George R. Nahass

George R. Nahass, Emma Koehler, Nicholas Tomaras et al.

Periorbital segmentation and distance prediction using deep learning allows for the objective quantification of disease state, treatment monitoring, and remote medicine. However, there are currently no reports of segmentation datasets for the purposes of training deep learning models with sub mm accuracy on the regions around the eyes. All images (n=2842) had the iris, sclera, lid, caruncle, and brow segmented by five trained annotators. Here, we validate this dataset through intra and intergrader reliability tests and show the utility of the data in training periorbital segmentation networks. All the annotations are publicly available for free download. Having access to segmentation datasets designed specifically for oculoplastic surgery will permit more rapid development of clinically useful segmentation networks which can be leveraged for periorbital distance prediction and disease classification. In addition to the annotations, we also provide an open-source toolkit for periorbital distance prediction from segmentation masks. The weights of all models have also been open-sourced and are publicly available for use by the community.

George R. Nahass, Sasha Hubschman, Jeffrey C. Peterson et al.

Periorbital distances are critical markers for diagnosing and monitoring a range of oculoplastic and craniofacial conditions. Manual measurement, however, is subjective and prone to intergrader variability. Automated methods have been developed but remain limited by standardized imaging requirements, small datasets, and a narrow focus on individual measurements. We developed a segmentation pipeline trained on a domain-specific dataset of healthy eyes and compared its performance against the Segment Anything Model (SAM) and the prior benchmark, PeriorbitAI. Segmentation accuracy was evaluated across multiple disease classes and imaging conditions. We further investigated the use of predicted periorbital distances as features for disease classification under in-distribution (ID) and out-of-distribution (OOD) settings, comparing shallow classifiers, CNNs, and fusion models. Our segmentation model achieved state-of-the-art accuracy across all datasets, with error rates within intergrader variability and superior performance relative to SAM and PeriorbitAI. In classification tasks, models trained on periorbital distances matched CNN performance on ID data (77--78\% accuracy) and substantially outperformed CNNs under OOD conditions (63--68\% accuracy vs. 14\%). Fusion models achieved the highest ID accuracy (80\%) but were sensitive to degraded CNN features under OOD shifts. Segmentation-derived periorbital distances provide robust, explainable features for disease classification and generalize better under domain shift than CNN image classifiers. These results establish a new benchmark for periorbital distance prediction and highlight the potential of anatomy-based AI pipelines for real-world deployment in oculoplastic and craniofacial care.

Mahtab Faraji, Homa Rashidisabet, George R. Nahass et al.

Here, we examine the latest advances in glaucoma detection through Deep Learning (DL) algorithms using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). This study focuses on three aspects of DL-based glaucoma detection frameworks: input data modalities, processing strategies, and model architectures and applications. Moreover, we analyze trends in employing each aspect since the onset of DL in this field. Finally, we address current challenges and suggest future research directions.

George R. Nahass, Zhu Wang, Homa Rashidisabet et al.

Machine unlearning aims to remove the influence of specific training samples from a trained model without full retraining. While prior work has largely focused on privacy-motivated settings, we recast unlearning as a general-purpose tool for post-deployment model revision. Specifically, we focus on utilizing unlearning in clinical contexts where data shifts, device deprecation, and policy changes are common. To this end, we propose a bilevel optimization formulation of boundary-based unlearning that can be solved using iterative algorithms. We provide convergence guarantees when first-order algorithms are used to unlearn. Our method introduces tunable loss design for controlling the forgetting-retention tradeoff and supports novel model composition strategies that merge the strengths of distinct unlearning runs. Across benchmark and real-world clinical imaging datasets, our approach outperforms baselines on both forgetting and retention metrics, including scenarios involving imaging devices and anatomical outliers. This work establishes machine unlearning as a modular, practical alternative to retraining for real-world model maintenance in clinical applications.

Jeff J. H. Kim, George R. Nahass, Yang Dai et al.

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality, with lung metastases being the most common site of distant spread and significantly worsening prognosis. Despite the growing availability of clinical and demographic data, predictive models for lung metastasis in HCC remain limited in scope and clinical applicability. In this study, we develop and validate an end-to-end machine learning pipeline using data from the Surveillance, Epidemiology, and End Results (SEER) database. We evaluated three machine learning models (Random Forest, XGBoost, and Logistic Regression) alongside a multilayer perceptron (MLP) neural network. Our models achieved high AUROC values and recall, with the Random Forest and MLP models demonstrating the best overall performance (AUROC = 0.82). However, the low precision across models highlights the challenges of accurately predicting positive cases. To address these limitations, we developed a custom loss function incorporating recall optimization, enabling the MLP model to achieve the highest sensitivity. An ensemble approach further improved overall recall by leveraging the strengths of individual models. Feature importance analysis revealed key predictors such as surgery status, tumor staging, and follow up duration, emphasizing the relevance of clinical interventions and disease progression in metastasis prediction. While this study demonstrates the potential of machine learning for identifying high-risk patients, limitations include reliance on imbalanced datasets, incomplete feature annotations, and the low precision of predictions. Future work should leverage the expanding SEER dataset, improve data imputation techniques, and explore advanced pre-trained models to enhance predictive accuracy and clinical utility.