Fair-Eye Net: A Fair, Trustworthy, Multimodal Integrated Glaucoma Full Chain AI System

Abstract

Glaucoma is a top cause of irreversible blindness globally, making early detection and longitudinal follow-up pivotal to preventing permanent vision loss. Current screening and progression assessment, however, rely on single tests or loosely linked examinations, introducing subjectivity and fragmented care. Limited access to high-quality imaging tools and specialist expertise further compromises consistency and equity in real-world use. To address these gaps, we developed Fair-Eye Net, a fair, reliable multimodal AI system closing the clinical loop from glaucoma screening to follow-up and risk alerting. It integrates fundus photos, OCT structural metrics, VF functional indices, and demographic factors via a dual-stream heterogeneous fusion architecture, with an uncertainty-aware hierarchical gating strategy for selective prediction and safe referral. A fairness constraint reduces missed diagnoses in disadvantaged subgroups. Experimental results show it achieved an AUC of 0.912 (96.7% specificity), cut racial false-negativity disparity by 73.4% (12.31% to 3.28%), maintained stable cross-domain performance, and enabled 3-12 months of early risk alerts (92% sensitivity, 88% specificity). Unlike post hoc fairness adjustments, Fair-Eye Net optimizes fairness as a primary goal with clinical reliability via multitask learning, offering a reproducible path for clinical translation and large-scale deployment to advance global eye health equity.