Enhancing Community Vision Screening -- AI Driven Retinal Photography for Early Disease Detection and Patient Trust

Community vision screening plays a crucial role in identifying individuals with vision loss and preventing avoidable blindness, particularly in rural communities where access to eye care services is limited. Currently, there is a pressing need for a simple and efficient process to screen and refer individuals with significant eye disease-related vision loss to tertiary eye care centers for further care. An ideal solution should seamlessly and readily integrate with existing workflows, providing comprehensive initial screening results to service providers, thereby enabling precise patient referrals for timely treatment. This paper introduces the Enhancing Community Vision Screening (ECVS) solution, which addresses the aforementioned concerns with a novel and feasible solution based on simple, non-invasive retinal photography for the detection of pathology-based visual impairment. Our study employs four distinct deep learning models: RETinal photo Quality Assessment (RETQA), Pathology Visual Impairment detection (PVI), Eye Disease Diagnosis (EDD) and Visualization of Lesion Regions of the eye (VLR). We conducted experiments on over 10 datasets, totaling more than 80,000 fundus photos collected from various sources. The models integrated into ECVS achieved impressive AUC scores of 0.98 for RETQA, 0.95 for PVI, and 0.90 for EDD, along with a DICE coefficient of 0.48 for VLR. These results underscore the promising capabilities of ECVS as a straightforward and scalable method for community-based vision screening.

LMOD: A Large Multimodal Ophthalmology Dataset and Benchmark for Large Vision-Language Models

Ophthalmology relies heavily on detailed image analysis for diagnosis and treatment planning. While large vision-language models (LVLMs) have shown promise in understanding complex visual information, their performance on ophthalmology images remains underexplored. We introduce LMOD, a dataset and benchmark for evaluating LVLMs on ophthalmology images, covering anatomical understanding, diagnostic analysis, and demographic extraction. LMODincludes 21,993 images spanning optical coherence tomography, scanning laser ophthalmoscopy, eye photos, surgical scenes, and color fundus photographs. We benchmark 13 state-of-the-art LVLMs and find that they are far from perfect for comprehending ophthalmology images. Models struggle with diagnostic analysis and demographic extraction, reveal weaknesses in spatial reasoning, diagnostic analysis, handling out-of-domain queries, and safeguards for handling biomarkers of ophthalmology images.

Enhancing Large Language Models with Domain-specific Retrieval Augment Generation: A Case Study on Long-form Consumer Health Question Answering in Ophthalmology

Despite the potential of Large Language Models (LLMs) in medicine, they may generate responses lacking supporting evidence or based on hallucinated evidence. While Retrieval Augment Generation (RAG) is popular to address this issue, few studies implemented and evaluated RAG in downstream domain-specific applications. We developed a RAG pipeline with 70,000 ophthalmology-specific documents that retrieve relevant documents to augment LLMs during inference time. In a case study on long-form consumer health questions, we systematically evaluated the responses including over 500 references of LLMs with and without RAG on 100 questions with 10 healthcare professionals. The evaluation focuses on factuality of evidence, selection and ranking of evidence, attribution of evidence, and answer accuracy and completeness. LLMs without RAG provided 252 references in total. Of which, 45.3% hallucinated, 34.1% consisted of minor errors, and 20.6% were correct. In contrast, LLMs with RAG significantly improved accuracy (54.5% being correct) and reduced error rates (18.8% with minor hallucinations and 26.7% with errors). 62.5% of the top 10 documents retrieved by RAG were selected as the top references in the LLM response, with an average ranking of 4.9. The use of RAG also improved evidence attribution (increasing from 1.85 to 2.49 on a 5-point scale, P<0.001), albeit with slight decreases in accuracy (from 3.52 to 3.23, P=0.03) and completeness (from 3.47 to 3.27, P=0.17). The results demonstrate that LLMs frequently exhibited hallucinated and erroneous evidence in the responses, raising concerns for downstream applications in the medical domain. RAG substantially reduced the proportion of such evidence but encountered challenges.

Localizing Anatomical Landmarks in Ocular Images using Zoom-In Attentive Networks

Localizing anatomical landmarks are important tasks in medical image analysis. However, the landmarks to be localized often lack prominent visual features. Their locations are elusive and easily confused with the background, and thus precise localization highly depends on the context formed by their surrounding areas. In addition, the required precision is usually higher than segmentation and object detection tasks. Therefore, localization has its unique challenges different from segmentation or detection. In this paper, we propose a zoom-in attentive network (ZIAN) for anatomical landmark localization in ocular images. First, a coarse-to-fine, or "zoom-in" strategy is utilized to learn the contextualized features in different scales. Then, an attentive fusion module is adopted to aggregate multi-scale features, which consists of 1) a co-attention network with a multiple regions-of-interest (ROIs) scheme that learns complementary features from the multiple ROIs, 2) an attention-based fusion module which integrates the multi-ROIs features and non-ROI features. We evaluated ZIAN on two open challenge tasks, i.e., the fovea localization in fundus images and scleral spur localization in AS-OCT images. Experiments show that ZIAN achieves promising performances and outperforms state-of-the-art localization methods. The source code and trained models of ZIAN are available at https://github.com/leixiaofeng-astar/OMIA9-ZIAN.