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arXiv · 2609.25697

Interpretable AI plus Handheld, Portable Retinal Photographs: A Low-Cost Glaucoma Screening Solution for West Africa

Charis Y. N. Chiang·Tarela Sarimiye·Adeyinka Ashaye·Martin Buist·Michael A. Hauser·Olusola Olawoye·Michaël J. A. Girard
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Abstract

Purpose: To develop and evaluate an interpretable artificial intelligence (AI) framework for glaucoma screening from low-cost portable, handheld retinal fundus photographs in a West African population and to compare its performance with clinical tabletop fundus imaging. Methods: We used data from a community-based study of 681 participants (1,362 eyes) in Nigeria, comprising 414 glaucoma, 478 glaucoma suspect, and 470 non-glaucoma eyes. Fundus photographs were acquired using the low-cost handheld, portable Volk Viva retinal camera and the Canon CR-2-AF tabletop camera. We fine-tuned component models separately to each device to perform vessel segmentation, cup and disc boundary segmentation, and feature extraction to detect optic nerve head features. A final classification model combined these components to classify scans as glaucoma, glaucoma suspect or non-glaucoma. Feature-weight analysis and Gradient-weighted Class Activation Mapping were used for interpretation. Results: The models performed well on both Volk Viva and Canon CR-2-AF images: Vessel segmentation: 0.98 Dice Coefficient (DC) (Volk) and 0.94 DC (Canon); Cup and disc segmentation: 0.95 DC (Volk) and 0.96 DC (Canon); Optic nerve head feature detection: area under the receiver operating characteristic curve (AUCs) of 0.83$\pm$0.03 (Volk) and 0.87$\pm$0.04 (Canon); Classification model: AUCs of 0.85$\pm$0.01 (Volk) and 0.93$\pm$0.01 (Canon). Reports for each image, present model decision confidence scores and decision-rationale visualizations to support clinical interpretation. Conclusions: Volk Viva results were reasonably comparable to Canon CR-2-AF in the component models and not far behind in classification. This shows that interpretable AI combined with low-cost, portable imaging may enhance community-level glaucoma screening, especially in settings with limited specialist access and resources.

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Charis Y. N. Chiang, Tarela Sarimiye, Adeyinka Ashaye, Martin Buist, Michael A. Hauser, Olusola Olawoye, Michaël J. A. Girard. 2026-09-22. Interpretable AI plus Handheld, Portable Retinal Photographs: A Low-Cost Glaucoma Screening Solution for West Africa. https://arxiv.org/abs/2609.25697

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