Beyond Natural-Image Foundation Models: Benchmarking Satellite Pretraining for Ophthalmic Image Analysis

Vision Foundation Models (VFMs) have emerged as a promising approach in medical imaging, producing broadly applicable systems that can be efficiently adapted across diverse imaging modalities, anatomical regions, and clinical tasks. However, VFMs require extensive training data, and their progress in medical image analysis is constrained by limited data availability, privacy concerns, and high development costs. To alleviate these constraints, medical VFMs (MedVFMs) are often built upon weights from generalist models pretrained on vast amounts of publicly available natural images, introducing a substantial distribution shift for medical task adaptation. To address this, we propose satellite imagery as a novel pretraining domain for MedVFM development and benchmarking, motivated by its closer visual alignment with medical data and its freedom from the privacy constraints that limit medical datasets. Across multiple ophthalmic imaging modalities, we compare DINOv3-SAT493m pretrained on 493 million satellite images against DINOv3-LVD1689m pretrained on 1.7 billion natural images, together with two medical specialist baselines: DINOv3-RETFound and MAE-RETFound. Our experiments show that satellite imagery is a stronger pretraining source than natural images for ophthalmic tasks, particularly on en face vascular-rich modalities. On several tasks, satellite pretraining matches or exceeds the medical specialists on high-resolution en face inputs, despite using no medical data.

Representation Transfer of Foundation Models for Ultra-Widefield Retinal Imaging

Despite the widespread adoption of foundation models as feature extractors for medical imaging, relatively little is understood about how different pretraining strategies influence the transferability of learned representations to weakly supervised ophthalmic imaging tasks. We investigate this question in ultra-widefield (UWF) retinal imaging by evaluating foundation model representations within a patch-based multiple instance learning (MIL) framework for disease classification on UWF images. We compare Vision Transformer encoders pretrained with supervised, Masked Autoencoder (MAE), and self-distillation objectives, while keeping the downstream aggregation architecture unchanged. Within a controlled comparison of ViT-B encoders pretrained on ImageNet-1k, the choice of pretraining objective substantially influenced frozen representation transfer, with supervised and self-distillation-based models outperforming MAE. A contemporary DINOv3 model pretrained at a larger scale achieved the strongest overall performance, with a quadratic weighted kappa of 0.863 for five-class diabetic retinopathy grading, comparable with DINOv1. Attention analysis further revealed distinct patch-aggregation behaviours associated with the different pretrained representations, while partial fine-tuning substantially reduced the performance gap for MAE. These findings suggest that pretraining strategy influences both representation transferability and the subsequent aggregation of patch-level evidence within MIL, resulting in differences in downstream classification performance.

Sparse Code Uplifting for Efficient 3D Language Gaussian Splatting

3D Language Gaussian Splatting (3DLGS) augments 3D Gaussian Splatting with language-aligned visual features for open-vocabulary 3D scene understanding. A core challenge is efficiently associating high-dimensional vision-language embeddings with millions of 3D Gaussians while preserving efficient feature rendering for text-based querying. Existing methods either store dense features directly on Gaussians, causing high storage costs and slow rendering, or learn compact representations through expensive per-scene optimization with repeated feature rasterization. No existing method simultaneously achieves fast 3D semantic reconstruction, efficient storage, and fast rendering. We propose SCOUP (Sparse COde UPlifting), which addresses all three by decoupling language representation learning from 3D Gaussian optimization. Rather than working directly in 3D, we learn sparse codebook-based representations entirely using features associated with 2D image regions, associating each region with a sparse set of codebook coefficients. We then uplift these coefficients to 3D Gaussians with our weighted sparse aggregation using Gaussian-to-pixel associations, where each Gaussian accumulates coefficients over codebook atoms across views. Top-$K$ filtering then extracts the most dominant multi-view coefficients per Gaussian, enabling efficient storage and fast rendering. Our method achieves up to $400\times$ training speedup while being $3\times$ more memory efficient during training compared to the state-of-the-art in rendering speed. Across multiple benchmarks, SCOUP matches or outperforms existing methods in open-vocabulary querying accuracy.