U-Net Optimization for Hyperreflective Foci Segmentation in Retinal OCT

Background/Objectives: Hyperreflective foci (HRF) are supportive optical coherence tomography (OCT) imaging biomarkers that have been examined for their association with disease progression and severity in various retinal disorders. The accurate identification and segmentation of these tiny structures of lipid extravasation remain complicated because of their small size, class imbalance, similarity in the reflectivity patterns with the surrounding structures and imaging artifacts. While U-Net-based models have promised exceptional results for medical image segmentation, optimal architectural settings and suitable preprocessing methods for HRF detection remain unclear. Methods: This research assessed optimal settings for U-Net-based models for HRF segmentation by evaluating standard U-Net and attention U-Net under different preprocessing regimes. Attention U-Net employed Z-score normalization and contrast-limited adaptive histogram equalization (CLAHE) enhancement with soft dice loss. The standard U-Net was trained on OCT images with CLAHE using focal Tversky loss. A total of 435 fovea-centered OCT B scans with the corresponding, consensus-annotated HRF masks were utilized for this research. Results: The standard U-Net outperformed attention U-Net with a dice score of 0.5207, an AUC of 0.8411, and a recall of 0.6439 on raw OCT images. The attention U-Net with preprocessing (dice: 0.5033, AUC: 0.6987, recall: 0.5391) demonstrated satisfactory performance. The results showed that the U-Net model with CLAHE and focal Tversky loss improved recall by 19.4% relative to the attention U-Net, and this corresponds roughly to a 23% relative decline in false negatives. This indicates increased sensitivity in identifying HRF regions. Conclusions: The best-performing configuration using U-Net-based architectures for segmentation of HRFs combines the standard U-Net model with CLAHE and focal Tversky loss for handling class imbalance. This approach yields relatively higher sensitivity, indicating that the standard U-Net model delivers a simple and robust framework for automated HRF segmentation on the evaluated dataset, promising further validation in broader clinical datasets.