# Generalizing to Unseen Domains in Diabetic Retinopathy Classification

arXiv: https://arxiv.org/abs/2310.17255 · HTML: https://mlsanity.com/paper/2310.17255/

## Key facts

- Cited by 7 papers in the map (data through 14 Oct 2026).
- Builds on 47 of its 72 references that are in the map.
- First posted on arXiv 26 Oct 2023.

## Builds on (most cited first, 30 of 47)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [PyTorch: An Imperative Style, High-Performance Deep Learning Library](https://mlsanity.com/paper/1912.01703/) (2019)
- [Distilling the Knowledge in a Neural Network](https://mlsanity.com/paper/1503.02531/) (2015)
- [Training data-efficient image transformers & distillation through attention](https://mlsanity.com/paper/2012.12877/) (2020)
- [Domain-Adversarial Training of Neural Networks](https://mlsanity.com/paper/1505.07818/) (2015)
- [Unsupervised Domain Adaptation by Backpropagation](https://mlsanity.com/paper/1409.7495/) (2014)
- [Invariant Risk Minimization](https://mlsanity.com/paper/1907.02893/) (2019)
- [Distributionally Robust Neural Networks for Group Shifts: On the Importance of Regularization for Worst-Case Generalization](https://mlsanity.com/paper/1911.08731/) (2019)
- [Deep CORAL: Correlation Alignment for Deep Domain Adaptation](https://mlsanity.com/paper/1607.01719/) (2016)
- [Tokens-to-Token ViT: Training Vision Transformers from Scratch on ImageNet](https://mlsanity.com/paper/2101.11986/) (2021)
- [In Search of Lost Domain Generalization](https://mlsanity.com/paper/2007.01434/) (2020)
- [Deeper, Broader and Artier Domain Generalization](https://mlsanity.com/paper/1710.03077/) (2017)
- [CvT: Introducing Convolutions to Vision Transformers](https://mlsanity.com/paper/2103.15808/) (2021)
- [Learning to Generalize: Meta-Learning for Domain Generalization](https://mlsanity.com/paper/1710.03463/) (2017)
- [Out-of-Distribution Generalization via Risk Extrapolation (REx)](https://mlsanity.com/paper/2003.00688/) (2020)
- [Domain Generalization via Invariant Feature Representation](https://mlsanity.com/paper/1301.2115/) (2013)
- [Domain Generalization by Solving Jigsaw Puzzles](https://mlsanity.com/paper/1903.06864/) (2019)
- [Measuring Calibration in Deep Learning](https://mlsanity.com/paper/1904.01685/) (2019)
- [SWAD: Domain Generalization by Seeking Flat Minima](https://mlsanity.com/paper/2102.08604/) (2021)
- [Self-Challenging Improves Cross-Domain Generalization](https://mlsanity.com/paper/2007.02454/) (2020)
- [Contrastive Adaptation Network for Unsupervised Domain Adaptation](https://mlsanity.com/paper/1901.00976/) (2019)
- [Domain Generalization via Model-Agnostic Learning of Semantic Features](https://mlsanity.com/paper/1910.13580/) (2019)
- [Unsupervised Domain Adaptation with Residual Transfer Networks](https://mlsanity.com/paper/1602.04433/) (2016)
- [Unified Deep Supervised Domain Adaptation and Generalization](https://mlsanity.com/paper/1709.10190/) (2017)
- [Learning to Generate Novel Domains for Domain Generalization](https://mlsanity.com/paper/2007.03304/) (2020)
- [FedDG: Federated Domain Generalization on Medical Image Segmentation via Episodic Learning in Continuous Frequency Space](https://mlsanity.com/paper/2103.06030/) (2021)
- [Generalizing Across Domains via Cross-Gradient Training](https://mlsanity.com/paper/1804.10745/) (2018)
- [Gradient Matching for Domain Generalization](https://mlsanity.com/paper/2104.09937/) (2021)
- [Episodic Training for Domain Generalization](https://mlsanity.com/paper/1902.00113/) (2019)

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

- [Single Domain Generalization in Diabetic Retinopathy: A Neuro-Symbolic Learning Approach](https://mlsanity.com/paper/2509.02918/) (2025)
- [Higher-Order Domain Generalization in Magnetic Resonance-Based Assessment of Alzheimer's Disease](https://mlsanity.com/paper/2601.01485/) (2026)
- [HypCBC: Domain-Invariant Hyperbolic Cross-Branch Consistency for Generalizable Medical Image Analysis](https://mlsanity.com/paper/2602.03264/) (2026)
- [Divergent Domains, Convergent Grading: Enhancing Generalization in Diabetic Retinopathy Grading](https://mlsanity.com/paper/2411.02614/) (2024)
- [AdvBlur: Adversarial Blur for Robust Diabetic Retinopathy Classification and Cross-Domain Generalization](https://mlsanity.com/paper/2510.24000/) (2025)
- [Learning to Fuse and Reconstruct Multi-View Graphs for Diabetic Retinopathy Grading](https://mlsanity.com/paper/2602.21944/) (2026)
- [Human Knowledge Integrated Multi-modal Learning for Single Source Domain Generalization](https://mlsanity.com/paper/2603.12369/) (2026)

## Abstract (arXiv)

Diabetic retinopathy (DR) is caused by long-standing diabetes and is among the fifth leading cause for visual impairments. The process of early diagnosis and treatments could be helpful in curing the disease, however, the detection procedure is rather challenging and mostly tedious. Therefore, automated diabetic retinopathy classification using deep learning techniques has gained interest in the medical imaging community. Akin to several other real-world applications of deep learning, the typical assumption of i.i.d data is also violated in DR classification that relies on deep learning. Therefore, developing DR classification methods robust to unseen distributions is of great value. In this paper, we study the problem of generalizing a model to unseen distributions or domains (a.k.a domain generalization) in DR classification. To this end, we propose a simple and effective domain generalization (DG) approach that achieves self-distillation in vision transformers (ViT) via a novel prediction softening mechanism. This prediction softening is an adaptive convex combination one-hot labels with the model's own knowledge. We perform extensive experiments on challenging open-source DR classification datasets under both multi-source and single-source DG settings with three different ViT backbones to establish the efficacy and applicability of our approach against competing methods. For the first time, we report the performance of several state-of-the-art DG methods on open-source DR classification datasets after conducting thorough experiments. Finally, our method is also capable of delivering improved calibration performance than other methods, showing its suitability for safety-critical applications, including healthcare. We hope that our contributions would investigate more DG research across the medical imaging community.