scans, and 16 biomarkers, along with 4 clinical labels and a disease diagnosis of DR or DME. In total, there are 96 eyes' data averaged over a period of at least two years with each eye treated for an average of 66 weeks and 7 injections. We benchmark the utility of OLIVES dataset for ophthalmic data as well as provide benchmarks and concrete research directions for core and emerging machine learning paradigms within medical image analysis.

By 2050, the National Institute of Health (NIH) National Eye Institute estimates that 14.6 million Americans will have diabetic retinopathy. A new study published in The Lancet demonstrates how artificial intelligence (AI) machine learning can screen in real-time for diabetic retinopathy--a leading cause of preventable blindness, particularly in areas with low-income or middle-income economies. According to the Centers for Disease Control (CDC), one in four American adults with vision loss reported anxiety or depression. Moreover, vision loss has been linked to fear, anxiety, worry, social isolation, and loneliness. Scientists affiliated with Google Health and their collaborators applied artificial intelligence (AI) machine learning to detect one of the most common causes of preventable blindness--diabetic retinopathy.