# Fairness-Aware Fine-Tuning of Vision-Language Models for Medical Glaucoma Diagnosis

arXiv: https://arxiv.org/abs/2512.03477 · HTML: https://mlsanity.com/paper/2512.03477/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical vision-language models, one of 16 directions in Multimodal LLMs / vision-language models.
- Builds on 11 of its 16 references that are in the map.
- First posted on arXiv 3 Dec 2025.

## Placed in

- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

## Builds on (most cited first, 11 of 11)

- [Language Models are Few-Shot Learners](https://mlsanity.com/paper/2005.14165/) (2020)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [LLaMA: Open and Efficient Foundation Language Models](https://mlsanity.com/paper/2302.13971/) (2023)
- [Improved Baselines with Visual Instruction Tuning](https://mlsanity.com/paper/2310.03744/) (2023)
- [Qwen2-VL: Enhancing Vision-Language Model's Perception of the World at Any Resolution](https://mlsanity.com/paper/2409.12191/) (2024)
- [Equality of Opportunity in Supervised Learning](https://mlsanity.com/paper/1610.02413/) (2016)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [Med-Flamingo: a Multimodal Medical Few-shot Learner](https://mlsanity.com/paper/2307.15189/) (2023)
- [Disparities in Dermatology AI: Assessments Using Diverse Clinical Images](https://mlsanity.com/paper/2111.08006/) (2021)
- [FairTune: Optimizing Parameter Efficient Fine Tuning for Fairness in Medical Image Analysis](https://mlsanity.com/paper/2310.05055/) (2023)
- [FairLoRA: Unpacking Bias Mitigation in Vision Models with Fairness-Driven Low-Rank Adaptation](https://mlsanity.com/paper/2410.17358/) (2024)

## Abstract (arXiv)

Vision-language models achieve expert-level performance on medical imaging tasks but exhibit significant diagnostic accuracy disparities across demographic groups. We introduce fairness-aware Low-Rank Adaptation for medical VLMs, combining parameter efficiency with explicit fairness optimization. Our key algorithmic contribution is a differentiable MaxAccGap loss that enables end-to-end optimization of accuracy parity across demographic groups. We propose three methods: FR-LoRA integrates MaxAccGap regularization into the training objective, GR-LoRA applies inverse frequency weighting to balance gradient contributions, and Hybrid-LoRA combines both mechanisms. Evaluated on 10,000 glaucoma fundus images, GR-LoRA reduces diagnostic accuracy disparities by 69% while maintaining 53.15% overall accuracy. Ablation studies reveal that strong regularization strength achieves optimal fairness with minimal accuracy trade-off, and race-specific optimization yields 60% disparity reduction. Our approach requires only 0.24% trainable parameters, enabling practical deployment of fair medical AI in resource-constrained healthcare settings.