Test-Time Adaptation in Optical Coherence Tomography Using Trajectory-Aligned Time-Independent Flow

Optical coherence tomography (OCT) is essential in ophthalmology, but inconsistent image quality especially in low-cost devices hinders automated analysis. To address this, we introduce a flow-matching-based test-time adaptation method that generates high-quality surrogate images from noisy inputs. Typically, domain gaps between test and training data cause pixel distribution mismatches during the denoising process. We overcome this by matching the test image's histogram to synthetic reference trajectories, successfully aligning the input with expected distributions. Additionally, we remove the network's time conditioning to account for slight deviations in real-world noise distributions. Our approach achieves state-of-the-art performance in segmenting critical biomarkers for two stages of Age-related Macular Degeneration (AMD). Code is available: https://github.com/Veit21/tta-flow.

Exploiting Intermediate Reconstructions in Optical Coherence Tomography for Test-Time Adaption of Medical Image Segmentation

Primary health care frequently relies on low-cost imaging devices, which are commonly used for screening purposes. To ensure accurate diagnosis, these systems depend on advanced reconstruction algorithms designed to approximate the performance of high-quality counterparts. Such algorithms typically employ iterative reconstruction methods that incorporate domain-specific prior knowledge. However, downstream task performance is generally assessed using only the final reconstructed image, thereby disregarding the informative intermediate representations generated throughout the reconstruction process. In this work, we propose IRTTA to exploit these intermediate representations at test-time by adapting the normalization-layer parameters of a frozen downstream network via a modulator network that conditions on the current reconstruction timescale. The modulator network is learned during test-time using an averaged entropy loss across all individual timesteps. Variation among the timestep-wise segmentations additionally provides uncertainty estimates at no extra cost. This approach enhances segmentation performance and enables semantically meaningful uncertainty estimation, all without modifying either the reconstruction process or the downstream model.