Anisha Raghu

Ananya Raghu, Anisha Raghu, Alice S. Tang et al.

Purpose: Early screening for eye diseases is critical in low- and middle-income countries where access to care is limited. We investigate whether a confidence-guided, multi-image diabetic retinopathy diagnosis framework can integrate image filtering with confidence-aware predictions for reliable screening at capture. Methods: We develop a multi-image fusion method that aggregates retinal views to improve confidence and balanced accuracy. Our method uses confidence to identify unreliable predictions, prompting retakes when needed. We compare: (1) a cascaded image-quality and disease diagnosis pipeline using a single image per patient, (2) confidence-based prediction, and (3) our confidence-based multi-image fusion pipeline. All methods are evaluated using a RETFoundGreen backbone on the mBRSET (n = 1,234) and BRSET (n = 7,599) datasets. Results: At 70% coverage, our method achieves 91% balanced accuracy on mBRSET and 97% on BRSET, improvements of ~12% and ~6%, respectively, over cascade filtering. The image-quality cascade reaches sensitivities of 61% on mBRSET and 86% on BRSET, whereas our framework reaches 94% and 96%, respectively, at 50% coverage. Conclusions: Human-annotated quality labels are weakly associated with diagnostic performance, and confidence-based filtering consistently outperforms image quality-based cascaded pipelines. Translational Relevance: Using confidence-based multi-image fusion, patients receive more reliable predictions, reducing incorrect diagnoses during screening. The lightweight backbone and single inference pass per image make the framework compatible with low-latency mobile screening systems in resource-limited settings.

Ananya Raghu, Anisha Raghu, Alice S. Tang et al.

Background/Objectives: Age-related macular degeneration, glaucoma, diabetic retinopathy (DR), diabetic macular edema, and pathological myopia affect hundreds of millions of people worldwide. Early screening for these diseases is essential, yet access to medical care remains limited in low- and middle-income countries as well as in resource-limited settings. We develop InSight, an AI-based app that combines patient metadata with fundus images for accurate diagnosis of five common eye diseases to improve accessibility of screenings. Methods: InSight features a three-stage pipeline: real-time image quality assessment, disease diagnosis model, and a DR grading model to assess severity. Our disease diagnosis model incorporates three key innovations: (a) Multimodal fusion technique (MetaFusion) combining clinical metadata and images; (b) Pretraining method leveraging supervised and self-supervised loss functions; and (c) Multitask model to simultaneously predict 5 diseases. We make use of BRSET (lab-captured images) and mBRSET (smartphone-captured images) datasets, both of which also contain clinical metadata for model training/evaluation. Results: Trained on a dataset of BRSET and mBRSET images, the image quality checker achieves near-100% accuracy in filtering out low-quality fundus images. The multimodal pretrained disease diagnosis model outperforms models using only images by 6% in balanced accuracy for BRSET and 4% for mBRSET. Conclusions: The InSight pipeline demonstrates robustness across varied image conditions and has high diagnostic accuracy across all five diseases, generalizing to both smartphone and lab captured images. The multitask model contributes to the lightweight nature of the pipeline, making it five times computationally efficient compared to having five individual models corresponding to each disease.