Distributed training of foundation models for ophthalmic diagnosis.

Vision impairment affects nearly 2.2 billion people globally, and nearly half of these cases could be prevented with early diagnosis and intervention-underscoring the urgent need for reliable and scalable detection methods for conditions like diabetic retinopathy and age-related macular degeneration. Here we propose a distributed deep learning framework that integrates self-supervised and domain-adaptive federated learning to enhance the detection of eye diseases from optical coherence tomography images. We employed a self-supervised, mask-based pre-training strategy to develop a robust foundation encoder. This encoder was trained on seven optical coherence tomography datasets, and we compared its performance under local, centralized, and federated learning settings. Our results show that self-supervised methods-both centralized and federated-improved the area under the curve by at least 10% compared to local models. Additionally, incorporating domain adaptation into the federated learning framework further boosted performance and generalization across different populations and imaging conditions. This approach supports collaborative model development without data sharing, providing a scalable, privacy-preserving solution for effective retinal disease screening and diagnosis in diverse clinical settings.