Uazman Alam

Xin Zhang, Liangxiu Han, Tam Sobeih et al.

Corneal Confocal Microscopy (CCM) is a sensitive tool for assessing small-fiber damage in Diabetic Peripheral Neuropathy (DPN), yet the development of robust, automated deep learning-based diagnostic models is limited by scarce labelled data and fine-grained variability in corneal nerve morphology. Although Artificial Intelligence (AI)-driven foundation generative models excel at natural image synthesis, they often struggle in medical imaging due to limited domain-specific training, compromising the anatomical fidelity required for clinical analysis. To overcome these limitations, we propose a Weight-Decomposed Low-Rank Adaptation (WDLoRA)-based multimodal generative framework for clinically guided CCM image synthesis. WDLoRA is a parameter-efficient fine-tuning (PEFT) mechanism that decouples magnitude and directional weight updates, enabling foundation generative models to independently learn the orientation (nerve topology) and intensity (stromal contrast) required for medical realism. By jointly conditioning on nerve segmentation masks and disease-specific clinical prompts, the model synthesises anatomically coherent images across the DPN spectrum (Control, T1NoDPN, T1DPN). A comprehensive three-pillar evaluation demonstrates that the proposed framework achieves state-of-the-art visual fidelity (Fréchet Inception Distance (FID): 5.18) and structural integrity (Structural Similarity Index Measure (SSIM): 0.630), significantly outperforming GAN and standard diffusion baselines. Crucially, the synthetic images preserve gold-standard clinical biomarkers and are statistically equivalent to real patient data. When used to train automated diagnostic models, the synthetic dataset improves downstream diagnostic accuracy by 2.1% and segmentation performance by 2.2%, validating the framework's potential to alleviate data bottlenecks in medical AI.

Zhuangzhi Gao, Hongyi Qin, He Zhao et al.

Multimodal large language models (MLLMs) hold promise for integrating diverse data modalities, but current medical adaptations such as LLaVA-Med often fail to fully exploit the synergy between color fundus photography (CFP) and optical coherence tomography (OCT), and offer limited interpretability of quantitative biomarkers. We introduce GROK, a grounded multimodal large language model that jointly processes CFP, OCT, and text to deliver clinician-grade diagnoses of ocular and systemic disease. GROK comprises three core modules: Knowledge-Guided Instruction Generation, CLIP-Style OCT-Biomarker Alignment, and Supervised Instruction Fine-Tuning, which together establish a quantitative-to-qualitative diagnostic chain of thought, mirroring real clinical reasoning when producing detailed lesion annotations. To evaluate our approach, we introduce the Grounded Ophthalmic Understanding benchmark, which covers six disease categories and three tasks: macro-level diagnostic classification, report generation quality, and fine-grained clinical assessment of the generated chain of thought. Experiments show that, with only LoRA (Low-Rank Adaptation) fine-tuning of a 7B-parameter Qwen2 backbone, GROK outperforms comparable 7B and 32B baselines on both report quality and fine-grained clinical metrics, and even exceeds OpenAI o3. Code and data are publicly available in the GROK repository.

Xin Zhang, Liangxiu Han, Yue Shi et al.

Diabetic Peripheral Neuropathy (DPN) affects nearly half of diabetes patients, requiring early detection. Corneal Confocal Microscopy (CCM) enables non-invasive diagnosis, but automated methods suffer from inefficient feature extraction, reliance on handcrafted priors, and data limitations. We propose HMSViT, a novel Hierarchical Masked Self-Supervised Vision Transformer (HMSViT) designed for corneal nerve segmentation and DPN diagnosis. Unlike existing methods, HMSViT employs pooling-based hierarchical and dual attention mechanisms with absolute positional encoding, enabling efficient multi-scale feature extraction by capturing fine-grained local details in early layers and integrating global context in deeper layers, all at a lower computational cost. A block-masked self supervised learning framework is designed for the HMSViT that reduces reliance on labelled data, enhancing feature robustness, while a multi-scale decoder is used for segmentation and classification by fusing hierarchical features. Experiments on clinical CCM datasets showed HMSViT achieves state-of-the-art performance, with 61.34% mIoU for nerve segmentation and 70.40% diagnostic accuracy, outperforming leading hierarchical models like the Swin Transformer and HiViT by margins of up to 6.39% in segmentation accuracy while using fewer parameters. Detailed ablation studies further reveal that integrating block-masked SSL with hierarchical multi-scale feature extraction substantially enhances performance compared to conventional supervised training. Overall, these comprehensive experiments confirm that HMSViT delivers excellent, robust, and clinically viable results, demonstrating its potential for scalable deployment in real-world diagnostic applications.