整合多模态数据的AI系统,提升青光眼筛查公平性与早期预警能力
Fair-Eye Net: A Fair, Trustworthy, Multimodal Integrated Glaucoma Full Chain AI System
- 多模态融合+不确定性感知架构,实现从筛查到随访的闭环诊断
- 在跨人群测试中降低种族误诊率73.4%,保持92%敏感度的早期预警
- 以公平性为首要目标,适合医疗资源不均地区推广使用
青光眼是全球导致不可逆失明的主要原因,早期检测与长期随访对防止视力永久丧失至关重要。当前筛查和进展评估依赖单一检测或松散关联的检查,存在主观性强、诊疗碎片化问题,且优质影像设备与专科医生资源有限,进一步影响实际应用中的一致性与公平性。为此,我们开发了Fair-Eye Net,一个公平、可信的多模态整合青光眼全链路AI系统,实现从筛查到随访及风险预警的闭环管理。该系统融合眼底图像、OCT结构指标、视野功能参数及人口统计学因素,采用双流异构融合架构,并引入不确定性感知的分层门控策略,实现选择性预测与安全转诊。通过公平性约束,显著降低弱势群体漏诊率。实验显示,其AUC达0.912(特异性96.7%),种族误诊率差异降低73.4%(从12.31%降至3.28%),跨域性能稳定,可提供3-12个月的早期风险预警(敏感度92%,特异性88%)。不同于事后公平性修正,Fair-Eye Net将公平性作为核心目标,通过多任务学习兼顾临床可靠性,为临床转化与大规模部署提供可复现路径,助力全球眼健康公平化。
原文摘要 · Abstract (English)
Glaucoma is a top cause of irreversible blindness globally, making early detection and longitudinal follow-up pivotal to preventing permanent vision loss. Current screening and progression assessment, however, rely on single tests or loosely linked examinations, introducing subjectivity and fragmented care. Limited access to high-quality imaging tools and specialist expertise further compromises consistency and equity in real-world use. To address these gaps, we developed Fair-Eye Net, a fair, reliable multimodal AI system closing the clinical loop from glaucoma screening to follow-up and risk alerting. It integrates fundus photos, OCT structural metrics, VF functional indices, and demographic factors via a dual-stream heterogeneous fusion architecture, with an uncertainty-aware hierarchical gating strategy for selective prediction and safe referral. A fairness constraint reduces missed diagnoses in disadvantaged subgroups. Experimental results show it achieved an AUC of 0.912 (96.7% specificity), cut racial false-negativity disparity by 73.4% (12.31% to 3.28%), maintained stable cross-domain performance, and enabled 3-12 months of early risk alerts (92% sensitivity, 88% specificity). Unlike post hoc fairness adjustments, Fair-Eye Net optimizes fairness as a primary goal with clinical reliability via multitask learning, offering a reproducible path for clinical translation and large-scale deployment to advance global eye health equity.
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