# Affective-ROPTester: Capability and Bias Analysis of LLMs in Predicting Retinopathy of Prematurity

arXiv: https://arxiv.org/abs/2507.05816 · HTML: https://mlsanity.com/paper/2507.05816/

## Key facts

- Cited by 3 papers in the map (data through 14 Oct 2026).
- Builds on 24 of its 55 references that are in the map.
- First posted on arXiv 8 Jul 2025.

## Builds on (most cited first, 24 of 24)

- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
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- [Gemma 2: Improving Open Language Models at a Practical Size](https://mlsanity.com/paper/2408.00118/) (2024)
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- [ChatGLM: A Family of Large Language Models from GLM-130B to GLM-4 All Tools](https://mlsanity.com/paper/2406.12793/) (2024)
- [BloombergGPT: A Large Language Model for Finance](https://mlsanity.com/paper/2303.17564/) (2023)
- [Yi: Open Foundation Models by 01.AI](https://mlsanity.com/paper/2403.04652/) (2024)
- [HuatuoGPT-o1, Towards Medical Complex Reasoning with LLMs](https://mlsanity.com/paper/2412.18925/) (2024)
- [A Survey of Large Language Models for Healthcare: from Data, Technology, and Applications to Accountability and Ethics](https://mlsanity.com/paper/2310.05694/) (2023)
- [ChiMed-GPT: A Chinese Medical Large Language Model with Full Training Regime and Better Alignment to Human Preferences](https://mlsanity.com/paper/2311.06025/) (2023)
- [Emo-bias: A Large Scale Evaluation of Social Bias on Speech Emotion Recognition](https://mlsanity.com/paper/2406.05065/) (2024)
- [Has Multimodal Learning Delivered Universal Intelligence in Healthcare? A Comprehensive Survey](https://mlsanity.com/paper/2408.12880/) (2024)
- [Chain-of-Interaction: Enhancing Large Language Models for Psychiatric Behavior Understanding by Dyadic Contexts](https://mlsanity.com/paper/2403.13786/) (2024)
- [Seeing Sound, Hearing Sight: Uncovering Modality Bias and Conflict of AI models in Sound Localization](https://mlsanity.com/paper/2505.11217/) (2025)
- [Uni-Retrieval: A Multi-Style Retrieval Framework for STEM's Education](https://mlsanity.com/paper/2502.05863/) (2025)
- [Time Matters: Examine Temporal Effects on Biomedical Language Models](https://mlsanity.com/paper/2407.17638/) (2024)
- [Towards Robust Evaluation of STEM Education: Leveraging MLLMs in Project-Based Learning](https://mlsanity.com/paper/2505.17050/) (2025)
- [Exploring Cognitive and Aesthetic Causality for Multimodal Aspect-Based Sentiment Analysis](https://mlsanity.com/paper/2504.15848/) (2025)
- [Evaluating multiple large language models in pediatric ophthalmology](https://mlsanity.com/paper/2311.04368/) (2023)
- [Fine-tuning Large Language Model (LLM) Artificial Intelligence Chatbots in Ophthalmology and LLM-based evaluation using GPT-4](https://mlsanity.com/paper/2402.10083/) (2024)
- [From Query to Explanation: Uni-RAG for Multi-Modal Retrieval-Augmented Learning in STEM](https://mlsanity.com/paper/2507.03868/) (2025)

## Built on by (most cited first, 3 of 3)

- [P2P: A Poison-to-Poison Remedy for Reliable Backdoor Defense in LLMs](https://mlsanity.com/paper/2510.04503/) (2025)
- [Beyond Vulnerabilities: A Survey of Adversarial Attacks as Both Threats and Defenses in Computer Vision Systems](https://mlsanity.com/paper/2508.01845/) (2025)
- [HarmReduction: Benchmarking LLMs in Harm Reduction Information Provision to Support People Who Use Drugs](https://mlsanity.com/paper/2507.21815/) (2025)

## Abstract (arXiv)

Despite the remarkable progress of large language models (LLMs) across various domains, their capacity to predict retinopathy of prematurity (ROP) risk remains largely unexplored. To address this gap, we introduce a novel Chinese benchmark dataset, termed CROP, comprising 993 admission records annotated with low, medium, and high-risk labels. To systematically examine the predictive capabilities and affective biases of LLMs in ROP risk stratification, we propose Affective-ROPTester, an automated evaluation framework incorporating three prompting strategies: Instruction-based, Chain-of-Thought (CoT), and In-Context Learning (ICL). The Instruction scheme assesses LLMs' intrinsic knowledge and associated biases, whereas the CoT and ICL schemes leverage external medical knowledge to enhance predictive accuracy. Crucially, we integrate emotional elements at the prompt level to investigate how different affective framings influence the model's ability to predict ROP and its bias patterns. Empirical results derived from the CROP dataset yield two principal observations. First, LLMs demonstrate limited efficacy in ROP risk prediction when operating solely on intrinsic knowledge, yet exhibit marked performance gains when augmented with structured external inputs. Second, affective biases are evident in the model outputs, with a consistent inclination toward overestimating medium- and high-risk cases. Third, compared to negative emotions, positive emotional framing contributes to mitigating predictive bias in model outputs. These findings highlight the critical role of affect-sensitive prompt engineering in enhancing diagnostic reliability and emphasize the utility of Affective-ROPTester as a framework for evaluating and mitigating affective bias in clinical language modeling systems.