# Forgetting-Resistant and Lesion-Aware Source-Free Domain Adaptive Fundus Image Analysis with Vision-Language Model

arXiv: https://arxiv.org/abs/2602.19471 · HTML: https://mlsanity.com/paper/2602.19471/

## 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 19 of its 31 references that are in the map.
- First posted on arXiv 23 Feb 2026.

## Placed in

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

## Builds on (most cited first, 19 of 19)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [Learning Deep Features for Discriminative Localization](https://mlsanity.com/paper/1512.04150/) (2015)
- [FixMatch: Simplifying Semi-Supervised Learning with Consistency and Confidence](https://mlsanity.com/paper/2001.07685/) (2020)
- [Do We Really Need to Access the Source Data? Source Hypothesis Transfer for Unsupervised Domain Adaptation](https://mlsanity.com/paper/2002.08546/) (2020)
- [Invariant Information Clustering for Unsupervised Image Classification and Segmentation](https://mlsanity.com/paper/1807.06653/) (2018)
- [Contrastive Test-Time Adaptation](https://mlsanity.com/paper/2204.10377/) (2022)
- [Exploiting the Intrinsic Neighborhood Structure for Source-free Domain Adaptation](https://mlsanity.com/paper/2110.04202/) (2021)
- [Attracting and Dispersing: A Simple Approach for Source-free Domain Adaptation](https://mlsanity.com/paper/2205.04183/) (2022)
- [A Foundation Language-Image Model of the Retina (FLAIR): Encoding Expert Knowledge in Text Supervision](https://mlsanity.com/paper/2308.07898/) (2023)
- [Source-Free Domain Adaptive Fundus Image Segmentation with Denoised Pseudo-Labeling](https://mlsanity.com/paper/2109.09735/) (2021)
- [Applications of Deep Learning in Fundus Images: A Review](https://mlsanity.com/paper/2101.09864/) (2021)
- [Confidence Score for Source-Free Unsupervised Domain Adaptation](https://mlsanity.com/paper/2206.06640/) (2022)
- [Source-Free Domain Adaptation with Frozen Multimodal Foundation Model](https://mlsanity.com/paper/2311.16510/) (2023)
- [C-SFDA: A Curriculum Learning Aided Self-Training Framework for Efficient Source Free Domain Adaptation](https://mlsanity.com/paper/2303.17132/) (2023)
- [Patch-based Output Space Adversarial Learning for Joint Optic Disc and Cup Segmentation](https://mlsanity.com/paper/1902.07519/) (2019)
- [BMD: A General Class-balanced Multicentric Dynamic Prototype Strategy for Source-free Domain Adaptation](https://mlsanity.com/paper/2204.02811/) (2022)
- [Rethinking the Role of Pre-Trained Networks in Source-Free Domain Adaptation](https://mlsanity.com/paper/2212.07585/) (2022)
- [MultiEYE: Dataset and Benchmark for OCT-Enhanced Retinal Disease Recognition from Fundus Images](https://mlsanity.com/paper/2412.09402/) (2024)

## Abstract (arXiv)

Source-free domain adaptation (SFDA) aims to adapt a model trained in the source domain to perform well in the target domain, with only unlabeled target domain data and the source model. Taking into account that conventional SFDA methods are inevitably error-prone under domain shift, recently greater attention has been directed to SFDA assisted with off-the-shelf foundation models, e.g., vision-language (ViL) models. However, existing works of leveraging ViL models for SFDA confront two issues: (i) Although mutual information is exploited to consider the joint distribution between the predictions of ViL model and the target model, we argue that the forgetting of some superior predictions of the target model still occurs, as indicated by the decline of the accuracies of certain classes during adaptation; (ii) Prior research disregards the rich, fine-grained knowledge embedded in the ViL model, which offers detailed grounding for fundus image diagnosis. In this paper, we introduce a novel forgetting-resistant and lesion-aware (FRLA) method for SFDA of fundus image diagnosis with ViL model. Specifically, a forgetting-resistant adaptation module explicitly preserves the confident predictions of the target model, and a lesion-aware adaptation module yields patch-wise predictions from ViL model and employs them to help the target model be aware of the lesion areas and leverage the ViL model's fine-grained knowledge. Extensive experiments show that our method not only significantly outperforms the vision-language model, but also achieves consistent improvements over the state-of-the-art methods. Our code will be released.