# Federated Uncertainty-Aware Aggregation for Fundus Diabetic Retinopathy Staging

arXiv: https://arxiv.org/abs/2303.13033 · HTML: https://mlsanity.com/paper/2303.13033/

## Key facts

- Cited by 7 papers in the map (data through 14 Oct 2026).
- Builds on 19 of its 30 references that are in the map.
- First posted on arXiv 23 Mar 2023.

## Builds on (most cited first, 19 of 19)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Communication-Efficient Learning of Deep Networks from Decentralized Data](https://mlsanity.com/paper/1602.05629/) (2016)
- [Dropout as a Bayesian Approximation: Representing Model Uncertainty in Deep Learning](https://mlsanity.com/paper/1506.02142/) (2015)
- [Simple and Scalable Predictive Uncertainty Estimation using Deep Ensembles](https://mlsanity.com/paper/1612.01474/) (2016)
- [Advances and Open Problems in Federated Learning](https://mlsanity.com/paper/1912.04977/) (2019)
- [Federated Optimization in Heterogeneous Networks](https://mlsanity.com/paper/1812.06127/) (2018)
- [Federated Learning: Challenges, Methods, and Future Directions](https://mlsanity.com/paper/1908.07873/) (2019)
- [Model-Contrastive Federated Learning](https://mlsanity.com/paper/2103.16257/) (2021)
- [FedBN: Federated Learning on Non-IID Features via Local Batch Normalization](https://mlsanity.com/paper/2102.07623/) (2021)
- [Federated Learning Based on Dynamic Regularization](https://mlsanity.com/paper/2111.04263/) (2021)
- [Federated Learning with Personalization Layers](https://mlsanity.com/paper/1912.00818/) (2019)
- [Exploiting Shared Representations for Personalized Federated Learning](https://mlsanity.com/paper/2102.07078/) (2021)
- [FedDC: Federated Learning with Non-IID Data via Local Drift Decoupling and Correction](https://mlsanity.com/paper/2203.11751/) (2022)
- [Trusted Multi-View Classification](https://mlsanity.com/paper/2102.02051/) (2021)
- [Applications of Deep Learning in Fundus Images: A Review](https://mlsanity.com/paper/2101.09864/) (2021)
- [Robust Calibration with Multi-domain Temperature Scaling](https://mlsanity.com/paper/2206.02757/) (2022)
- [TBraTS: Trusted Brain Tumor Segmentation](https://mlsanity.com/paper/2206.09309/) (2022)
- [Deep Learning based Computer-Aided Diagnosis Systems for Diabetic Retinopathy: A Survey](https://mlsanity.com/paper/1811.01238/) (2018)
- [Evidence fusion with contextual discounting for multi-modality medical image segmentation](https://mlsanity.com/paper/2206.11739/) (2022)

## Built on by (most cited first, 7 of 7)

- [CAR-MFL: Cross-Modal Augmentation by Retrieval for Multimodal Federated Learning with Missing Modalities](https://mlsanity.com/paper/2407.08648/) (2024)
- [Navigating Distribution Shifts in Medical Image Analysis: A Survey](https://mlsanity.com/paper/2411.05824/) (2024)
- [Evidential Federated Learning for Skin Lesion Image Classification](https://mlsanity.com/paper/2411.10071/) (2024)
- [Which Client is Reliable?: A Reliable and Personalized Prompt-based Federated Learning for Medical Image Question Answering](https://mlsanity.com/paper/2410.17484/) (2024)
- [Uncertainty-Aware Ordinal Deep Learning for cross-Dataset Diabetic Retinopathy Grading](https://mlsanity.com/paper/2602.10315/) (2026)
- [TreeFedDG: Alleviating Global Drift in Federated Domain Generalization for Medical Image Segmentation](https://mlsanity.com/paper/2510.18268/) (2025)
- [Evidential Trust-Aware Model Personalization in Decentralized Federated Learning for Wearable IoT](https://mlsanity.com/paper/2512.19131/) (2025)

## Abstract (arXiv)

Deep learning models have shown promising performance in the field of diabetic retinopathy (DR) staging. However, collaboratively training a DR staging model across multiple institutions remains a challenge due to non-iid data, client reliability, and confidence evaluation of the prediction. To address these issues, we propose a novel federated uncertainty-aware aggregation paradigm (FedUAA), which considers the reliability of each client and produces a confidence estimation for the DR staging. In our FedUAA, an aggregated encoder is shared by all clients for learning a global representation of fundus images, while a novel temperature-warmed uncertainty head (TWEU) is utilized for each client for local personalized staging criteria. Our TWEU employs an evidential deep layer to produce the uncertainty score with the DR staging results for client reliability evaluation. Furthermore, we developed a novel uncertainty-aware weighting module (UAW) to dynamically adjust the weights of model aggregation based on the uncertainty score distribution of each client. In our experiments, we collect five publicly available datasets from different institutions to conduct a dataset for federated DR staging to satisfy the real non-iid condition. The experimental results demonstrate that our FedUAA achieves better DR staging performance with higher reliability compared to other federated learning methods. Our proposed FedUAA paradigm effectively addresses the challenges of collaboratively training DR staging models across multiple institutions, and provides a robust and reliable solution for the deployment of DR diagnosis models in real-world clinical scenarios.