用轻量LoRA与联邦学习实现隐私保护的视网膜病诊断，兼顾准确与可解释。

Accurate and privacy-preserving diagnosis of ophthalmic diseases remains a critical challenge in medical imaging, particularly given the limitations of existing deep learning models in handling data imbalance, data privacy concerns, spatial feature diversity, and clinical interpretability. This paper proposes a novel Data efficient Image Transformer (DeiT) based framework that integrates context aware multiscale patch embedding, Low-Rank Adaptation (LoRA), knowledge distillation, and federated learning to address these challenges in a unified manner. The proposed model effectively captures both local and global retinal features by leveraging multi scale patch representations with local and global attention mechanisms. LoRA integration enhances computational efficiency by reducing the number of trainable parameters, while federated learning ensures secure, decentralized training without compromising data privacy. A knowledge distillation strategy further improves generalization in data scarce settings. Comprehensive evaluations on two benchmark datasets OCTDL and the Eye Disease Image Dataset demonstrate that the proposed framework consistently outperforms both traditional CNNs and state of the art transformer architectures across key metrics including AUC, F1 score, and precision. Furthermore, Grad-CAM++ visualizations provide interpretable insights into model predictions, supporting clinical trust. This work establishes a strong foundation for scalable, secure, and explainable AI applications in ophthalmic diagnostics.