Robust retinal biometrics for patient identity verification and retrieval across age and imaging devices

Patient identity errors can compromise longitudinal medical records, research databases, and downstream clinical decisions. We present a retinal biometric system for verifying claimed identities and retrieving the correct identity from color fundus images. We trained a 512-dimensional metric-learning encoder combining a ConvNeXtV2 backbone with ArcFace and triplet losses on 227,004 images from 21,851 patient-eye identities in the Rotterdam Study, spanning multiple imaging devices and up to 32.6 years of follow-up. The system was evaluated on held-out Rotterdam Study data and externally on the UK Biobank and Age-Related Eye Disease Study (AREDS). Before evaluation, we used the model to screen for identity inconsistencies and manually adjudicated flagged images, identifying incorrect assignments in 0.588% of Rotterdam Study images, 0.259% of UK Biobank images, and 0.164% of AREDS images. In retrospective-only verification after removing near-duplicate images, the system achieved AUROCs of 0.9998, 0.9997, and 0.9998 in the Rotterdam Study, UK Biobank, and AREDS, respectively. For identity retrieval using only previously acquired images, Recall@1 was 99.7%, 97.2%, and 97.6%, respectively, from galleries averaging 4436-8510 identities; the correct identity appeared among the top five results in at least 98.6% of cases. Performance remained robust across imaging devices and long follow-up intervals, while lower image quality and inconsistent retinal fields accounted for most failures. These findings establish retinal anatomy as a durable biometric signal, useful for safeguarding the integrity of longitudinal imaging records.

Algorithmic statistics of retinal images

There has been a tremendous amount of image processing and machine learning research to measure and classify disease progression from live optical coherence tomography (OCT) imaging of the retina. The images considered here are large, complex, three-dimensional (3-D) and difficult to visualize effectively. Many current supervised machine learning approaches, \emph{e.g.} neural networks, are non-metric meaning that any features or measurements generated can introduce systematic distortion that may be correlated with underlying non-meaningful physiological differences. Here we present a metric learning approach using the normalized compression distance (NCD) combined with anisotropic structure-enhancing filters to quantify and visualize the principal differences among a collection of 3-D retinal images. We validate the NCD-measured structural differences between pairs of images against the physician-measured change in visual field function, achieving a prediction error of $\sim$ 0.5 dB, more accurate than non-metric deep learning approaches. The normalized compression vectors (NCV) are proposed as a feature set measuring visual differences among a collection of 3-D microscopy images. The utility of the NCV for visualizing and measuring patterns of change is demonstrated for a human with moderate non-progressing glaucoma and for a non-human primate model using intraocular pressure setting manipulation. We conclude with a brief simulation of non-metric embedding features, \emph{e.g.} from neural networks, introducing class-correlated statistical distortion.