Exploring the Transferability of a Foundation Model for Fundus Images: Application to Hypertensive Retinopathy

Using deep learning models pre-trained on Imagenet is the traditional solution for medical image classification to deal with data scarcity. Nevertheless, relevant literature supports that this strategy may offer limited gains due to the high dissimilarity between domains. Currently, the paradigm of adapting domain-specialized foundation models is proving to be a promising alternative. However, how to perform such knowledge transfer, and the benefits and limitations it presents, are under study. The CGI-HRDC challenge for Hypertensive Retinopathy diagnosis on fundus images introduces an appealing opportunity to evaluate the transferability of a recently released vision-language foundation model of the retina, FLAIR [42]. In this work, we explore the potential of using FLAIR features as starting point for fundus image classification, and we compare its performance with regard to Imagenet initialization on two popular transfer learning methods: Linear Probing (LP) and Fine-Tuning (FP). Our empirical observations suggest that, in any case, the use of the traditional strategy provides performance gains. In contrast, direct transferability from FLAIR model allows gains of \(\sim \) 2.5%. When fine-tuning the whole network, the performance gap increases up to \(\sim \) 4%. In this case, we show that avoiding feature deterioration via LP initialization of the classifier allows the best re-use of the rich pre-trained features. Although direct transferability using LP still offers limited performance, we believe that foundation models such as FLAIR will drive the evolution of deep-learning-based fundus image analysis.