Abstract
The segmentation of the foveal avascular zone (FAZ) in optical coherence tomography angiography (OCTA) images plays a crucial role in diagnosing and monitoring ocular diseases such as diabetic retinopathy (DR) and age-related macular degeneration (AMD). However, accurate FAZ segmentation remains challenging due to image quality and variability. This paper provides a comprehensive review of FAZ segmentation techniques, including traditional image processing methods and recent deep learning-based approaches. We propose two novel deep learning methodologies: a multitask learning framework that integrates vessel and FAZ segmentation, and a conditionally trained network that employs vessel-aware loss functions. The performance of the proposed methods was evaluated on the OCTA-500 dataset using the Dice coefficient, Jaccard index, 95% Hausdorff distance, and average symmetric surface distance. Experimental results demonstrate that the multitask segmentation framework outperforms existing state-of-the-art methods, achieving superior FAZ boundary delineation and segmentation accuracy. The conditionally trained network also improves upon standard U-Net-based approaches but exhibits limitations in refining the FAZ contours. © 2025 Elsevier B.V., All rights reserved.

Abstract
Artificial intelligence (AI) models have received considerable attention in recent years for their ability to identify optical coherence tomography (OCT) biomarkers with clinical diagnostic potential and predict disease progression. This study aims to externally validate a deep learning (DL) algorithm by comparing its segmentation of retinal layers and fluid with a gold-standard method for manually adjusting the automatic segmentation of the Heidelberg Spectralis HRA + OCT software Version 6.16.8.0. A total of sixty OCT images of healthy subjects and patients with intermediate and exudative age-related macular degeneration (AMD) were included. A quantitative analysis of the retinal thickness and fluid area was performed, and the discrepancy between these methods was investigated. The results showed a moderate-to-strong correlation between the metrics extracted by both software types, in all the groups, and an overall near-perfect area overlap was observed, except for in the inner segment ellipsoid (ISE) layer. The DL system detected a significant difference in the outer retinal thickness across disease stages and accurately identified fluid in exudative cases. In more diseased eyes, there was significantly more disagreement between these methods. This DL system appears to be a reliable method for accessing important OCT biomarkers in AMD. However, further accuracy testing should be conducted to confirm its validity in real-world settings to ultimately aid ophthalmologists in OCT imaging management and guide timely treatment approaches.

Abstract
Purpose: The development of accurate methods for retinal layer and fluid segmentation in optical coherence tomography images can help the ophthalmologists in the diagnosis and follow-up of retinal diseases. Recent works based on joint segmentation presented good results for the segmentation of most retinal layers, but the fluid segmentation results are still not satisfactory. We report a hierarchical framework that starts by distinguishing the retinal zone from the background, then separates the fluid-filled regions from the rest, and finally, discriminates the several retinal layers.Approach: Three fully convolutional networks were trained sequentially. The weighting scheme used for computing the loss function during training is derived from the outputs of the networks trained previously. To reinforce the relative position between retinal layers, the mutex Dice loss (included for optimizing the last network) was further modified so that errors between more distant layers are more penalized. The method's performance was evaluated using a public dataset.Results: The proposed hierarchical approach outperforms previous works in the segmentation of the inner segment ellipsoid layer and fluid (Dice coefficient = 0.95 and 0.82, respectively). The results achieved for the remaining layers are at a state-of-the-art level.Conclusions: The proposed framework led to significant improvements in fluid segmentation, without compromising the results in the retinal layers. Thus, its output can be used by ophthalmologists as a second opinion or as input for automatic extraction of relevant quantitative biomarkers.

Abstract
The development of accurate methods for OCT image analysis is highly dependent on the availability of large annotated datasets. As such datasets are usually expensive and hard to obtain, novel approaches based on deep generative models have been proposed for data augmentation. In this work, a flow-based network (SRFlow) and a generative adversarial network (ESRGAN) are used for synthesizing high-resolution OCT B-scans from low-resolution versions of real OCT images. The quality of the images generated by the two models is assessed using two standard fidelity-oriented metrics and a learned perceptual quality metric. The performance of two classification models trained on real and synthetic images is also evaluated. The obtained results show that the images generated by SRFlow preserve higher fidelity to the ground truth, while the outputs of ESRGAN present, on average, better perceptual quality. Independently of the architecture of the network chosen to classify the OCT B-scans, the model's performance always improves when images generated by SRFlow are included in the training set.

Abstract
Diabetic Retinopathy (DR) is the most common cause of avoidable vision loss, predominantly affecting the working-age population across the globe. Screening for DR, coupled with timely consultation and treatment, is a globally trusted policy to avoid vision loss. However, implementation of DR screening programs is challenging due to the scarcity of medical professionals able to screen a growing global diabetic population at risk for DR. Computer-aided disease diagnosis in retinal image analysis could provide a sustainable approach for such large-scale screening effort. The recent scientific advances in computing capacity and machine learning approaches provide an avenue for biomedical scientists to reach this goal. Aiming to advance the state-of-the-art in automatic DR diagnosis, a grand challenge on "Diabetic Retinopathy - Segmentation and Grading" was organized in conjunction with the IEEE International Symposium on Biomedical Imaging (ISBI-2018). In this paper, we report the set-up and results of this challenge that is primarily based on Indian Diabetic Retinopathy Image Dataset (IDRiD). There were three principal subchallenges: lesion segmentation, disease severity grading, and localization of retinal landmarks and segmentation. These multiple tasks in this challenge allow to test the generalizability of algorithms, and this is what makes it different from existing ones. It received a positive response from the scientific community with 148 submissions from 495 registrations effectively entered in this challenge. This paper outlines the challenge, its organization, the dataset used, evaluation methods and results of top-performing participating solutions. The top-performing approaches utilized a blend of clinical information, data augmentation, and an ensemble of models. These findings have the potential to enable new developments in retinal image analysis and image-based DR screening in particular.