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

• URL: http://arxiv.org/abs/2603.13403v1
• Date: Thu, 12 Mar 2026 06:49:32 GMT
• Title: Diabetic Retinopathy Grading with CLIP-based Ranking-Aware Adaptation:A Comparative Study on Fundus Image
• Abstract summary: We investigate three CLIP-based approaches for five-class diabetic retinopathy severity grading.<n>A ranking-aware prompting model encodes the ordinal structure of DR progression.<n>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.
• Score: 7.6889618752994595
• License: http://creativecommons.org/licenses/by/4.0/
• Abstract: 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.

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