RetCond: A Conditional Diffusion Model for Self-Explanatory Multi-Class Fundus Image Classification

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Comparable performance to RETFound (96.99%)

• Primary Outcome: Classification accuracy of 96.98% for multi-class retinal disease detection

• Nnt Or Sensitivity: Sensitivity and specificity values not provided

• Confidence Interval: Not reported

Clinical Application

Requires significant computational resources and technical expertise for implementation Could support teleophthalmology initiatives in rural Australia, but would need TGA approval as medical device software and integration with existing imaging systems Patients undergoing fundus photography for retinal disease screening

Abstract

Vision impairment remains a major global health challenge, and early diagnosis of retinal diseases is essential to prevent avoidable vision loss. Color fundus photography is widely used for retinal assessment, but manual interpretation is time-consuming and prone to inter-clinician variability. Although deep learning has improved automated retinal disease detection, most classification models lack transparency. We introduce RetCond, a self-explanatory generative classifier designed to provide both accurate predictions and counterfactual visual explanations. RetCond is a diffusion model repurposed as a classifier whose generative capabilities enable counterfactual synthesis for built-in explanations. These counterfactual images depict the retinal changes associated with alternative diagnoses, offering insight into the model's decisions. We curated a diverse dataset of 19,565 images containing five retinal disease conditions to train and evaluate the model. Performance is assessed using standard classification metrics and by qualitatively and quantitatively evaluating the self-explanatory component. Comparisons are made against strong discriminative baselines. RetCond achieves a classification accuracy of 96.98%, comparable to RETFound (96.99%). In contrast to standard models, RetCond produces counterfactual images that highlight condition-specific retinal features, confirming its learned concepts and demonstrating its self-explanatory properties. These results show that RetCond matches state-of-the-art discriminative performance while addressing limitations of post-hoc interpretability techniques in standard deep learning models. RetCond, therefore, constitutes a contribution toward more trustworthy AI solutions in ophthalmology.

References

1. 1.Ahsan, O., Ahmad, Nielsen, C., Souza, R., Aulakh, A., Forkert, N. D., & Wilms, M. (2026). RetCond: A Conditional Diffusion Model for Self-Explanatory Multi-Class Fundus Image Classification. Journal of Medical Systems. https://doi.org/10.1007/s10916-026-02414-0