Triple-Phase Multimodal Knowledge Aggregation Framework for Microbial Keratitis Subtype Diagnosis on Slit-Lamp Photography

Yiqing Wang; Maria A. Woodward; Ziyun Yang; N. Venkatesh Prajna; Chunming He; Leslie M. Niziol; Mercy Pawar; Ming-Chen Lu; Guillermo Amescua; Rachel Wozniak; Sejal Amin; Abinaya Krishnan; Prabhleen Kochar; Sina Farsiu

arXiv · 2607.03740

Triple-Phase Multimodal Knowledge Aggregation Framework for Microbial Keratitis Subtype Diagnosis on Slit-Lamp Photography

Yiqing Wang·Maria A. Woodward·Ziyun Yang·N. Venkatesh Prajna·Chunming He·Leslie M. Niziol·Mercy Pawar·Ming-Chen Lu·Guillermo Amescua·Rachel Wozniak·Sejal Amin·Abinaya Krishnan·Prabhleen Kochar·Sina Farsiu

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Abstract

Microbial keratitis requires rapid pathogen identification to guide treatment, but culture- and PCR-based diagnostics are slow and resource-intensive. We developed a triple-phase multimodal framework for bacterial-versus-fungal keratitis classification using slit-lamp photographs acquired under blue-light, sclerotic-scatter, and white-light illumination, together with clinical metadata. The model combines cross-modality contrastive learning, modality-specific fine-tuning, and feature-level multimodal ensemble learning for patient-level prediction. We evaluated the framework on a multicenter dataset of 1,645 patients and 17,158 images from India and the United States. The model achieved 85.84% accuracy, 84.46% average F1-score, and 0.885 AUC. Site-specific evaluation showed that pooled results were overly optimistic, whereas resampling- and balance-based re-evaluation provided a more realistic assessment of cross-site generalization. Under all settings, our framework remained the top-performing approach. The code is available at https://github.com/yqwang01/TPMKA and dataset access will be provided subject to University of Michigan data-sharing clearance.

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Yiqing Wang, Maria A. Woodward, Ziyun Yang, N. Venkatesh Prajna, Chunming He, Leslie M. Niziol, Mercy Pawar, Ming-Chen Lu, Guillermo Amescua, Rachel Wozniak, Sejal Amin, Abinaya Krishnan, Prabhleen Kochar, Sina Farsiu. 2026-07-04. Triple-Phase Multimodal Knowledge Aggregation Framework for Microbial Keratitis Subtype Diagnosis on Slit-Lamp Photography. https://arxiv.org/abs/2607.03740

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