# Evaluating Fundus-Specific Foundation Models for Diabetic Macular Edema Detection

arXiv: https://arxiv.org/abs/2510.07277 · HTML: https://mlsanity.com/paper/2510.07277/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 23 of its 42 references that are in the map.
- First posted on arXiv 8 Oct 2025.

## Builds on (most cited first, 23 of 23)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Masked Autoencoders Are Scalable Vision Learners](https://mlsanity.com/paper/2111.06377/) (2021)
- [EfficientNet: Rethinking Model Scaling for Convolutional Neural Networks](https://mlsanity.com/paper/1905.11946/) (2019)
- [RandAugment: Practical automated data augmentation with a reduced search space](https://mlsanity.com/paper/1909.13719/) (2019)
- [Publicly Available Clinical BERT Embeddings](https://mlsanity.com/paper/1904.03323/) (2019)
- [Quantifying Attention Flow in Transformers](https://mlsanity.com/paper/2005.00928/) (2020)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [A Cookbook of Self-Supervised Learning](https://mlsanity.com/paper/2304.12210/) (2023)
- [A review of deep learning in medical imaging: Imaging traits, technology trends, case studies with progress highlights, and future promises](https://mlsanity.com/paper/2008.09104/) (2020)
- [A Foundation Language-Image Model of the Retina (FLAIR): Encoding Expert Knowledge in Text Supervision](https://mlsanity.com/paper/2308.07898/) (2023)
- [MedFMC: A Real-world Dataset and Benchmark For Foundation Model Adaptation in Medical Image Classification](https://mlsanity.com/paper/2306.09579/) (2023)
- [A ChatGPT Aided Explainable Framework for Zero-Shot Medical Image Diagnosis](https://mlsanity.com/paper/2307.01981/) (2023)
- [RET-CLIP: A Retinal Image Foundation Model Pre-trained with Clinical Diagnostic Reports](https://mlsanity.com/paper/2405.14137/) (2024)
- [EyeFound: A Multimodal Generalist Foundation Model for Ophthalmic Imaging](https://mlsanity.com/paper/2405.11338/) (2024)
- [Medical Multimodal Foundation Models in Clinical Diagnosis and Treatment: Applications, Challenges, and Future Directions](https://mlsanity.com/paper/2412.02621/) (2024)
- [UrFound: Towards Universal Retinal Foundation Models via Knowledge-Guided Masked Modeling](https://mlsanity.com/paper/2408.05618/) (2024)
- [Foundation Models in Medical Imaging: A Review and Outlook](https://mlsanity.com/paper/2506.09095/) (2025)
- [ViLReF: An Expert Knowledge Enabled Vision-Language Retinal Foundation Model](https://mlsanity.com/paper/2408.10894/) (2024)
- [A Novel Ophthalmic Benchmark for Evaluating Multimodal Large Language Models with Fundus Photographs and OCT Images](https://mlsanity.com/paper/2503.07094/) (2025)
- [Exploring the Transferability of a Foundation Model for Fundus Images: Application to Hypertensive Retinopathy](https://mlsanity.com/paper/2401.15526/) (2024)
- [Evaluation of Transfer Learning for Classification of: (1) Diabetic Retinopathy by Digital Fundus Photography and (2) Diabetic Macular Edema, Choroidal Neovascularization and Drusen by Optical Coherence Tomography](https://mlsanity.com/paper/1902.04151/) (2019)

## Abstract (arXiv)

Diabetic Macular Edema (DME) is a leading cause of vision loss among patients with Diabetic Retinopathy (DR). While deep learning has shown promising results for automatically detecting this condition from fundus images, its application remains challenging due the limited availability of annotated data. Foundation Models (FM) have emerged as an alternative solution. However, it is unclear if they can cope with DME detection in particular. In this paper, we systematically compare different FM and standard transfer learning approaches for this task. Specifically, we compare the two most popular FM for retinal images-RETFound and FLAIR-and an EfficientNetB0 backbone, across different training regimes and evaluation settings in IDRiD, MESSIDOR-2 and OCT-and-Eye-FundusImages (OEFI). Results show that despite their scale, FM do not consistently outperform fine-tuned CNNs in this task. In particular, EfficientNet-B0 consistently achieves competitive or superior performance across evaluation settings, with FLAIR being the most competitive foundation model, consistently outperforming RETFound. These findings suggest that FMs do not necessarily provide an advantage for fine-grained ophthalmic tasks such as DME detection, even after fine-tuning, highlighting lightweight CNNs as strong baselines in data-scarce environments.