Soumili Ghosh, Debapriya Roy, Aryan Das +1cs.CV cs.AI
Precise segmentation of the optic disc and cup is critical for the early detection and diagnosis of glaucoma. However, achieving consistently high performance across datasets while maintaining low computational requirements remains a significant challenge. In glaucoma detection, low-computation methods are crucial for enabling rapid, large-scale screening and facilitating deployment in resource-limited clinical environments. While deep learning models such as UNets, Vision Transformers (ViTs), and Diffusion models have demonstrated strong segmentation performance but these methods often come with substantial computational overhead. UNets are efficient at capturing local features but are limited in modeling global contextual information. Conversely, ViTs excel at long-range dependency modeling but are computationally intensive. Hybrid architectures, such as UNetR, which combine transformer-based encoders with UNet-style decoders, have shown improved performance but while incurring additional complexity. Considering these, in this work, we propose OptiModNet, a light weight novel hybrid architecture tailored for optic disc and cup segmentation. The model integrates diverse attention mechanisms at multiple stages of the network to enhance both local and global feature representation. We include an Aggregated Pyramid Loss that supervises predictions at multiple decoder depths, to promote better gradient flow and structural consistency. We evaluate OptiModNet on the REFUGE2 dataset for both optic disc and cup segmentation tasks. Our method achieves state-of-the-art performance, exceeding existing approaches by over 2.5\%, while maintaining high efficiency with only 3.73 GFLOPs and 1.93M parameters. The code is available at https://github.com/SG1947/OptiModNet.
Large language models (LLMs) show promise in medical image interpretation but suffer from hallucination, limited accuracy, and run-to-run inconsistency. We developed and validated an agentic AI framework integrating LLMs with specialized deep learning tools for glaucoma detection from fundus photography. The workflow had three steps: (1) LLM initial assessment; (2) function calling to invoke specialized tools for image quality (QAModel, FundaQ-8), glaucoma classification (SwinV2-Tiny), and optic disc/cup segmentation (SegFormer-B0); and (3) LLM reflection integrating the initial impression with tool outputs. Two LLMs (Gemini 2.5 Flash, GPT-5.4 mini) were evaluated on two public datasets (ORIGA, n=100; RIM-ONE-v3, n=100) under uncropped and cropped fields of view; all images were independently graded by a masked fellowship-trained glaucoma specialist. The agentic workflow improved classification accuracy by 16 to 47 percentage points across all conditions, reaching within 6 points of the specialist; on RIM-ONE-v3 the best configurations matched the specialist accuracy of 88%. LLM-alone approaches failed in two ways: GPT-5.4 mini showed positive bias (sensitivity 95-100%, specificity 0-5%), while Gemini 2.5 Flash varied stochastically between runs; the agentic workflow corrected both. Cup-to-disc ratio error fell 15-50% (MAE 0.156-0.228 to 0.104-0.132), and correlation with specialist grading rose from weak (r=0.12-0.39) to moderate-strong (r=0.59-0.84). Run-to-run consistency rose from near-random (kappa as low as -0.01) to near-perfect (kappa up to 0.96). Integrating LLMs with specialized tools addressed key limitations of LLM-alone approaches, including over-diagnosis and run-to-run variability. Gains held for both LLMs, suggesting generalizability across backbones, and may signal a shift from monolithic models toward orchestrated multi-agent systems in medical AI.
Sai Venkatesh Chilukoti, Krishna Rauniyar, Min Shi +1cs.CV cs.AI
Glaucoma is a group of eye diseases that damage the optic nerve, often caused by elevated intraocular pressure. It is a leading cause of irreversible vision loss and is typically developed slowly and painlessly, making it difficult to notice until significant damage has occurred. Therefore, early detection is crucial to prevent or slow the progression of vision loss. In recent years, deep learning based uni-modal models have improved the accuracy and efficiency of glaucoma detection, empowering doctors with tools for earlier diagnosis, better monitoring, and timely treatment. Building on this, multi-modal models have emerged, leveraging the strengths of different imaging modalities to learn richer and more robust representations, further enhancing glaucoma detection accuracy. However, multi-modal learning faces challenges such as imbalanced and under-optimized uni-modal representations due to joint learning objectives. To address this, we propose a balanced soft mixture-experts model with three experts and load balancing loss. The performance is measured by AUC, our proposed method surpasses the performance of all uni-modal baselines, conventional multi-modal models, and current stateof- the-art balanced multi-modal models. The proposed model can be generalized to other disease detections such as diabetic retinopathy.
Ishrat Jahan, Muhammad E. H Chowdhury, Murugappan Murugappan +7cs.CV
Glaucoma is a progressive eye disease that can lead to irreversible vision loss if not detected at an early stage. Conventional diagnostic procedures are often time-consuming and rely heavily on expert interpretation, limiting their scalability for large-scale screening. In this study, glaucoma detection is investigated under two evaluation settings: sample-wise, where individual samples are analyzed independently, and patient-wise, where data from each patient are aggregated for final prediction. An automated multimodal framework is proposed that integrates fundus images with clinical data. Under the sample-wise setting, detection is performed using fundus images and clinical features individually, as well as through their multimodal combination. Under the patient-wise setting, predictions are obtained by aggregating multiple fundus image representations with corresponding clinical information for each patient. Deep visual features are extracted using a Vision Transformer (ViT) architecture and classified using classical machine-learning models, with a stacking-based ensemble of the three best-performing classifiers employed to optimize performance. Experiments conducted on the publicly available PAPILA dataset demonstrate strong diagnostic performance, achieving 97.47% accuracy and a 97.50% F1-score for sample-wise multimodal classification, and 98.97% accuracy and F1-score for subject-wise detection. The proposed framework is further deployed as an end-to-end web-based platform to support automated glaucoma screening and clinical decision support.
This work proposes an integrated pipeline for automatic glaucoma detection method from easily available colour fundas images based on an adaptive algorithm for ellipse-based polar transformation, to enhance the analysis of the Retinal Nerve Fiber Layer (RNFL) as the primary biomarker for observing glaucomatous changes, regardless of optic disc and macula position. Utilizing this transformation, we introduce two distinct frameworks tailored to different operational needs. The first framework, a deep learning-inspired feature fusion approach, achieves a 99.3% detection rate, ideal for settings where high precision is essential, despite higher computational demands. The second framework employs a novel image-processing algorithm based on bit-plane slicing, offering 92.31% accuracy and optimized for environments requiring rapid inference with minimal resource consumption. Both frameworks provide scalable and cost-effective solutions for early glaucoma detection. This study highlights the potential of RNFL-based diagnostic tools in addressing the global challenge of glaucoma, particularly in underserved regions.
Automated glaucoma detection is critical for preventing irreversible vision loss and reducing the burden on healthcare systems. However, ensuring fairness across diverse patient populations remains a significant challenge. In this paper, we propose FairEnc, a fair pretraining method for vision-language models (VLMs) that enables simultaneous debiasing across multiple sensitive attributes. FairEnc jointly mitigates biases in both textual and visual modalities with respect to multiple sensitive attributes, including race, gender, ethnicity, and language. Specifically, for the textual encoder, we leverage a large language model to generate synthetic clinical descriptions with varied sensitive attributes while preserving disease semantics, and employ a contrastive alignment objective to encourage demographic-invariant representations. For the visual encoder, we propose a dual-level fairness strategy that combines mutual information regularization to reduce statistical dependence between learned features and demographic groups, with multi-discriminator adversarial debiasing. Comprehensive experiments on the publicly available Harvard-FairVLMed dataset demonstrate that FairEnc effectively reduces demographic disparity as measured by DPD and DEOdds while achieving strong diagnostic performance under both zero-shot and linear probing evaluations. Additional experiments on the private FairFundus dataset show that FairEnc consistently preserves fairness advantages under cross-domain and cross-modality settings and maintains diagnostic performance within a competitive range. These results highlight FairEnc's ability to generalize fairness under distribution shifts, supporting its potential for more equitable deployment in real-world clinical settings. Our codebase and synthetic clinical notes are available at https://github.com/Mohamed-Elhabebe/FairEnc