Fundus Image-based Glaucoma Screening via Retinal Knowledge-Oriented Dynamic Multi-Level Feature Integration

Abstract

While deep learning has advanced automated glaucoma screening via color fundus photography, existing purely data-driven models often overfit to confounding imaging artifacts and struggle to capture unpredictable pathological cues located beyond predefined anatomical boundaries. To address these limitations, we propose a retinal knowledge-oriented framework that synergizes dynamic multi-scale feature learning with domain-specific anatomical priors. The proposed architecture adopts a tri-branch structure to jointly model the global retinal context, the structural characteristics of the optic cup and disc, and dynamically cropped pathological regions. Specifically, we devise a Dynamic Window Mechanism (DWM) that adaptively discovers diagnostically informative patches via image-level supervision. Furthermore, we introduce a Knowledge-Enhanced Convolutional Block Attention Module (KE-CBAM) that explicitly incorporates retinal priors from a pre-trained foundation model RETFound to guide spatial attention, preventing the network from assigning spurious weights to irrelevant background noise. Extensive evaluations on the large-scale AIROGS dataset demonstrate that our method achieves a state-of-the-art AUC of $98.5\%$ and an accuracy of $94.6\%$. More importantly, the integration of anatomical priors effectively mitigates the inherent class imbalance, significantly improving the detection of referable glaucoma cases. Additional validations on the SMDG-19 benchmark further confirm its superior cross-domain generalization, indicating that our contribution provides a robust, interpretable, and scalable solution for real-world clinical glaucoma diagnosis. Our code is available at https://github.com/magiczhuo/Glaucoma-Detection

15 pages. Published in Knowledge-based System