Generalist versus Specialist Vision Foundation Models for Ocular Disease and Oculomics

Medical foundation models, pre-trained with large-scale clinical data, demonstrate strong performance in diverse clinically relevant applications. RETFound, trained on nearly one million retinal images, exemplifies this approach in applications with retinal images. However, the emergence of increasingly powerful and multifold larger generalist foundation models such as DINOv2 and DINOv3 raises the question of whether domain-specific pre-training remains essential, and if so, what gap persists. To investigate this, we systematically evaluated the adaptability of DINOv2 and DINOv3 in retinal image applications, compared to two specialist RETFound models, RETFound-MAE and RETFound-DINOv2. We assessed performance on ocular disease detection and systemic disease prediction using two adaptation strategies: fine-tuning and linear probing. Data efficiency and adaptation efficiency were further analysed to characterise trade-offs between predictive performance and computational cost. Our results show that although scaling generalist models yields strong adaptability across diverse tasks, RETFound-DINOv2 consistently outperforms these generalist foundation models in ocular-disease detection and oculomics tasks, demonstrating stronger generalisability and data efficiency. These findings suggest that specialist retinal foundation models remain the most effective choice for clinical applications, while the narrowing gap with generalist foundation models suggests that continued data and model scaling can deliver domain-relevant gains and position them as strong foundations for future medical foundation models.

A graph neural network-based multispectral-view learning model for diabetic macular ischemia detection from color fundus photographs

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.