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.

This study introduces the Hybrid Multi-modal VGG (HM-VGG) model, a cutting-edge deep learning approach for the early diagnosis of glaucoma. The HM-VGG model utilizes an attention mechanism to process Visual Field (VF) data, enabling the extraction of key features that are vital for identifying early signs of glaucoma. Despite the common reliance on large annotated datasets, the HM-VGG model excels in scenarios with limited data, achieving remarkable results with small sample sizes. The model's performance is underscored by its high metrics in Precision, Accuracy, and F1-Score, indicating its potential for real-world application in glaucoma detection. The paper also discusses the challenges associated with ophthalmic image analysis, particularly the difficulty of obtaining large volumes of annotated data. It highlights the importance of moving beyond single-modality data, such as VF or Optical Coherence Tomography (OCT) images alone, to a multimodal approach that can provide a richer, more comprehensive dataset. This integration of different data types is shown to significantly enhance diagnostic accuracy. The HM- VGG model offers a promising tool for doctors, streamlining the diagnostic process and improving patient outcomes. Furthermore, its applicability extends to telemedicine and mobile healthcare, making diagnostic services more accessible. The research presented in this paper is a significant step forward in the field of medical image processing and has profound implications for clinical ophthalmology.

The diagnosis of glaucoma plays a critical role in the management and treatment of this vision-threatening disease. Glaucoma is a group of eye diseases that cause blindness by damaging the optic nerve at the back of the eye. Often called "silent thief of sight", it exhibits no symptoms during the early stages. Therefore, early detection is crucial to prevent vision loss. With the rise of Artificial Intelligence (AI), particularly Deep Learning (DL) techniques, Computer-Aided Diagnosis (CADx) systems have emerged as promising tools to assist clinicians in accurately diagnosing glaucoma early. This paper aims to provide a comprehensive overview of AI techniques utilized in CADx systems for glaucoma diagnosis. Through a detailed analysis of current literature, we identify key gaps and challenges in these systems, emphasizing the need for improved safety, reliability, interpretability, and explainability. By identifying research gaps, we aim to advance the field of CADx systems especially for the early diagnosis of glaucoma, in order to prevent any potential loss of vision.

Glaucoma is a leading cause of irreversible blindness worldwide. While deep learning approaches using fundus images have largely improved early diagnosis of glaucoma, variations in images from different devices and locations (known as domain shifts) challenge the use of pre-trained models in real-world settings. To address this, we propose a novel Graph-guided Test-Time Adaptation (GTTA) framework to generalize glaucoma diagnosis models to unseen test environments. GTTA integrates the topological information of fundus images into the model training, enhancing the model's transferability and reducing the risk of learning spurious correlation. During inference, GTTA introduces a novel test-time training objective to make the source-trained classifier progressively adapt to target patterns with reliable class conditional estimation and consistency regularization. Experiments on cross-domain glaucoma diagnosis benchmarks demonstrate the superiority of the overall framework and individual components under different backbone networks.

Precis: A hybrid deep-learning model combines NFL reflectance and other OCT parameters to improve glaucoma diagnosis. Objective: To investigate if a deep learning model could be used to combine nerve fiber layer (NFL) reflectance and other OCT parameters for glaucoma diagnosis. Patients and Methods: This is a prospective observational study where of 106 normal subjects and 164 perimetric glaucoma (PG) patients. Peripapillary NFL reflectance map, NFL thickness map, optic head analysis of disc, and macular ganglion cell complex thickness were obtained using spectral domain OCT. A hybrid deep learning model combined a fully connected network (FCN) and a convolution neural network (CNN) to develop and combine those OCT maps and parameters to distinguish normal and PG eyes. Two deep learning models were compared based on whether the NFL reflectance map was used as part of the input or not. Results: The hybrid deep learning model with reflectance achieved 0.909 sensitivity at 99% specificity and 0.926 at 95%. The overall accuracy was 0.948 with 0.893 sensitivity and 1.000 specificity, and the AROC was 0.979, which is significantly better than the logistic regression models (p < 0.001). The second best model is the hybrid deep learning model w/o reflectance, which also had significantly higher AROC than logistic regression models (p < 0.001). Logistic regression with reflectance model had slightly higher AROC or sensitivity than the other logistic regression model without reflectance (p = 0.024). Conclusions: Hybrid deep learning model significantly improved the diagnostic accuracy, without or without NFL reflectance. Hybrid deep learning model, combining reflectance/NFL thickness/GCC thickness/ONH parameter, may be a practical model for glaucoma screen purposes.

Glaucoma is the leading cause of irreversible blindness worldwide and poses significant diagnostic challenges due to its reliance on subjective evaluation. However, recent advances in computer vision and deep learning have demonstrated the potential for automated assessment. In this paper, we survey recent studies on AI-based glaucoma diagnosis using fundus, optical coherence tomography, and visual field images, with a particular emphasis on deep learning-based methods. We provide an updated taxonomy that organizes methods into architectural paradigms and includes links to available source code to enhance the reproducibility of the methods. Through rigorous benchmarking on widely-used public datasets, we reveal performance gaps in generalizability, uncertainty estimation, and multimodal integration. Additionally, our survey curates key datasets while highlighting limitations such as scale, labeling inconsistencies, and bias. We outline open research challenges and detail promising directions for future studies. This survey is expected to be useful for both AI researchers seeking to translate advances into practice and ophthalmologists aiming to improve clinical workflows and diagnosis using the latest AI outcomes.

With the advancement of deep learning techniques, an increasing number of methods have been proposed for optic disc and cup (OD/OC) segmentation from the fundus images. Clinically, OD/OC segmentation is often annotated by multiple clinical experts to mitigate the personal bias. However, it is hard to train the automated deep learning models on multiple labels. A common practice to tackle the issue is majority vote, e.g., taking the average of multiple labels. However such a strategy ignores the different expertness of medical experts. Motivated by the observation that OD/OC segmentation is often used for the glaucoma diagnosis clinically, in this paper, we propose a novel strategy to fuse the multi-rater OD/OC segmentation labels via the glaucoma diagnosis performance. Specifically, we assess the expertness of each rater through an attentive glaucoma diagnosis network. For each rater, its contribution for the diagnosis will be reflected as an expertness map. To ensure the expertness maps are general for different glaucoma diagnosis models, we further propose an Expertness Generator (ExpG) to eliminate the high-frequency components in the optimization process. Based on the obtained expertness maps, the multi-rater labels can be fused as a single ground-truth which we dubbed as Diagnosis First Ground-truth (DiagFirstGT). Experimental results show that by using DiagFirstGT as ground-truth, OD/OC segmentation networks will predict the masks with superior glaucoma diagnosis performance.

Purpose: To assess whether the three-dimensional (3D) structural configuration of the central retinal vessel trunk and its branches (CRVT&B) could be used as a diagnostic marker for glaucoma. Method: We trained a deep learning network to automatically segment the CRVT&B from the B-scans of the optical coherence tomography (OCT) volume of the optic nerve head (ONH). Subsequently, two different approaches were used for glaucoma diagnosis using the structural configuration of the CRVT&B as extracted from the OCT volumes. In the first approach, we aimed to provide a diagnosis using only 3D CNN and the 3D structure of the CRVT&B. For the second approach, we projected the 3D structure of the CRVT&B orthographically onto three planes to obtain 2D images, and then a 2D CNN was used for diagnosis. The segmentation accuracy was evaluated using the Dice coefficient, whereas the diagnostic accuracy was assessed using the area under the receiver operating characteristic curves (AUC). The diagnostic performance of the CRVT&B was also compared with that of retinal nerve fiber layer (RNFL) thickness. Results: Our segmentation network was able to efficiently segment retinal blood vessels from OCT scans. On a test set, we achieved a Dice coefficient of 0.81\pm0.07. The 3D and 2D diagnostic networks were able to differentiate glaucoma from non-glaucoma subjects with accuracies of 82.7% and 83.3%, respectively. The corresponding AUCs for CRVT&B were 0.89 and 0.90, higher than those obtained with RNFL thickness alone. Conclusions: Our work demonstrated that the diagnostic power of the CRVT&B is superior to that of a gold-standard glaucoma parameter, i.e., RNFL thickness. Our work also suggested that the major retinal blood vessels form a skeleton -- the configuration of which may be representative of major ONH structural changes as typically observed with the development and progression of glaucoma.

Convolutional neural networks (CNNs) are a promising technique for automated glaucoma diagnosis from images of the fundus, and these images are routinely acquired as part of an ophthalmic exam. Nevertheless, CNNs typically require a large amount of well-labeled data for training, which may not be available in many biomedical image classification applications, especially when diseases are rare and where labeling by experts is costly. This paper makes two contributions to address this issue: (1) It introduces a new network architecture and training method for low-shot learning when labeled data are limited and imbalanced, and (2) it introduces a new semi-supervised learning strategy that uses additional unlabeled training data to achieve great accuracy. Our multi-task twin neural network (MTTNN) can use any backbone CNN, and we demonstrate with ResNet-50 and MobileNet-v2 that its accuracy with limited training data approaches the accuracy of a finetuned backbone trained with a dataset that is 50 times larger. We also introduce One-Vote Veto (OVV) self-training, a semi-supervised learning strategy, that is designed specifically for MTTNNs. By taking both self-predictions and contrastive-predictions of the unlabeled training data into account, OVV self-training provides additional pseudo labels for finetuning a pretrained MTTNN. Using a large dataset with more than 50,000 fundus images acquired over 25 years, extensive experimental results demonstrate the effectiveness of low-shot learning with MTTNN and semi-supervised learning with OVV. Three additional, smaller clinical datasets of fundus images acquired under different conditions (cameras, instruments, locations, populations), are used to demonstrate generalizability of the methods. Source code and pretrained models will be publicly available upon publication.

Could a computer one day beat the best ophthalmologists in diagnosing glaucoma? Not soon, but that day may be just around the corner. Computers already using artificial intelligence (AI) have equaled dermatologists in diagnosing skin cancer and nearly matched retina specialists in recognizing diabetic retinopathy from fundus images. In his presentation, "New Innovations in Hacking Glaucoma," during the Glaucoma Symposium at the 2017 Glaucoma 360 meeting, Robert Chang, MD, an assistant professor of ophthalmology, Stanford University, outlined how the technology might work. Dr. Chang is developing AI for glaucoma.