RetiGen: Framework leveraging domain generalization and test-time adaptation for multi-view retinal diagnostics

Domain generalization techniques involve training a model on one set of domains and evaluating its performance on different, unseen domains. In contrast, test-time adaptation optimizes the model specifically for the target domain during inference. Both approaches improve diagnostic accuracy in medical imaging models. However, no research to date has leveraged the advantages of both approaches in an end-to-end fashion. Our paper introduces RetiGen, a test-time optimization framework designed to be integrated with existing domain generalization approaches. With an emphasis on the ophthalmic imaging domain, RetiGen leverages unlabeled multi-view color fundus photographs-a critical optical technology in retinal diagnostics. By utilizing information from multiple viewing angles, our approach significantly enhances the robustness and accuracy of machine learning models when applied across different domains. By integrating class balancing, test-time adaptation, and a multi-view optimization strategy, RetiGen effectively addresses the persistent issue of domain shift, which often hinders the performance of imaging models. Experimental results demonstrate that our method outperforms state-of-the-art techniques in both domain generalization and test-time optimization. Specifically, RetiGen increases the generalizability of the MFIDDR dataset, improving the AUC from 0.751 to 0.872, a 0.121 improvement. Similarly, for the DRTiD dataset, the AUC increased from 0.794 to 0.879, a 0.085 improvement. The code for RetiGen is publicly available at https://github.com/RViMLab/RetiGen.