# Explainable Diabetic Retinopathy Classification Using Vision Foundation Models

arXiv: https://arxiv.org/abs/2608.28207 · HTML: https://mlsanity.com/paper/2608.28207/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 17 of its 25 references that are in the map.
- First posted on arXiv 28 Aug 2026.

## Builds on (most cited first, 17 of 17)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [DINOv2: Learning Robust Visual Features without Supervision](https://mlsanity.com/paper/2304.07193/) (2023)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [On the Opportunities and Risks of Foundation Models](https://mlsanity.com/paper/2108.07258/) (2021)
- [Quantifying Attention Flow in Transformers](https://mlsanity.com/paper/2005.00928/) (2020)
- [Score-CAM: Score-Weighted Visual Explanations for Convolutional Neural Networks](https://mlsanity.com/paper/1910.01279/) (2019)
- [A Survey on Explainable Artificial Intelligence (XAI): Towards Medical XAI](https://mlsanity.com/paper/1907.07374/) (2019)
- [Explainable Artificial Intelligence: Understanding, Visualizing and Interpreting Deep Learning Models](https://mlsanity.com/paper/1708.08296/) (2017)
- [Eigen-CAM: Class Activation Map using Principal Components](https://mlsanity.com/paper/2008.00299/) (2020)
- [Use HiResCAM instead of Grad-CAM for faithful explanations of convolutional neural networks](https://mlsanity.com/paper/2011.08891/) (2020)
- [Using explainable AI to investigate electrocardiogram changes during healthy aging -- from expert features to raw signals](https://mlsanity.com/paper/2310.07463/) (2023)
- [Benchmarking ECG FMs: A Reality Check Across Clinical Tasks](https://mlsanity.com/paper/2509.25095/) (2025)
- [Explainable machine learning for neoplasms diagnosis via electrocardiograms: an externally validated study](https://mlsanity.com/paper/2412.07737/) (2024)
- [A Multimodal Deep Learning Framework for Predicting ICU Deterioration: Integrating ECG Waveforms with Clinical Data and Clinician Benchmarking](https://mlsanity.com/paper/2601.06645/) (2026)

## Abstract (arXiv)

Diabetic retinopathy (DR) is a major cause of preventable blindness, creating a need for accurate and trustworthy automated screening. This study investigates an explainable DR classification framework using vision foundation models and multiple transfer learning strategies. Three backbones, DINOv2, CLIP, and Vision Transformer (ViT), were evaluated using full fine-tuning, linear probing, and Low-Rank Adaptation (LoRA). Models were trained and internally evaluated on the ODIR dataset and externally evaluated on APTOS to assess generalization. DINOv2-LoRA achieved the highest internal AUROC of 0.758, while DINOv2 full fine-tuning and ViT full fine-tuning achieved the highest external AUROC of 0.920. Calibration was further assessed using reliability analysis after isotonic regression. For explainability, Grad-CAM and HiResCAM were evaluated against expert-annotated lesion masks from the IDRiD dataset using Dice, Intersection over Union (IoU), and Pointing Game metrics. The results demonstrate that foundation models, particularly DINOv2, can provide strong predictive performance, while LoRA offers a parameter-efficient alternative to full fine-tuning. Quantitative evaluation of explanation maps further supports the assessment of whether model attention corresponds to clinically relevant retinal lesions.