A foundation model for generalizable disease detection from retinal images
Open accessAbstract
Medical artificial intelligence (AI) offers great potential for recognizing signs of health conditions in retinal images and expediting the diagnosis of eye diseases and systemic disorders 1. However, the development of AI models requires substantial annotation and models are usually task-specific with limited generalizability to different clinical applications 2. Here, we present RETFound, a foundation model for retinal images that learns generalizable representations from unlabelled retinal images and provides a basis for label-efficient model adaptation in several applications. Specifically, RETFound is trained on 1.6 million unlabelled retinal images by means of self-supervised learning and then adapted to disease detection tasks with explicit labels. We show that adapted RETFound consistently outperforms several comparison models in the diagnosis and prognosis of sight-threatening eye diseases, as well as incident prediction of complex systemic disorders such as heart failure and myocardial infarction with fewer labelled data. RETFound provides a generalizable solution to improve model performance and alleviate the annotation workload of experts to enable broad clinical AI applications from retinal imaging.
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Specialty-specific foundation models typically focus on single imaging modalities.
“Specialty-specific foundation models20,21,23 typically focus on single imaging modalities”
From A Multimodal Vision Foundation Model for Clinical Dermatology (2025) · cites this paper as [20]
PanDerm's scaling behavior aligns with recent foundation model trends.
“The scaling behavior observed in PanDerm’s performance aligns with recent foundation model trends20,22,23,59”
From A Multimodal Vision Foundation Model for Clinical Dermatology (2025) · cites this paper as [20]
Foundation models reduce the data requirements for specialized tasks, for example in predicting diseases from retinal photographs.
“Foundation models reduce the data requirements for specialized tasks, for example in predicting diseases from retinal photographs17.”
From Large language models and multimodal foundation models for precision oncology (2024) · cites this paper as [17]
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InfluentialA semantic-enhanced multi-modal remote sensing foundation model for Earth observation
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Foundation model of ECG diagnosis: Diagnostics and explanations of any form and rhythm on ECG
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Retinal Alterations Predict Early Prodromal Signs of Neurodegenerative Disease
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Improving Representation of High-Frequency Components for Medical Visual Foundation Models
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- Authors
- Zhou, Y., Chia, M. A., Wagner, S. K., Ayhan, M. S., Williamson, D. J., Struyven, R. R., Liu, T., Xu, M., Lozano, M. G., Woodward-Court, P., Kihara, Y., UK Biobank Eye & Vision Consortium, Allen, N., Gallacher, J. E. J., Littlejohns, T., Aslam, T., Bishop, P., Black, G., Sergouniotis, P., Atan, D., Dick, A. D., Williams, C., Barman, S., Barrett, J. H., Mackie, S., Braithwaite, T., Carare, R. O., Ennis, S., Gibson, J., Lotery, A. J., Self, J., Chakravarthy, U., Hogg, R. E., Paterson, E., Woodside, J., Peto, T., Mckay, G., Mcguinness, B., Foster, P. J., Balaskas, K., Khawaja, A. P., Pontikos, N., Rahi, J. S., Lascaratos, G., Patel, P. J., Chan, M., Chua, S. Y. L., Day, A., Desai, P., Egan, C., Fruttiger, M., Garway-Heath, D. F., Hardcastle, A., Khaw, S. P. T., Moore, T., Sivaprasad, S., Strouthidis, N., Thomas, D., Tufail, A., Viswanathan, A. C., Dhillon, B., Macgillivray, T., Sudlow, C., Vitart, V., Doney, A., Trucco, E., Guggeinheim, J. A., Morgan, J. E., Hammond, C. J., Williams, K., Hysi, P., Harding, S. P., Zheng, Y., Luben, R., Luthert, P., Sun, Z., McKibbin, M., O’Sullivan, E., Oram, R., Weedon, M., Owen, C. G., Rudnicka, A. R., Sattar, N., Steel, D., Stratton, I., Tapp, R., Yates, M. M., Petzold, A., Madhusudhan, S., Altmann, A., Lee, A. Y., Topol, E. J., Denniston, A. K., Alexander, D. C., & Keane, P. A.
- Affiliations
- Moorfields Eye Hospital NHS Foundation Trust (GB)
- University College London (GB)
- Universidade da Coruña (ES)
- University of Washington (US)
- University of Oxford (GB)
- University of Manchester (GB)
- University of Bristol (GB)
- Kingston University London (GB)
- University of Leeds (GB)
- St Thomas' Hospital (GB)
- University of Southampton (GB)
- Queen's University Belfast (GB)
- University of Edinburgh (GB)
- University of Dundee (GB)
- Cardiff University (GB)
- King's College London (GB)
- University of Liverpool (GB)
- Leeds Teaching Hospitals NHS Trust (GB)
- King's College Hospital NHS Foundation Trust (GB)
- University of Exeter (GB)
- University of London (GB)
- University of Glasgow (GB)
- Newcastle University (GB)
- Gloucestershire Hospitals NHS Foundation Trust (GB)
- St George's, University of London (GB)
- University of East Anglia (GB)
- UCL Queen Square Institute of Neurology (GB)
- Royal Liverpool University Hospital (GB)
- University Hospitals Birmingham NHS Foundation Trust (GB)
- Corresponding author
- Zhou, Yukun
- Keane, Pearse A.
- ORCID
- Zhou, Yukun
- Chia, Mark A.
- Wagner, Siegfried K.
- Ayhan, Murat S.
- Williamson, Dominic J.
- Struyven, Robbert R.
- Liu, Timing
- Xu, Moucheng
- Lozano, Mateo G.
- Woodward-Court, Peter
- Kihara, Yuka
- Allen, Naomi
- Gallacher, John E. J.
- Littlejohns, Thomas
- Aslam, Tariq
- Black, Graeme
- Sergouniotis, Panagiotis
- Atan, Denize
- Dick, Andrew D.
- Williams, Cathy
- Barman, Sarah
- Mackie, Sarah
- Braithwaite, Tasanee
- Carare, Roxana O.
- Ennis, Sarah
- Lotery, Andrew J.
- Self, Jay
- Chakravarthy, Usha
- Hogg, Ruth E.
- Paterson, Euan
- Woodside, Jayne
- Mckay, Gareth
- Mcguinness, Bernadette
- Foster, Paul J.
- Balaskas, Konstantinos
- Khawaja, Anthony P.
- Pontikos, Nikolas
- Rahi, Jugnoo S.
- Lascaratos, Gerassimos
- Patel, Praveen J.
- Chan, Michelle
- Chua, Sharon Y. L.
- Day, Alexander
- Desai, Parul
- Fruttiger, Marcus
- Hardcastle, Alison
- Moore, Tony
- Sivaprasad, Sobha
- Strouthidis, Nicholas
- Thomas, Dhanes
- Tufail, Adnan
- Viswanathan, Ananth C.
- Dhillon, Bal
- Macgillivray, Tom
- Sudlow, Cathie
- Trucco, Emanuele
- Williams, Katie
- Hysi, Pirro
- Harding, Simon P.
- Zheng, Yalin
- Luben, Robert
- Sun, Zihan
- McKibbin, Martin
- Oram, Richard
- Rudnicka, Alicja R.
- Sattar, Naveed
- Steel, David
- Stratton, Irene
- Tapp, Robyn
- Yates, Max M.
- Petzold, Axel
- Madhusudhan, Savita
- Altmann, Andre
- Lee, Aaron Y.
- Topol, Eric J.
- Denniston, Alastair K.
- Alexander, Daniel C.
- Keane, Pearse A.
- Venue
- Nature
- Published
- 2023-09-13
- Volume
- 622
- Issue
- 7981
- Pages
- 156-163
- ISSN
- 0028-0836 (ISSN-L)
- 1476-4687
- PMC
- PMC10550819
- OpenAlex
- W4386697749
- Cited by
- 1,014
- References
- 55
- Citations by year
- 2026: 388 · 2025: 389 · 2024: 214 · 2023: 21
- FWCI
- 166.84
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Nature (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (publishedVersion, cc-by)
- Pure Amsterdam UMC (publishedVersion, cc-by)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- Research Portal (Queen's University Belfast) (publishedVersion, cc-by)
- Explore Bristol Research (publishedVersion, cc-by)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- RUC (Universidade Da Coruña) (submittedVersion, cc-by)
- RUNA. Repositorio Institucional del Sergas (Servicio Gallego de Salud (SERGAS)) (submittedVersion, cc-by)
- Newcastle University ePrints (Newcastle Univesity) (cc-by)
- Funders
- National Institute for Health and Care Research (NIHR205103, NF-SI-0515-10020, NIHR205096, NIHR205109)
- University College London Hospitals NHS Foundation Trust
- Moorfields Eye Hospital NHS Foundation Trust
- Moorfields Eye Charity (R190028A)
- Medical Research Council (MR/K003364/1, MR/TR000953/1, MC_UU_00007/10, MR/T019050/1)
- Engineering and Physical Sciences Research Council (EP/M020533/1, EP/V034537/1, M020533/1, M020533, EP/R014019/1, V034537, R014019)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Health Sciences › Medicine › Ophthalmology › Ophthalmology and Visual Health Research
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Keywords
- RETFound, foundation models, fundus images, self-supervised learning, eye disease detection, heart failure, myocardial infarction, artificial intelligence in healthcare, annotation workload reduction
- MeSH terms
- Supervised Machine Learning, Artificial Intelligence, Eye Diseases, Heart Failure, Humans, Myocardial Infarction, Retina
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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