Cited by 1,014Retinal Imaging and AnalysisOphthalmology and Visual Health ResearchArtificial Intelligence in Healthcare and Education

A foundation model for generalizable disease detection from retinal images

Open access
Zhou, Yukun, Chia, Mark A., Wagner, Siegfried K., Ayhan, Murat S., Williamson, Dominic J., Struyven, Robbert R., Liu, Timing, Xu, Moucheng +87 more·2023·Nature

Abstract

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.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1038/s41586-023-06555-x

Cites

58 of 58 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. [13]Chen, T., Kornblith, S., Swersky, K., Norouzi, M. & Hinton, G. Big self-supervised models are strong semi-supervised learners. In Proc. 34th International Conference on Neural Information Processing Systems (ed. Ranzato, M.) 22243–22255 (Neurips, 2020).
  2. [16]Chen, T., Kornblith, S., Norouzi, M. & Hinton, G. A simple framework for contrastive learning of visual representations. In Proc. 37th International Conference on Machine Learning (eds Iii, H. D. & Singh, A.) 1597–1607 (PMLR, 2020).
  3. [30]Truong, T., Mohammadi, S. & Lenga, M. How transferable are self-supervised features in medical image classification tasks? In Proc. 2021 Machine Learning for Health (eds Roy, S. et al.) 54–74 (PMLR, 2021)
  4. [47]Guo, C., Pleiss, G., Sun, Y. & Weinberger, K. Q. On calibration of modern neural networks. In Proc. 34th International Conference on Machine Learning (eds Precup, D. & Teh, Y. W.) Vol. 70, 1321–1330 (PMLR, 2017).
  5. [58]Dosovitskiy, A. et al. An image is worth 16×16 words: transformers for image recognition at scale. In Proc. 9th International Conference on Learning Representations (eds Hofmann, K. et al.) https://openreview.net/forum?id=YicbFdNTTy (ICLR 2021).

Cited by

Sorted by citations

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.
Venue
Nature
Published
2023-09-13
Volume
622
Issue
7981
Pages
156-163
ISSN
  • 0028-0836 (ISSN-L)
  • 1476-4687
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
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.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review