Chad A. Purnell

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.

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.