Danqi Fang

Meng Wang, Tian Lin, Qingshan Hou et al.

Artificial intelligence (AI) shows remarkable potential in medical imaging diagnostics, yet most current models require retraining when applied across different clinical settings, limiting their scalability. We introduce GlobeReady, a clinician-friendly AI platform that enables fundus disease diagnosis that operates without retraining, fine-tuning, or the needs for technical expertise. GlobeReady demonstrates high accuracy across imaging modalities: 93.9-98.5% for 11 fundus diseases using color fundus photographs (CPFs) and 87.2-92.7% for 15 fundus diseases using optic coherence tomography (OCT) scans. By leveraging training-free local feature augmentation, GlobeReady platform effectively mitigates domain shifts across centers and populations, achieving accuracies of 88.9-97.4% across five centers on average in China, 86.3-96.9% in Vietnam, and 73.4-91.0% in Singapore, and 90.2-98.9% in the UK. Incorporating a bulit-in confidence-quantifiable diagnostic mechanism further enhances the platform's accuracy to 94.9-99.4% with CFPs and 88.2-96.2% with OCT, while enabling identification of out-of-distribution cases with 86.3% accuracy across 49 common and rare fundus diseases using CFPs, and 90.6% accuracy across 13 diseases using OCT. Clinicians from countries rated GlobeReady highly for usability and clinical relevance (average score 4.6/5). These findings demonstrate GlobeReady's robustness, generalizability and potential to support global ophthalmic care without technical barriers.

Qinghua He, Hongyang Jiang, Danqi Fang et al.

Diabetic macular ischemia (DMI), marked by the loss of retinal capillaries in the macular area, contributes to vision impairment in patients with diabetes. Although color fundus photographs (CFPs), combined with artificial intelligence (AI), have been extensively applied in detecting various eye diseases, including diabetic retinopathy (DR), their applications in detecting DMI remain unexplored, partly due to skepticism among ophthalmologists regarding its feasibility. In this study, we propose a graph neural network-based multispectral view learning (GNN-MSVL) model designed to detect DMI from CFPs. The model leverages higher spectral resolution to capture subtle changes in fundus reflectance caused by ischemic tissue, enhancing sensitivity to DMI-related features. The proposed approach begins with computational multispectral imaging (CMI) to reconstruct 24-wavelength multispectral fundus images from CFPs. ResNeXt101 is employed as the backbone for multi-view learning to extract features from the reconstructed images. Additionally, a GNN with a customized jumper connection strategy is designed to enhance cross-spectral relationships, facilitating comprehensive and efficient multispectral view learning. The study included a total of 1,078 macula-centered CFPs from 1,078 eyes of 592 patients with diabetes, of which 530 CFPs from 530 eyes of 300 patients were diagnosed with DMI. The model achieved an accuracy of 84.7 percent and an area under the receiver operating characteristic curve (AUROC) of 0.900 (95 percent CI: 0.852-0.937) on eye-level, outperforming both the baseline model trained from CFPs and human experts (p-values less than 0.01). These findings suggest that AI-based CFP analysis holds promise for detecting DMI, contributing to its early and low-cost screening.

Meng Wang, Tian Lin, Aidi Lin et al.

Previous foundation models for fundus images were pre-trained with limited disease categories and knowledge base. Here we introduce a knowledge-rich vision-language model (RetiZero) that leverages knowledge from more than 400 fundus diseases. For RetiZero's pretraining, we compiled 341,896 fundus images paired with texts, sourced from public datasets, ophthalmic literature, and online resources, encompassing a diverse range of diseases across multiple ethnicities and countries. RetiZero exhibits remarkable performance in several downstream tasks, including zero-shot disease recognition, image-to-image retrieval, AI-assisted clinical diagnosis,few-shot fine-tuning, and internal- and cross-domain disease identification. In zero-shot scenarios, RetiZero achieves Top-5 accuracies of 0.843 for 15 diseases and 0.756 for 52 diseases. For image retrieval, it achieves Top-5 scores of 0.950 and 0.886 for the same sets, respectively. AI-assisted clinical diagnosis results show that RetiZero's Top-3 zero-shot performance surpasses the average of 19 ophthalmologists from Singapore, China, and the United States. RetiZero substantially enhances clinicians' accuracy in diagnosing fundus diseases, in particularly rare ones. These findings underscore the value of integrating the RetiZero into clinical settings, where various fundus diseases are encountered.