Deep Learning Based Estimation of Blood Glucose Levels from Multidirectional Scleral Blood Vessel Imaging

Regular monitoring of glycemic status is essential for diabetes management, yet conventional blood-based testing can be burdensome for frequent assessment. The sclera contains superficial microvasculature that may exhibit diabetes related alterations and is readily visible on the ocular surface. We propose ScleraGluNet, a multiview deep-learning framework for three-class metabolic status classification (normal, controlled diabetes, and high-glucose diabetes) and continuous fasting plasma glucose (FPG) estimation from multidirectional scleral vessel images. The dataset comprised 445 participants (150/140/155) and 2,225 anterior-segment images acquired from five gaze directions per participant. After vascular enhancement, features were extracted using parallel convolutional branches, refined with Manta Ray Foraging Optimization (MRFO), and fused via transformer-based cross-view attention. Performance was evaluated using subject-wise five-fold cross-validation, with all images from each participant assigned to the same fold. ScleraGluNet achieved 93.8% overall accuracy, with one-vs-rest AUCs of 0.971,0.956, and 0.982 for normal, controlled diabetes, and high-glucose diabetes, respectively. For FPG estimation, the model achieved MAE = 6.42 mg/dL and RMSE = 7.91 mg/dL, with strong correlation to laboratory measurements (r = 0.983; R2 = 0.966). Bland Altman analysis showed a mean bias of +1.45 mg/dL with 95% limits of agreement from -8.33 to +11.23 mg/dL. These results support multidirectional scleral vessel imaging with multiview learning as a promising noninvasive approach for glycemic assessment, warranting multicenter validation before clinical deployment.