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.

Glaucoma is a progressive eye disease that leads to optic nerve damage, causing irreversible vision loss if left untreated. Optical coherence tomography (OCT) has become a crucial tool for glaucoma diagnosis, offering high-resolution 3D scans of the retina and optic nerve. However, the conventional practice of condensing information from 3D OCT volumes into 2D reports often results in the loss of key structural details. To address this, we propose a novel hybrid deep learning model that integrates cross-attention mechanisms into a 3D convolutional neural network (CNN), enabling the extraction of critical features from the superior and inferior hemiretinas, as well as from the optic nerve head (ONH) and macula, within OCT volumes. We introduce Channel Attention REpresentations (CAREs) to visualize cross-attention outputs and leverage them for consistency-based multi-task fine-tuning, aligning them with Gradient-Weighted Class Activation Maps (Grad-CAMs) from the CNN's final convolutional layer to enhance performance, interpretability, and anatomical coherence. We have named this model AI-CNet3D (AI-`See'-Net3D) to reflect its design as an Anatomically-Informed Cross-attention Network operating on 3D data. By dividing the volume along two axes and applying cross-attention, our model enhances glaucoma classification by capturing asymmetries between the hemiretinal regions while integrating information from the optic nerve head and macula. We validate our approach on two large datasets, showing that it outperforms state-of-the-art attention and convolutional models across all key metrics. Finally, our model is computationally efficient, reducing the parameter count by one-hundred--fold compared to other attention mechanisms while maintaining high diagnostic performance and comparable GFLOPS.

Purpose: To classify eyes as slow or fast glaucoma progressors in patients with primary angle closure glaucoma (PACG) using an integrated approach combining optic nerve head (ONH) structural features and sector-based visual field (VF) functional parameters. Methods: PACG patients with >5 reliable VF tests over >5 years were included. Progression was assessed in Zeiss Forum, with baseline VF within six months of OCT. Fast progression was VFI decline <-2.0% per year; slow progression >-2.0% per year. OCT volumes were AI-segmented to extract 31 ONH parameters. The Glaucoma Hemifield Test defined five regions per hemifield, aligned with RNFL distribution. Mean sensitivity per region was combined with structural parameters to train ML classifiers. Multiple models were tested, and SHAP identified key predictors. Main outcome measures: Classification of slow versus fast progressors using combined structural and functional data. Results: We analyzed 451 eyes from 299 patients. Mean VFI progression was -0.92% per year; 369 eyes progressed slowly and 82 rapidly. The Random Forest model combining structural and functional features achieved the best performance (AUC = 0.87, 2000 Monte Carlo iterations). SHAP identified six key predictors: inferior MRW, inferior and inferior-temporal RNFL thickness, nasal-temporal LC curvature, superior nasal VF sensitivity, and inferior RNFL and GCL+IPL thickness. Models using only structural or functional features performed worse with AUC of 0.82 and 0.78, respectively. Conclusions: Combining ONH structural and VF functional parameters significantly improves classification of progression risk in PACG. Inferior ONH features, MRW and RNFL thickness, were the most predictive, highlighting the critical role of ONH morphology in monitoring disease progression.

Early and accurate detection of glaucoma is critical to prevent irreversible vision loss. However, existing methods often rely on unimodal data and lack interpretability, limiting their clinical utility. In this paper, we present GlaBoost, a multimodal gradient boosting framework that integrates structured clinical features, fundus image embeddings, and expert-curated textual descriptions for glaucoma risk prediction. GlaBoost extracts high-level visual representations from retinal fundus photographs using a pretrained convolutional encoder and encodes free-text neuroretinal rim assessments using a transformer-based language model. These heterogeneous signals, combined with manually assessed risk scores and quantitative ophthalmic indicators, are fused into a unified feature space for classification via an enhanced XGBoost model. Experiments conducted on a real-world annotated dataset demonstrate that GlaBoost significantly outperforms baseline models, achieving a validation accuracy of 98.71%. Feature importance analysis reveals clinically consistent patterns, with cup-to-disc ratio, rim pallor, and specific textual embeddings contributing most to model decisions. GlaBoost offers a transparent and scalable solution for interpretable glaucoma diagnosis and can be extended to other ophthalmic disorders.

Large language models (LLMs) can simulate clinical reasoning based on natural language prompts, but their utility in ophthalmology is largely unexplored. This study evaluated GPT-4's ability to interpret structured textual descriptions of retinal fundus photographs and simulate clinical decisions for diabetic retinopathy (DR) and glaucoma screening, including the impact of adding real or synthetic clinical metadata. We conducted a retrospective diagnostic validation study using 300 annotated fundus images. GPT-4 received structured prompts describing each image, with or without patient metadata. The model was tasked with assigning an ICDR severity score, recommending DR referral, and estimating the cup-to-disc ratio for glaucoma referral. Performance was evaluated using accuracy, macro and weighted F1 scores, and Cohen's kappa. McNemar's test and change rate analysis were used to assess the influence of metadata. GPT-4 showed moderate performance for ICDR classification (accuracy 67.5%, macro F1 0.33, weighted F1 0.67, kappa 0.25), driven mainly by correct identification of normal cases. Performance improved in the binary DR referral task (accuracy 82.3%, F1 0.54, kappa 0.44). For glaucoma referral, performance was poor across all settings (accuracy ~78%, F1 <0.04, kappa <0.03). Metadata inclusion did not significantly affect outcomes (McNemar p > 0.05), and predictions remained consistent across conditions. GPT-4 can simulate basic ophthalmic decision-making from structured prompts but lacks precision for complex tasks. While not suitable for clinical use, LLMs may assist in education, documentation, or image annotation workflows in ophthalmology.

Glaucoma is an eye condition that damages the optic nerve, which can lead to vision loss or blindness. This condition affects individuals worldwide, but early glaucoma detection can help diagnose the condition faster and enhance patient treatment. Traditional diagnostic methods, such as Tonometry, Ophthalmoscopy, and Gonioscopy are costly, invasive to the eye, and require a medical specialist. However, non-invasive methods such as deep-learning approaches based on fundus images of the eye show promising results but such architectures are typically trained on single datasets, which limits their practical generalizability to different patients. In this project, we develop a convolutional neural network (CNN) model based on the EfficientNet architecture, trained sequentially across the ACRIMA, ORIGA, and RIM-ONE datasets of fundus images, to enhance diagnostic accuracy and model generalizability. By conducting experiments on the trained model and evaluating metrics such as accuracy, sensitivity, specificity, and AUC-ROC, we demonstrate this method's capability for improved glaucoma detection and its potential use in clinical data for early detection. Ultimately, our work aims to deliver an accurate, easy-to-use, and scalable model for non-invasive early glaucoma screening, which contributes to better patient treatment through timely clinical intervention.

Objective: (1) To assess whether ONH biomechanics improves prediction of three progressive visual field loss patterns in glaucoma; (2) to use explainable AI to identify strain-sensitive ONH regions contributing to these predictions. Methods: We recruited 237 glaucoma subjects. The ONH of one eye was imaged under two conditions: (1) primary gaze and (2) primary gaze with IOP elevated to ~35 mmHg via ophthalmo-dynamometry. Glaucoma experts classified the subjects into four categories based on the presence of specific visual field defects: (1) superior nasal step (N=26), (2) superior partial arcuate (N=62), (3) full superior hemifield defect (N=25), and (4) other/non-specific defects (N=124). Automatic ONH tissue segmentation and digital volume correlation were used to compute IOP-induced neural tissue and lamina cribrosa (LC) strains. Biomechanical and structural features were input to a Geometric Deep Learning model. Three classification tasks were performed to detect: (1) superior nasal step, (2) superior partial arcuate, (3) full superior hemifield defect. For each task, the data were split into 80% training and 20% testing sets. Area under the curve (AUC) was used to assess performance. Explainable AI techniques were employed to highlight the ONH regions most critical to each classification. Results: Models achieved high AUCs of 0.77-0.88, showing that ONH strain improved VF loss prediction beyond morphology alone. The inferior and inferotemporal rim were identified as key strain-sensitive regions, contributing most to visual field loss prediction and showing progressive expansion with increasing disease severity. Conclusion and Relevance: ONH strain enhances prediction of glaucomatous VF loss patterns. Neuroretinal rim, rather than the LC, was the most critical region contributing to model predictions.

Early and accurate identification of retinal ailments is crucial for averting ocular decline; however, access to dependable diagnostic devices is not often available in low-resourced settings. This project proposes to solve that by developing a lightweight, edge-device deployable disease classifier using cross-architecture knowledge distilling. We first train a high-capacity vision transformer (ViT) teacher model, pre-trained using I-JEPA self-supervised learning, to classify fundus images into four classes: Normal, Diabetic Retinopathy, Glaucoma, and Cataract. We kept an Internet of Things (IoT) focus when compressing to a CNN-based student model for deployment in resource-limited conditions, such as the NVIDIA Jetson Nano. This was accomplished using a novel framework which included a Partitioned Cross-Attention (PCA) projector, a Group-Wise Linear (GL) projector, and a multi-view robust training method. The teacher model has 97.4 percent more parameters than the student model, with it achieving 89 percent classification with a roughly 93 percent retention of the teacher model's diagnostic performance. The retention of clinical classification behavior supports our method's initial aim: compression of the ViT while retaining accuracy. Our work serves as an example of a scalable, AI-driven triage solution for retinal disorders in under-resourced areas.

Recent advances in reasoning-focused large language models (LLMs) mark a shift from general LLMs toward models designed for complex decision-making, a crucial aspect in medicine. However, their performance in specialized domains like ophthalmology remains underexplored. This study comprehensively evaluated and compared the accuracy and reasoning capabilities of four newly developed reasoning-focused LLMs, namely DeepSeek-R1, OpenAI o1, o3-mini, and Gemini 2.0 Flash-Thinking. Each model was assessed using 5,888 multiple-choice ophthalmology exam questions from the MedMCQA dataset in zero-shot setting. Quantitative evaluation included accuracy, Macro-F1, and five text-generation metrics (ROUGE-L, METEOR, BERTScore, BARTScore, and AlignScore), computed against ground-truth reasonings. Average inference time was recorded for a subset of 100 randomly selected questions. Additionally, two board-certified ophthalmologists qualitatively assessed clarity, completeness, and reasoning structure of responses to differential diagnosis questions.O1 (0.902) and DeepSeek-R1 (0.888) achieved the highest accuracy, with o1 also leading in Macro-F1 (0.900). The performance of models across the text-generation metrics varied: O3-mini excelled in ROUGE-L (0.151), o1 in METEOR (0.232), DeepSeek-R1 and o3-mini tied for BERTScore (0.673), DeepSeek-R1 (-4.105) and Gemini 2.0 Flash-Thinking (-4.127) performed best in BARTScore, while o3-mini (0.181) and o1 (0.176) led AlignScore. Inference time across the models varied, with DeepSeek-R1 being slowest (40.4 seconds) and Gemini 2.0 Flash-Thinking fastest (6.7 seconds). Qualitative evaluation revealed that DeepSeek-R1 and Gemini 2.0 Flash-Thinking tended to provide detailed and comprehensive intermediate reasoning, whereas o1 and o3-mini displayed concise and summarized justifications.

Subject of research: is the study of methods for analyzing perimetric images for the diagnosis and control of glaucoma diseases. Objects of research: is a dataset collected on the ophthalmological perimeter with the results of various patient pathologies, since the ophthalmological community is acutely aware of the issue of disease control and import substitution. [5]. Purpose of research: is to consider various machine learning methods that can classify glaucoma. This is possible thanks to the classifier built after labeling the dataset. It is able to determine from the image whether the visual fields depicted on it are the results of the impact of glaucoma on the eyes or other visual diseases. Earlier in the work [3], a dataset was described that was collected on the Tomey perimeter. The average age of the examined patients ranged from 30 to 85 years. Methods of research: machine learning methods for classifying image results (stochastic gradient descent, logistic regression, random forest, naive Bayes). Main results of research: the result of the study is computer modeling that can determine from the image whether the result is glaucoma or another disease (binary classification).