# oculomix: Hierarchical Sampling for Retinal-Based Systemic Disease Prediction

arXiv: https://arxiv.org/abs/2601.19939 · HTML: https://mlsanity.com/paper/2601.19939/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 7 of its 14 references that are in the map.
- First posted on arXiv 16 Jan 2026.

## Builds on (most cited first, 7 of 7)

- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [mixup: Beyond Empirical Risk Minimization](https://mlsanity.com/paper/1710.09412/) (2017)
- [Training data-efficient image transformers & distillation through attention](https://mlsanity.com/paper/2012.12877/) (2020)
- [CutMix: Regularization Strategy to Train Strong Classifiers with Localizable Features](https://mlsanity.com/paper/1905.04899/) (2019)
- [Puzzle Mix: Exploiting Saliency and Local Statistics for Optimal Mixup](https://mlsanity.com/paper/2009.06962/) (2020)
- [TransMix: Attend to Mix for Vision Transformers](https://mlsanity.com/paper/2111.09833/) (2021)
- [Improving Pairwise Ranking for Multi-label Image Classification](https://mlsanity.com/paper/1704.03135/) (2017)

## Abstract (arXiv)

Oculomics - the concept of predicting systemic diseases, such as cardiovascular disease and dementia, through retinal imaging - has advanced rapidly due to the data efficiency of transformer-based foundation models like RETFound. Image-level mixed sample data augmentations, such as CutMix and MixUp, are frequently used for training transformers, yet these techniques perturb patient-specific attributes, such as medical comorbidity and clinical factors, since they only account for images and labels. To address this limitation, we propose a hierarchical sampling strategy, Oculomix, for mixed sample augmentations. Our method is based on two clinical priors. First (exam level), images acquired from the same patient at the same time point share the same attributes. Second (patient level), images acquired from the same patient at different time points have a soft temporal trend, as morbidity generally increases over time. Guided by these priors, our method constrains the mixing space to the patient and exam levels to better preserve patient-specific characteristics and leverages their hierarchical relationships. The proposed method is validated using ViT models on a five-year prediction of major adverse cardiovascular events (MACE) in a large ethnically diverse population (Alzeye). We show that Oculomix consistently outperforms image-level CutMix and MixUp by up to 3% in AUROC, demonstrating the necessity and value of the proposed method in oculomics.