# Diabetic Retinopathy Grading with CLIP-based Ranking-Aware Adaptation:A Comparative Study on Fundus Image

arXiv: https://arxiv.org/abs/2603.13403 · HTML: https://mlsanity.com/paper/2603.13403/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 4 of its 6 references that are in the map.
- First posted on arXiv 12 Mar 2026.

## Builds on (most cited first, 4 of 4)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [CBAM: Convolutional Block Attention Module](https://mlsanity.com/paper/1807.06521/) (2018)
- [A Foundation Language-Image Model of the Retina (FLAIR): Encoding Expert Knowledge in Text Supervision](https://mlsanity.com/paper/2308.07898/) (2023)
- [CLIP-DR: Textual Knowledge-Guided Diabetic Retinopathy Grading with Ranking-aware Prompting](https://mlsanity.com/paper/2407.04068/) (2024)

## Abstract (arXiv)

Diabetic retinopathy (DR) is a leading cause of preventable blindness, and automated fundus image grading can play an important role in large-scale screening. In this work, we investigate three CLIP-based approaches for five-class DR severity grading: (1) a zero-shot baseline using prompt engineering, (2) a hybrid FCN-CLIP model augmented with CBAM attention, and (3) a ranking-aware prompting model that encodes the ordinal structure of DR progression. We train and evaluate on a combined dataset of APTOS 2019 and Messidor-2 (n=5,406), addressing class imbalance through resampling and class-specific optimal thresholding. Our experiments show that the ranking-aware model achieves the highest overall accuracy (93.42%, AUROC 0.9845) and strong recall on clinically critical severe cases, while the hybrid FCN-CLIP model (92.49%, AUROC 0.99) excels at detecting proliferative DR. Both substantially outperform the zero-shot baseline (55.17%, AUROC 0.75). We analyze the complementary strengths of each approach and discuss their practical implications for screening contexts.