Diabetic Retinopathy (DR) affects individuals with long-term diabetes. Without early diagnosis, DR can lead to vision loss. Fundus photography captures the structure of the retina along with abnormalities indicative of the stage of the disease. Artificial Intelligence (AI) can support clinicians in identifying these lesions, reducing manual workload, but models require high-quality annotated datasets. Due to the complexity of retinal structures, errors in image acquisition and lesion interpretation of manual annotators can occur. We proposed a quality-control framework, ensuring only high-standard data is used for evaluation and AI training. First, an explainable feature-based classifier is used to filter inadequate images. The features are extracted both using image processing and contrastive learning. Then, the images are enhanced and put subject to annotation, using deep-learning-based assistance. Lastly, the agreement between annotators calculated using derived formulas determines the usability of the annotations.

As a representative optic degenerative condition, glaucoma has been a threat to millions due to its irreversibility and severe impact on human vision fields. Mainly characterized by dimmed and blurred visions, or peripheral vision loss, glaucoma is well known to occur due to damages in the optic nerve from increased intraocular pressure (IOP) or neovascularization within the retina. Traditionally, most glaucoma related works and clinical diagnosis focused on detecting these damages in the optic nerve by using patient data from perimetry tests, optic papilla inspections and tonometer-based IOP measurements. Recently, with advancements in computer vision AI models, such as VGG16 or Vision Transformers (ViT), AI-automatized glaucoma detection and optic cup segmentation based on retinal fundus images or OCT recently exhibited significant performance in aiding conventional diagnosis with high performance. However, current AI-driven glaucoma detection approaches still have significant room for improvement in terms of reliability, excessive parameter usage, possibility of spurious correlation within detection, and limitations in applications to intervention analysis or clinical simulations. Thus, this research introduced a novel causal representation driven glaucoma detection model: LightHCG, an extremely lightweight Convolutional VAE-based latent glaucoma representation model that can consider the true causality among glaucoma-related physical factors within the optic nerve region. Using HSIC-based latent space disentanglement and Graph Autoencoder based unsupervised causal representation learning, LightHCG not only exhibits higher performance in classifying glaucoma with 93~99% less weights, but also enhances the possibility of AI-driven intervention analysis, compared to existing advanced vision models such as InceptionV3, MobileNetV2 or VGG16.

Reliable detection of retinal diseases from fundus images is challenged by the variability in imaging quality, subtle early-stage manifestations, and domain shift across datasets. In this study, we systematically evaluated a Vision Transformer (ViT) classifier under multiple augmentation and enhancement strategies across several heterogeneous public datasets, as well as the AEyeDB dataset, a high-quality fundus dataset created in-house and made available for the research community. The ViT demonstrated consistently strong performance, with accuracies ranging from 0.789 to 0.843 across datasets and diseases. Diabetic retinopathy and age-related macular degeneration were detected reliably, whereas glaucoma remained the most frequently misclassified disease. Geometric and color augmentations provided the most stable improvements, while histogram equalization benefited datasets dominated by structural subtlety. Laplacian enhancement reduced performance across different settings. On the Papila dataset, the ViT with geometric augmentation achieved an AUC of 0.91, outperforming previously reported convolutional ensemble baselines (AUC of 0.87), underscoring the advantages of transformer architectures and multi-dataset training. To complement the classifier, we developed a GANomaly-based anomaly detector, achieving an AUC of 0.76 while providing inherent reconstruction-based explainability and robust generalization to unseen data. Probabilistic calibration using GUESS enabled threshold-independent decision support for future clinical implementation.

Retinal image quality assessment (RIQA) supports computer-aided diagnosis of eye diseases. However, most tools classify only overall image quality, without indicating acquisition defects to guide recapture. This gap is mainly due to the high cost of detailed annotations. In this paper, we aim to mitigate this limitation by introducing a hybrid semi-supervised learning approach that combines manual labels for overall quality with pseudo-labels of quality details within a multi-task framework. Our objective is to obtain more interpretable RIQA models without requiring extensive manual labeling. Pseudo-labels are generated by a Teacher model trained on a small dataset and then used to fine-tune a pre-trained model in a multi-task setting. Using a ResNet-18 backbone, we show that these weak annotations improve quality assessment over single-task baselines (F1: 0.875 vs. 0.863 on EyeQ, and 0.778 vs. 0.763 on DeepDRiD), matching or surpassing existing methods. The multi-task model achieved performance statistically comparable to the Teacher for most detail prediction tasks (p > 0.05). In a newly annotated EyeQ subset released with this paper, our model performed similarly to experts, suggesting that pseudo-label noise aligns with expert variability. Our main finding is that the proposed semi-supervised approach not only improves overall quality assessment but also provides interpretable feedback on capture conditions (illumination, clarity, contrast). This enhances interpretability at no extra manual labeling cost and offers clinically actionable outputs to guide image recapture.

Segmenting of clinically important retinal blood vessels into arteries and veins is a prerequisite for retinal vessel analysis. Such analysis can provide potential insights and bio-markers for identifying and diagnosing various retinal eye diseases. Alteration in the regularity and width of the retinal blood vessels can act as an indicator of the health of the vasculature system all over the body. It can help identify patients at high risk of developing vasculature diseases like stroke and myocardial infarction. Over the years, various Deep Learning architectures have been proposed to perform retinal vessel segmentation. Recently, attention mechanisms have been increasingly used in image segmentation tasks. The work proposes a new Deep Learning approach for artery-vein segmentation. The new approach is based on the Attention mechanism that is incorporated into the WNet Deep Learning model, and we call the model as Attention-WNet. The proposed approach has been tested on publicly available datasets such as HRF and DRIVE datasets. The proposed approach has outperformed other state-of-art models available in the literature.

Abstract-- Choroidal nevi are common benign pigmented lesions in the eye, with a small risk of transforming into melanoma. Early detection is critical to improving survival rates, but misdiagnosis or delayed diagnosis can lead to poor outcomes. Despite advancements in AI-based image analysis, diagnosing choroidal nevi in colour fundus images remains challenging, particularly for clinicians without specialized expertise. Existing datasets often suffer from low resolution and inconsistent labelling, limiting the effectiveness of segmentation models. This paper addresses the challenge of achieving precise segmentation of fundus lesions, a critical step toward developing robust diagnostic tools. While deep learning models like U-Net have demonstrated effectiveness, their accuracy heavily depends on the quality and quantity of annotated data. Previous mathematical/clustering segmentation methods, though accurate, required extensive human input, making them impractical for medical applications. This paper proposes a novel approach that combines mathematical/clustering segmentation models with insights from U-Net, leveraging the strengths of both methods. This hybrid model improves accuracy, reduces the need for large-scale training data, and achieves significant performance gains on high-resolution fundus images. The proposed model achieves a Dice coefficient of 89.7% and an IoU of 80.01% on 1024 1024 fundus images, outperforming the Attention U-Net model, which achieved 51.3% and 34.2%, respectively. It also demonstrated better generalizability on external datasets. This work forms a part of a broader effort to develop a decision support system for choroidal nevus diagnosis, with potential applications in automated lesion annotation to enhance the speed and accuracy of diagnosis and monitoring. This research is funded by New Frontiers Research Fund - Explorations grant Submission Date: February 20 2025 Mohammadmahdi Eshragh is with Department of Electrical & Software Engineering, University of Calgary, Canada. Emad A. Mohammed is with the Department of Computer Science and Physics, Wilfrid Laurier University, Waterloo, Canada.

Retinal disease diagnosis is critical in preventing vision loss and reducing socioeconomic burdens. Globally, over 2.2 billion people are affected by some form of vision impairment, resulting in annual productivity losses estimated at $411 billion. Traditional manual grading of retinal fundus images by ophthalmologists is time-consuming and subjective. In contrast, deep learning has revolutionized medical diagnostics by automating retinal image analysis and achieving expert-level performance. In this study, we present EYE-DEX, an automated framework for classifying 10 retinal conditions using the large-scale Retinal Disease Dataset comprising 21,577 eye fundus images. We benchmark three pre-trained Convolutional Neural Network (CNN) models--VGG16, VGG19, and ResNet50--with our finetuned VGG16 achieving a state-of-the-art global benchmark test accuracy of 92.36%. To enhance transparency and explainability, we integrate the Gradient-weighted Class Activation Mapping (Grad-CAM) technique to generate visual explanations highlighting disease-specific regions, thereby fostering clinician trust and reliability in AI-assisted diagnostics.

This study aimed to enhance disease classification accuracy from retinal fundus images by integrating fine-grained image features and global textual context using a novel multimodal deep learning architecture. Existing multimodal large language models (MLLMs) often struggle to capture low-level spatial details critical for diagnosing retinal diseases such as glaucoma, diabetic retinopathy, and retinitis pigmentosa. This model development and validation study was conducted on 1,305 fundus image-text pairs compiled from three public datasets (FIVES, HRF, and StoneRounds), covering acquired and inherited retinal diseases, and evaluated using classification accuracy and F1-score. The MDF-MLLM integrates skip features from four U-Net encoder layers into cross-attention blocks within a LLaMA 3.2 11B MLLM. Vision features are patch-wise projected and fused using scaled cross-attention and FiLM-based U-Net modulation. Baseline MLLM achieved 60% accuracy on the dual-type disease classification task. MDF-MLLM, with both U-Net and MLLM components fully fine-tuned during training, achieved a significantly higher accuracy of 94%, representing a 56% improvement. Recall and F1-scores improved by as much as 67% and 35% over baseline, respectively. Ablation studies confirmed that the multi-depth fusion approach contributed to substantial gains in spatial reasoning and classification, particularly for inherited diseases with rich clinical text. MDF-MLLM presents a generalizable, interpretable, and modular framework for fundus image classification, outperforming traditional MLLM baselines through multi-scale feature fusion. The architecture holds promise for real-world deployment in clinical decision support systems. Future work will explore synchronized training techniques, a larger pool of diseases for more generalizability, and extending the model for segmentation tasks.

Significant advancements in AI-driven multimodal medical image diagnosis have led to substantial improvements in ophthalmic disease identification in recent years. However, acquiring paired multimodal ophthalmic images remains prohibitively expensive. While fundus photography is simple and cost-effective, the limited availability of OCT data and inherent modality imbalance hinder further progress. Conventional approaches that rely solely on fundus or textual features often fail to capture fine-grained spatial information, as each imaging modality provides distinct cues about lesion predilection sites. In this study, we propose a novel unpaired multimodal framework \UOPSL that utilizes extensive OCT-derived spatial priors to dynamically identify predilection sites, enhancing fundus image-based disease recognition. Our approach bridges unpaired fundus and OCTs via extended disease text descriptions. Initially, we employ contrastive learning on a large corpus of unpaired OCT and fundus images while simultaneously learning the predilection sites matrix in the OCT latent space. Through extensive optimization, this matrix captures lesion localization patterns within the OCT feature space. During the fine-tuning or inference phase of the downstream classification task based solely on fundus images, where paired OCT data is unavailable, we eliminate OCT input and utilize the predilection sites matrix to assist in fundus image classification learning. Extensive experiments conducted on 9 diverse datasets across 28 critical categories demonstrate that our framework outperforms existing benchmarks.

Ophthalmic diseases pose a significant global health burden. However, traditional diagnostic methods and existing monocular image-based deep learning approaches often overlook the pathological correlations between the two eyes. In practical medical robotic diagnostic scenarios, paired retinal images (binocular fundus images) are frequently required as diagnostic evidence. To address this, we propose DMS-Net-a dual-modal multi-scale siamese network for binocular retinal image classification. The framework employs a weight-sharing siamese ResNet-152 architecture to concurrently extract deep semantic features from bilateral fundus images. To tackle challenges like indistinct lesion boundaries and diffuse pathological distributions, we introduce the OmniPool Spatial Integrator Module (OSIM), which achieves multi-resolution feature aggregation through multi-scale adaptive pooling and spatial attention mechanisms. Furthermore, the Calibrated Analogous Semantic Fusion Module (CASFM) leverages spatial-semantic recalibration and bidirectional attention mechanisms to enhance cross-modal interaction, aggregating modality-agnostic representations of fundus structures. To fully exploit the differential semantic information of lesions present in bilateral fundus features, we introduce the Cross-Modal Contrastive Alignment Module (CCAM). Additionally, to enhance the aggregation of lesion-correlated semantic information, we introduce the Cross-Modal Integrative Alignment Module (CIAM). Evaluation on the ODIR-5K dataset demonstrates that DMS-Net achieves state-of-the-art performance with an accuracy of 82.9%, recall of 84.5%, and a Cohen's kappa coefficient of 83.2%, showcasing robust capacity in detecting symmetrical pathologies and improving clinical decision-making for ocular diseases. Code and the processed dataset will be released subsequently.