An efficient and precise diagnosis of retinal diseases is a fundamental goal for auxiliary diagnostic systems in ophthalmology. Inspired by the importance of scattered subtle lesions in manual retinal disease diagnosis, recent research has achieved state-of-the-art performance by mining information related to subtle lesions, including their texture and shape. However, the spatial distribution patterns of subtle lesion areas, which are also crucial in manual diagnosis, have been overlooked in existing research. Neglecting these spatial distribution patterns (e.g., the ring distribution of microaneurysms in diabetic macular edema) may negatively impact the diagnostic process. In this paper, we introduce the Saliency-Image-Graph (SIGraph) network to capture the spatial distribution patterns of lesion areas. We first employ saliency-based perception to identify latent lesion pixels. Subsequently, we propose a novel image-graph block to efficiently capture the global distribution of abundant lesion pixels with minimal information loss. By leveraging additional distribution patterns, SIGraph achieves state-of-the-art performance with at least a 1.5% performance gain across three datasets. Furthermore, ablation studies demonstrate that our image-graph block can be integrated into other visual backbones and effectively boost performance.

Automatic and accurate retinal disease diagnosis is critical to guide proper therapy and prevent potential vision loss. Previous works simply exploit the most discriminative features while ignoring the pathological visual clues of scattered subtle lesions. Therefore, without a comprehensive understanding of features from different lesion regions, they are vulnerable to noise from complex backgrounds and suffer from misclassification failures. In this paper, we address these limitations with a novel saliency-guided abnormality-aware transformer which explicitly captures the correlation between different lesion features from a global perspective with enhanced pathological semantics. The model has several merits. First, we propose a saliency enhancement module (SEM) which adaptively integrates disease related semantics and highlights potentially salient lesion regions. Second, to the best of our knowledge, this is the first work to explore comprehensive lesion feature dependencies via a tailored efficient self-attention. Third, with the saliency enhancement module and abnormality-aware attention, we propose a new variant of Vision Transformer models, called SatFormer, which outperforms the state-of-the-art methods on two public retinal disease classification benchmarks. Ablation study shows that the proposed components can be easily embedded into any Vision Transformers via a plug-and-play manner and effectively boost the performance.