Oana Dumitrașcu

Wenhui Zhu, Peijie Qiu, Xiwen Chen et al.

Over the past few decades, convolutional neural networks (CNNs) have been at the forefront of the detection and tracking of various retinal diseases (RD). Despite their success, the emergence of vision transformers (ViT) in the 2020s has shifted the trajectory of RD model development. The leading-edge performance of ViT-based models in RD can be largely credited to their scalability-their ability to improve as more parameters are added. As a result, ViT-based models tend to outshine traditional CNNs in RD applications, albeit at the cost of increased data and computational demands. ViTs also differ from CNNs in their approach to processing images, working with patches rather than local regions, which can complicate the precise localization of small, variably presented lesions in RD. In our study, we revisited and updated the architecture of a CNN model, specifically MobileNet, to enhance its utility in RD diagnostics. We found that an optimized MobileNet, through selective modifications, can surpass ViT-based models in various RD benchmarks, including diabetic retinopathy grading, detection of multiple fundus diseases, and classification of diabetic macular edema. The code is available at https://github.com/Retinal-Research/NN-MOBILENET

Vamsi Krishna Vasa, Peijie Qiu, Wenhui Zhu et al.

Retinal fundus photography offers a non-invasive way to diagnose and monitor a variety of retinal diseases, but is prone to inherent quality glitches arising from systemic imperfections or operator/patient-related factors. However, high-quality retinal images are crucial for carrying out accurate diagnoses and automated analyses. The fundus image enhancement is typically formulated as a distribution alignment problem, by finding a one-to-one mapping between a low-quality image and its high-quality counterpart. This paper proposes a context-informed optimal transport (OT) learning framework for tackling unpaired fundus image enhancement. In contrast to standard generative image enhancement methods, which struggle with handling contextual information (e.g., over-tampered local structures and unwanted artifacts), the proposed context-aware OT learning paradigm better preserves local structures and minimizes unwanted artifacts. Leveraging deep contextual features, we derive the proposed context-aware OT using the earth mover's distance and show that the proposed context-OT has a solid theoretical guarantee. Experimental results on a large-scale dataset demonstrate the superiority of the proposed method over several state-of-the-art supervised and unsupervised methods in terms of signal-to-noise ratio, structural similarity index, as well as two downstream tasks. The code is available at \url{https://github.com/Retinal-Research/Contextual-OT}.

Wenhui Zhu, Peijie Qiu, Mohammad Farazi et al.

Real-world non-mydriatic retinal fundus photography is prone to artifacts, imperfections and low-quality when certain ocular or systemic co-morbidities exist. Artifacts may result in inaccuracy or ambiguity in clinical diagnoses. In this paper, we proposed a simple but effective end-to-end framework for enhancing poor-quality retinal fundus images. Leveraging the optimal transport theory, we proposed an unpaired image-to-image translation scheme for transporting low-quality images to their high-quality counterparts. We theoretically proved that a Generative Adversarial Networks (GAN) model with a generator and discriminator is sufficient for this task. Furthermore, to mitigate the inconsistency of information between the low-quality images and their enhancements, an information consistency mechanism was proposed to maximally maintain structural consistency (optical discs, blood vessels, lesions) between the source and enhanced domains. Extensive experiments were conducted on the EyeQ dataset to demonstrate the superiority of our proposed method perceptually and quantitatively.

Wenhui Zhu, Peijie Qiu, Oana M. Dumitrascu et al.

Non-mydriatic retinal color fundus photography (CFP) is widely available due to the advantage of not requiring pupillary dilation, however, is prone to poor quality due to operators, systemic imperfections, or patient-related causes. Optimal retinal image quality is mandated for accurate medical diagnoses and automated analyses. Herein, we leveraged the Optimal Transport (OT) theory to propose an unpaired image-to-image translation scheme for mapping low-quality retinal CFPs to high-quality counterparts. Furthermore, to improve the flexibility, robustness, and applicability of our image enhancement pipeline in the clinical practice, we generalized a state-of-the-art model-based image reconstruction method, regularization by denoising, by plugging in priors learned by our OT-guided image-to-image translation network. We named it as regularization by enhancing (RE). We validated the integrated framework, OTRE, on three publicly available retinal image datasets by assessing the quality after enhancement and their performance on various downstream tasks, including diabetic retinopathy grading, vessel segmentation, and diabetic lesion segmentation. The experimental results demonstrated the superiority of our proposed framework over some state-of-the-art unsupervised competitors and a state-of-the-art supervised method.

Wenhui Zhu, Peijie Qiu, Xiwen Chen et al.

Multiple instance learning (MIL) was a weakly supervised learning approach that sought to assign binary class labels to collections of instances known as bags. However, due to their weak supervision nature, the MIL methods were susceptible to overfitting and required assistance in developing comprehensive representations of target instances. While regularization typically effectively combated overfitting, its integration with the MIL model has been frequently overlooked in prior studies. Meanwhile, current regularization methods for MIL have shown limitations in their capacity to uncover a diverse array of representations. In this study, we delve into the realm of regularization within the MIL model, presenting a novel approach in the form of a Progressive Dropout Layer (PDL). We aim to not only address overfitting but also empower the MIL model in uncovering intricate and impactful feature representations. The proposed method was orthogonal to existing MIL methods and could be easily integrated into them to boost performance. Our extensive evaluation across a range of MIL benchmark datasets demonstrated that the incorporation of the PDL into multiple MIL methods not only elevated their classification performance but also augmented their potential for weakly-supervised feature localizations.

Xin Li, Wenhui Zhu, Xuanzhao Dong et al.

Retinal imaging is a critical, non-invasive modality for the early detection and monitoring of ocular and systemic diseases. Deep learning, particularly convolutional neural networks (CNNs), has significant progress in automated retinal analysis, supporting tasks such as fundus image classification, lesion detection, and vessel segmentation. As a representative lightweight network, nnMobileNet has demonstrated strong performance across multiple retinal benchmarks while remaining computationally efficient. However, purely convolutional architectures inherently struggle to capture long-range dependencies and model the irregular lesions and elongated vascular patterns that characterize on retinal images, despite the critical importance of vascular features for reliable clinical diagnosis. To further advance this line of work and extend the original vision of nnMobileNet, we propose nnMobileNet++, a hybrid architecture that progressively bridges convolutional and transformer representations. The framework integrates three key components: (i) dynamic snake convolution for boundary-aware feature extraction, (ii) stage-specific transformer blocks introduced after the second down-sampling stage for global context modeling, and (iii) retinal image pretraining to improve generalization. Experiments on multiple public retinal datasets for classification, together with ablation studies, demonstrate that nnMobileNet++ achieves state-of-the-art or highly competitive accuracy while maintaining low computational cost, underscoring its potential as a lightweight yet effective framework for retinal image analysis.

Wenhui Zhu, Xin Li, Xiwen Chen et al.

Recently, Multimodal Large Language Models (MLLMs) have gained significant attention for their remarkable ability to process and analyze non-textual data, such as images, videos, and audio. Notably, several adaptations of general-domain MLLMs to the medical field have been explored, including LLaVA-Med. However, these medical adaptations remain insufficiently advanced in understanding and interpreting retinal images. In contrast, medical experts emphasize the importance of quantitative analyses for disease detection and interpretation. This underscores a gap between general-domain and medical-domain MLLMs: while general-domain MLLMs excel in broad applications, they lack the specialized knowledge necessary for precise diagnostic and interpretative tasks in the medical field. To address these challenges, we introduce \textit{RetinalGPT}, a multimodal conversational assistant for clinically preferred quantitative analysis of retinal images. Specifically, we achieve this by compiling a large retinal image dataset, developing a novel data pipeline, and employing customized visual instruction tuning to enhance both retinal analysis and enrich medical knowledge. In particular, RetinalGPT outperforms MLLM in the generic domain by a large margin in the diagnosis of retinal diseases in 8 benchmark retinal datasets. Beyond disease diagnosis, RetinalGPT features quantitative analyses and lesion localization, representing a pioneering step in leveraging LLMs for an interpretable and end-to-end clinical research framework. The code is available at https://github.com/Retinal-Research/RetinalGPT

Wenhui Zhu, Xuanzhao Dong, Xin Li et al.

Over the past decade, generative models have achieved significant success in enhancement fundus images.However, the evaluation of these models still presents a considerable challenge. A comprehensive evaluation benchmark for fundus image enhancement is indispensable for three main reasons: 1) The existing denoising metrics (e.g., PSNR, SSIM) are hardly to extend to downstream real-world clinical research (e.g., Vessel morphology consistency). 2) There is a lack of comprehensive evaluation for both paired and unpaired enhancement methods, along with the need for expert protocols to accurately assess clinical value. 3) An ideal evaluation system should provide insights to inform future developments of fundus image enhancement. To this end, we propose a novel comprehensive benchmark, EyeBench, to provide insights that align enhancement models with clinical needs, offering a foundation for future work to improve the clinical relevance and applicability of generative models for fundus image enhancement. EyeBench has three appealing properties: 1) multi-dimensional clinical alignment downstream evaluation: In addition to evaluating the enhancement task, we provide several clinically significant downstream tasks for fundus images, including vessel segmentation, DR grading, denoising generalization, and lesion segmentation. 2) Medical expert-guided evaluation design: We introduce a novel dataset that promote comprehensive and fair comparisons between paired and unpaired methods and includes a manual evaluation protocol by medical experts. 3) Valuable insights: Our benchmark study provides a comprehensive and rigorous evaluation of existing methods across different downstream tasks, assisting medical experts in making informed choices. Additionally, we offer further analysis of the challenges faced by existing methods. The code is available at \url{https://github.com/Retinal-Research/EyeBench}

Xin Li, Wenhui Zhu, Xuanzhao Dong et al.

With the rapid development of deep learning, CNN-based U-shaped networks have succeeded in medical image segmentation and are widely applied for various tasks. However, their limitations in capturing global features hinder their performance in complex segmentation tasks. The rise of Vision Transformer (ViT) has effectively compensated for this deficiency of CNNs and promoted the application of ViT-based U-networks in medical image segmentation. However, the high computational demands of ViT make it unsuitable for many medical devices and mobile platforms with limited resources, restricting its deployment on resource-constrained and edge devices. To address this, we propose EViT-UNet, an efficient ViT-based segmentation network that reduces computational complexity while maintaining accuracy, making it ideal for resource-constrained medical devices. EViT-UNet is built on a U-shaped architecture, comprising an encoder, decoder, bottleneck layer, and skip connections, combining convolutional operations with self-attention mechanisms to optimize efficiency. Experimental results demonstrate that EViT-UNet achieves high accuracy in medical image segmentation while significantly reducing computational complexity.

Hao Wang, Wenhui Zhu, Xuanzhao Dong et al.

In this work, we propose Many-MobileNet, an efficient model fusion strategy for retinal disease classification using lightweight CNN architecture. Our method addresses key challenges such as overfitting and limited dataset variability by training multiple models with distinct data augmentation strategies and different model complexities. Through this fusion technique, we achieved robust generalization in data-scarce domains while balancing computational efficiency with feature extraction capabilities.