Abstract
Purpose:
To determine whether strictly curated synthetic images can improve grading performance in diabetic retinopathy (DR) diagnosis within limited data regimes, and to compare the utility of representative generative adversarial network and diffusion architectures.
Method:
StyleGAN3 and Medfusion models were pretrained on an auxiliary data set. To prevent mode collapse and severity downshift, synthetic images were curated through a domain-matched Oracle network using Latent Space Rejection Sampling and Class-Conditioned SDEdit Escalation. Efficacy was evaluated on an isolated downstream DR classification task (Indian DR Image Dataset) across three architectures (ConvNeXt, ResNet50, VGG16) using five random seeds.
Results:
Curated StyleGAN3 data set achieved better Fréchet inception distance (FID) (24.25) and padded structural similarity index measure (0.9037) compared with Medfusion (58.70 and 0.8852), although Medfusion yielded a higher inception score (2.35). In the isolated downstream classification task, baseline ConvNeXt models trained solely on real Indian DR Image Dataset data achieved a quadratic weighted kappa of 0.6350 ± 0.0135. Augmentation with curated StyleGAN3 improved the quadratic weighted kappa to 0.7185 ± 0.0309, while Medfusion augmentation achieved 0.7695 ± 0.0254 (an absolute improvement of 0.1345). Crucially, Medfusion augmentation successfully doubled the sensitivity (Recall) for proliferative DR from 0.2615 ± 0.1595 to 0.5385 ± 0.0942.
Conclusion:
Data augmentation using strictly curated synthetic images successfully addresses data imbalance and scarcity, significantly improving the ordinal accuracy and minority-class sensitivity of DR diagnosis models. Furthermore, standard global image quality metrics like FID may not fully capture localized pathological utility; diffusion models with higher FID scores ultimately provided superior structural diversity and downstream clinical performance.