APTOS-2024 challenge report: Generation of synthetic 3D OCT images from fundus photographs

Optical Coherence Tomography (OCT) provides high-resolution, 3D, and non-invasive visualization of retinal layers in vivo, serving as a critical tool for lesion localization and disease diagnosis. However, its widespread adoption is limited by equipment costs and the need for specialized operators. In comparison, 2D color fundus photography offers faster acquisition and greater accessibility with less dependence on expensive devices. Although generative artificial intelligence has demonstrated promising results in medical image synthesis, translating 2D fundus images into 3D OCT images presents unique challenges due to inherent differences in data dimensionality and biological information between modalities. To advance generative models in the fundus-to-3D-OCT setting, the Asia Pacific Tele-Ophthalmology Society (APTOS-2024) organized a challenge titled Artificial Intelligence-based OCT Generation from Fundus Images. This paper details the challenge framework (referred to as APTOS-2024 Challenge), including: the benchmark dataset, evaluation methodology featuring two fidelity metrics-image-based distance (pixel-level OCT B-scan similarity) and video-based distance (semantic-level volumetric consistency), and analysis of top-performing solutions. The challenge attracted 342 participating teams, with 42 preliminary submissions and 9 finalists. Leading methodologies incorporated innovations in hybrid data preprocessing or augmentation (cross-modality collaborative paradigms), pre-training on external ophthalmic imaging datasets, integration of vision foundation models, and model architecture improvement. The APTOS-2024 Challenge is the first benchmark demonstrating the feasibility of fundus-to-3D-OCT synthesis as a potential solution for improving ophthalmic care accessibility in under-resourced healthcare settings, while helping to expedite medical research and clinical applications.

Unpacking Positional Encoding in Transformers: A Spectral Analysis of Content-Position Coupling

Positional encoding (PE) is essential for enabling Transformers to model sequential structure. However, the mechanisms by which different PE schemes couple token content and positional information-and how these mechanisms influence model dynamics-remain theoretically underexplored. In this work, we present a unified framework that analyzes PE through the spectral properties of Toeplitz and related matrices derived from attention logits. We show that multiplicative content-position coupling-exemplified by Rotary Positional Encoding (RoPE) via a Hadamard product with a Toeplitz matrix-induces spectral contraction, which theoretically improves optimization stability and efficiency. Guided by this theory, we construct synthetic tasks that contrast content-position dependent and content-position independent settings, and evaluate a range of PE methods. Our experiments reveal strong alignment with theory: RoPE consistently outperforms other methods on position-sensitive tasks and induces "single-head deposit" patterns in early layers, indicating localized positional processing. Further analyses show that modifying the method and timing of PE coupling, such as MLA in Deepseek-V3, can effectively mitigate this concentration. These results establish explicit content-relative mixing with relative-position Toeplitz signals as a key principle for effective PE design and provide new insight into how positional structure is integrated in Transformer architectures.

FaceInsight: A Multimodal Large Language Model for Face Perception

Recent advances in multimodal large language models (MLLMs) have demonstrated strong capabilities in understanding general visual content. However, these general-domain MLLMs perform poorly in face perception tasks, often producing inaccurate or misleading responses to face-specific queries. To address this gap, we propose FaceInsight, the versatile face perception MLLM that provides fine-grained facial information. Our approach introduces visual-textual alignment of facial knowledge to model both uncertain dependencies and deterministic relationships among facial information, mitigating the limitations of language-driven reasoning. Additionally, we incorporate face segmentation maps as an auxiliary perceptual modality, enriching the visual input with localized structural cues to enhance semantic understanding. Comprehensive experiments and analyses across three face perception tasks demonstrate that FaceInsight consistently outperforms nine compared MLLMs under both training-free and fine-tuned settings.

Generalized Semantic Contrastive Learning via Embedding Side Information for Few-Shot Object Detection

The objective of few-shot object detection (FSOD) is to detect novel objects with few training samples. The core challenge of this task is how to construct a generalized feature space for novel categories with limited data on the basis of the base category space, which could adapt the learned detection model to unknown scenarios. However, limited by insufficient samples for novel categories, two issues still exist: (1) the features of the novel category are easily implicitly represented by the features of the base category, leading to inseparable classifier boundaries, (2) novel categories with fewer data are not enough to fully represent the distribution, where the model fine-tuning is prone to overfitting. To address these issues, we introduce the side information to alleviate the negative influences derived from the feature space and sample viewpoints and formulate a novel generalized feature representation learning method for FSOD. Specifically, we first utilize embedding side information to construct a knowledge matrix to quantify the semantic relationship between the base and novel categories. Then, to strengthen the discrimination between semantically similar categories, we further develop contextual semantic supervised contrastive learning which embeds side information. Furthermore, to prevent overfitting problems caused by sparse samples, a side-information guided region-aware masked module is introduced to augment the diversity of samples, which finds and abandons biased information that discriminates between similar categories via counterfactual explanation, and refines the discriminative representation space further. Extensive experiments using ResNet and ViT backbones on PASCAL VOC, MS COCO, LVIS V1, FSOD-1K, and FSVOD-500 benchmarks demonstrate that our model outperforms the previous state-of-the-art methods, significantly improving the ability of FSOD in most shots/splits.

Beyond Progress Measures: Theoretical Insights into the Mechanism of Grokking

Grokking, referring to the abrupt improvement in test accuracy after extended overfitting, offers valuable insights into the mechanisms of model generalization. Existing researches based on progress measures imply that grokking relies on understanding the optimization dynamics when the loss function is dominated solely by the weight decay term. However, we find that this optimization merely leads to token uniformity, which is not a sufficient condition for grokking. In this work, we investigate the grokking mechanism underlying the Transformer in the task of prime number operations. Based on theoretical analysis and experimental validation, we present the following insights: (i) The weight decay term encourages uniformity across all tokens in the embedding space when it is minimized. (ii) The occurrence of grokking is jointly determined by the uniformity of the embedding space and the distribution of the training dataset. Building on these insights, we provide a unified perspective for understanding various previously proposed progress measures and introduce a novel, concise, and effective progress measure that could trace the changes in test loss more accurately. Finally, to demonstrate the versatility of our theoretical framework, we design a dedicated dataset to validate our theory on ResNet-18, successfully showcasing the occurrence of grokking.

Less is More: Efficient Black-box Attribution via Minimal Interpretable Subset Selection

To develop a trustworthy AI system, which aim to identify the input regions that most influence the models decisions. The primary task of existing attribution methods lies in efficiently and accurately identifying the relationships among input-prediction interactions. Particularly when the input data is discrete, such as images, analyzing the relationship between inputs and outputs poses a significant challenge due to the combinatorial explosion. In this paper, we propose a novel and efficient black-box attribution mechanism, LiMA (Less input is More faithful for Attribution), which reformulates the attribution of important regions as an optimization problem for submodular subset selection. First, to accurately assess interactions, we design a submodular function that quantifies subset importance and effectively captures their impact on decision outcomes. Then, efficiently ranking input sub-regions by their importance for attribution, we improve optimization efficiency through a novel bidirectional greedy search algorithm. LiMA identifies both the most and least important samples while ensuring an optimal attribution boundary that minimizes errors. Extensive experiments on eight foundation models demonstrate that our method provides faithful interpretations with fewer regions and exhibits strong generalization, shows an average improvement of 36.3% in Insertion and 39.6% in Deletion. Our method also outperforms the naive greedy search in attribution efficiency, being 1.6 times faster. Furthermore, when explaining the reasons behind model prediction errors, the average highest confidence achieved by our method is, on average, 86.1% higher than that of state-of-the-art attribution algorithms. The code is available at https://github.com/RuoyuChen10/LIMA.

Fundus2Globe: Generative AI-Driven 3D Digital Twins for Personalized Myopia Management

Myopia, projected to affect 50% population globally by 2050, is a leading cause of vision loss. Eyes with pathological myopia exhibit distinctive shape distributions, which are closely linked to the progression of vision-threatening complications. Recent understanding of eye-shape-based biomarkers requires magnetic resonance imaging (MRI), however, it is costly and unrealistic in routine ophthalmology clinics. We present Fundus2Globe, the first AI framework that synthesizes patient-specific 3D eye globes from ubiquitous 2D color fundus photographs (CFPs) and routine metadata (axial length, spherical equivalent), bypassing MRI dependency. By integrating a 3D morphable eye model (encoding biomechanical shape priors) with a latent diffusion model, our approach achieves submillimeter accuracy in reconstructing posterior ocular anatomy efficiently. Fundus2Globe uniquely quantifies how vision-threatening lesions (e.g., staphylomas) in CFPs correlate with MRI-validated 3D shape abnormalities, enabling clinicians to simulate posterior segment changes in response to refractive shifts. External validation demonstrates its robust generation performance, ensuring fairness across underrepresented groups. By transforming 2D fundus imaging into 3D digital replicas of ocular structures, Fundus2Globe is a gateway for precision ophthalmology, laying the foundation for AI-driven, personalized myopia management.

FFA Sora, video generation as fundus fluorescein angiography simulator

Fundus fluorescein angiography (FFA) is critical for diagnosing retinal vascular diseases, but beginners often struggle with image interpretation. This study develops FFA Sora, a text-to-video model that converts FFA reports into dynamic videos via a Wavelet-Flow Variational Autoencoder (WF-VAE) and a diffusion transformer (DiT). Trained on an anonymized dataset, FFA Sora accurately simulates disease features from the input text, as confirmed by objective metrics: Frechet Video Distance (FVD) = 329.78, Learned Perceptual Image Patch Similarity (LPIPS) = 0.48, and Visual-question-answering Score (VQAScore) = 0.61. Specific evaluations showed acceptable alignment between the generated videos and textual prompts, with BERTScore of 0.35. Additionally, the model demonstrated strong privacy-preserving performance in retrieval evaluations, achieving an average Recall@K of 0.073. Human assessments indicated satisfactory visual quality, with an average score of 1.570(scale: 1 = best, 5 = worst). This model addresses privacy concerns associated with sharing large-scale FFA data and enhances medical education.

Interpreting Object-level Foundation Models via Visual Precision Search

Advances in multimodal pre-training have propelled object-level foundation models, such as Grounding DINO and Florence-2, in tasks like visual grounding and object detection. However, interpreting these models\' decisions has grown increasingly challenging. Existing interpretable attribution methods for object-level task interpretation have notable limitations: (1) gradient-based methods lack precise localization due to visual-textual fusion in foundation models, and (2) perturbation-based methods produce noisy saliency maps, limiting fine-grained interpretability. To address these, we propose a Visual Precision Search method that generates accurate attribution maps with fewer regions. Our method bypasses internal model parameters to overcome attribution issues from multimodal fusion, dividing inputs into sparse sub-regions and using consistency and collaboration scores to accurately identify critical decision-making regions. We also conducted a theoretical analysis of the boundary guarantees and scope of applicability of our method. Experiments on RefCOCO, MS COCO, and LVIS show our approach enhances object-level task interpretability over SOTA for Grounding DINO and Florence-2 across various evaluation metrics, with faithfulness gains of 23.7\%, 31.6\%, and 20.1\% on MS COCO, LVIS, and RefCOCO for Grounding DINO, and 102.9\% and 66.9\% on MS COCO and RefCOCO for Florence-2. Additionally, our method can interpret failures in visual grounding and object detection tasks, surpassing existing methods across multiple evaluation metrics. The code will be released at \url{https://github.com/RuoyuChen10/VPS}.

EyeDiff: text-to-image diffusion model improves rare eye disease diagnosis

The rising prevalence of vision-threatening retinal diseases poses a significant burden on the global healthcare systems. Deep learning (DL) offers a promising solution for automatic disease screening but demands substantial data. Collecting and labeling large volumes of ophthalmic images across various modalities encounters several real-world challenges, especially for rare diseases. Here, we introduce EyeDiff, a text-to-image model designed to generate multimodal ophthalmic images from natural language prompts and evaluate its applicability in diagnosing common and rare diseases. EyeDiff is trained on eight large-scale datasets using the advanced latent diffusion model, covering 14 ophthalmic image modalities and over 80 ocular diseases, and is adapted to ten multi-country external datasets. The generated images accurately capture essential lesional characteristics, achieving high alignment with text prompts as evaluated by objective metrics and human experts. Furthermore, integrating generated images significantly enhances the accuracy of detecting minority classes and rare eye diseases, surpassing traditional oversampling methods in addressing data imbalance. EyeDiff effectively tackles the issue of data imbalance and insufficiency typically encountered in rare diseases and addresses the challenges of collecting large-scale annotated images, offering a transformative solution to enhance the development of expert-level diseases diagnosis models in ophthalmic field.