Hybrid Convolutional Transformer Learning Utilizing Ordinal Sensitive Loss for Automated Grading of Diabetic Retinopathy
DOI:
https://doi.org/10.21015/vtse.v14i1.2344Abstract
Diabetic retinopathy (DR) is a major cause of preventable blindness globally requiring precise and dependable automated grading systems to facilitate extensive screening initiatives. Recent deep learning techniques utilizing convolutional neural networks (CNNs) have yielded encouraging outcomes however, they predominantly concentrate on local lesion identification and frequently neglect to encompass the global retinal context. Furthermore, the majority of current methodologies regard diabetic retinopathy grading as a conventional multi-class classification issue, neglecting the ordinal characteristics of disease severity and the significant class imbalance present in clinical datasets. In this paper, we propose a hybrid convolutional-transformer learning framework with ordinal-sensitive loss for automated diabetic retinopathy grading. The suggested model combines a deep CNN backbone for strong local feature extraction with a lightweight transformer encoder that works on convolutionally down sampled feature maps to model long-range dependencies in a computationally efficient manner. This design reduces the quadratic complexity of self-attention while keeping the global context information needed to figure out how bad something is. To deal with class imbalance and penalties for misclassifying ordinal data, an ordinal-sensitive focal loss is used to make the model focus on clinically important mistakes. We test the framework on publicly available fundus image datasets using a wide range of performance metrics, such as accuracy, macro-F1 score, balanced accuracy, area under the ROC curve (AUC), and quadratic Cohen's kappa. Experimental results show that the suggested method consistently beats CNN-only baselines and standard cross-entropy-based training, getting better accuracy of 85%
References
O. Gaidai, Y. Cao, and S. Loginov, “Global cardiovascular diseases death rate prediction,” Current Problems in Cardiology, vol. 48, no. 5, p. 101622, 2023.
A. Timmis et al., “European Society of Cardiology: Cardiovascular disease statistics 2021,” European Heart Journal, vol. 43, no. 8, pp. 716–799, 2022.
Y.-Q. Cai et al., “Pitfalls in developing machine learning models for predicting cardiovascular diseases: Challenges and solutions,” Journal of Medical Internet Research, vol. 26, p. e47645, 2024.
G. C. R. Consortium, “Global effect of modifiable risk factors on cardiovascular disease and mortality,” New England Journal of Medicine, vol. 389, no. 14, pp. 1273–1285, 2023.
H. A. Al-Alshaikh et al., “Comprehensive evaluation and performance analysis of machine learning in heart disease prediction,” Scientific Reports, vol. 14, no. 1, p. 7819, 2024.
C. Zhou et al., “A comprehensive review of deep learning-based models for heart disease prediction,” Artificial Intelligence Review, vol. 57, no. 10, p. 263, 2024.
S. Subramani et al., “Cardiovascular diseases prediction by machine learning incorporation with deep learning,” Frontiers in Medicine, vol. 10, p. 1150933, 2023.
O. Taylan et al., “Early prediction in classification of cardiovascular diseases with machine learning, neuro-fuzzy and statistical methods,” Biology, vol. 12, no. 1, p. 117, 2023.
V. Pandey, U. K. Lilhore, and R. Walia, “A systematic review on cardiovascular disease detection and classification,” Biomedical Signal Processing and Control, vol. 102, p. 107329, 2025.
E. Vaz, “Quantum machine learning in spatial analysis: A paradigm shift in resource allocation and environmental modeling,” Letters in Spatial and Resource Sciences, vol. 17, no. 1, p. 11, 2024.
S. Khurana, M. Nene, and M. J. Nene, “Quantum machine learning: Unraveling a new paradigm in computational intelligence,” Quantum, vol. 74, no. 1, 2024.
J. Park et al., “Over the quantum rainbow: Explaining hybrid quantum reinforcement learning,” in Proc. IEEE Int. Conf. Quantum Computing and Engineering (QCE), 2024, pp. 1583–1594.
S. Y.-C. Chen et al., “Variational quantum reinforcement learning via evolutionary optimization,” Machine Learning: Science and Technology, vol. 3, no. 1, p. 015025, 2022.
S. Y.-C. Chen, “Asynchronous training of quantum reinforcement learning,” Procedia Computer Science, vol. 222, pp. 321–330, 2023.
X. Fang et al., “Industry application of digital twin: From concept to implementation,” International Journal of Advanced Manufacturing Technology, vol. 121, no. 7, pp. 4289–4312, 2022.
E. Katsoulakis et al., “Digital twins for health: A scoping review,” NPJ Digital Medicine, vol. 7, no. 1, p. 77, 2024.
K. Zhang et al., “Concepts and applications of digital twins in healthcare and medicine,” Patterns, vol. 5, no. 8, 2024.
A. Vallée, “Digital twin for healthcare systems,” Frontiers in Digital Health, vol. 5, p. 1253050, 2023.
T. O. Fatunmbi, “Leveraging robotics, artificial intelligence, and machine learning for enhanced disease diagnosis and treatment,” World Journal of Advanced Engineering Technology and Sciences, vol. 6, no. 2, pp. 121–135, 2022.
H. Sadr et al., “Unveiling the potential of artificial intelligence in revolutionizing disease diagnosis and prediction,” European Journal of Medical Research, vol. 30, no. 1, p. 418, 2025.
J. Yi et al., “Optimization of transformer heart disease prediction model based on particle swarm optimization algorithm,” in Proc. Int. Conf. Frontier Technologies of Information and Computer (ICFTIC), 2024, pp. 1109–1113.
B. Ahmad, J. Chen, and H. Chen, “Feature selection strategies for optimized heart disease diagnosis using ML and DL models,” arXiv preprint arXiv:2503.16577, 2025.
M. T. García-Ordás et al., “Heart disease risk prediction using deep learning techniques with feature augmentation,” Multimedia Tools and Applications, vol. 82, no. 20, pp. 31759–31773, 2023.
M. S. K. Dhara et al., “Hybrid deep learning framework for enhanced cardiovascular disease detection using ECG signal,” Scientific Reports, vol. 15, 2025.
S. Dhandapani, H. Somasundaram, and T. Angamuthu, “Hybrid deep learning framework for heart disease prediction using ECG signal images,” Scientific Reports, vol. 15, no. 1, p. 33922, 2025. doi: 10.1038/s41598-025-10062-6.
K. S. L. Prasanna, N. P. Challa, and J. Nagaraju, “Heart disease prediction using reinforcement learning technique,” in Proc. Int. Conf. Advances in Electrical, Computing, Communication and Sustainable Technologies (ICAECT), 2023, pp. 1–5.
R. Gayathri, S. K. B. Sangeetha, and M. B. B. A. Malar, “Enhancing heart disease prediction with reinforcement learning and data augmentation,” Systems and Soft Computing, vol. 6, p. 200129, 2024.
Y. Zhao et al., “Systematic literature review on reinforcement learning in non-communicable disease interventions,” Artificial Intelligence in Medicine, vol. 154, p. 102901, 2024.
R. Detrano et al., “Heart disease,” UCI Machine Learning Repository, 1989. doi: 10.24432/C52P4X.
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