Global RETFound: A Protocol for the World’s First Global Medical Foundation Model
Year: 2026
Type: article
Abstract: Purpose: Foundation models (FMs) are pretrained on large-scale unlabeled data sets and are adaptable to a wide spectrum of downstream diagnostic and prognostic tasks. However, limited representation in existing ophthalmic artificial intelligence (AI) data sets, particularly from Latin America, Africa, the Middle East, and Central Asia, could exacerbate health disparities. We describe an international collaborative protocol to develop and validate Global RETFound, an open-access FM for ophthalmic and oculomics research, pretrained on synthetic and anonymized real color fundus photographs (CFPs). Design: International multicenter study. Subjects: Data from a global consortium of institutions. Methods: International collaborators are supported with Docker-based tools, model/data sharing agreements, open-access licenses, tailored protocols, and standardized guides. Under a flexible 2-tier contribution framework, collaborators share fine-tuned generative AI (GenAI) weights or anonymized real CFPs. Main Outcome Measures: Prespecified outcomes include successful development of a globally representative, open-access FM and downstream performance evaluation across ocular and systemic diseases, assessed using discrimination metrics (area under the receiver operating characteristic curve and area under the precision-recall curve), sensitivity, specificity, F1-score, calibration, and task-specific regression and segmentation measures. Results: The Global RETFound consortium has established an international collaborative study with broad geographic representation. As of the 10th of July 2026, 232 collaborators from 78 countries have been onboarded, and 88 study assets (in the form of GenAI weights or anonymized real CFPs) from 39 countries have been shared. Conclusions: The Global RETFound protocol is a novel, privacy-preserving, inclusive strategy for developing a large-scale FM using synthetic and real CFPs. By enabling global participation from institutions with varying technical resources, and focusing on underrepresented populations, the initiative aims to advance equitable and generalizable FMs for ophthalmic and systemic disease. This initiative is positioned as a blueprint for future global FM collaborations in other medical specialties. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Source: Ophthalmology Science
Authors: Paul Nderitu, Yukun Zhou, An Ran Ran, Jocelyn Hui Lin Goh, Hongyang Jiang, Sahana Srinivasan, Gatera Fiston Kitema, Polly Rawlinson, Lucy Arnold, Ka Wai Yuen, Ke Zou, Gabriel Dawei Yang, Carol Y. Cheung, Pearse A. Keane, Yih Chung Tham, Hatem M. Abdelakher, Eberechukwu Achigbu, Feyi Grace Adepoju, Leonard Agbahounga, Rupesh Agrawal, Referano Agustiawan, Islam Sh. Ahmed, Kwadwo Owusu Akuffo, Shehab Ahmad Al-Abed, Esraa Khalaf Al-Ajaleen, Minhaj Nur Alam, Sura Yousef Alaroud, Abdulrahman F. Albloushi, Neilya Aldasheva, Tsedeke Asaminew Alemu, Nchifor Alice, Faisal Alkathery, Mutaz Al-Nawaflh, Otim Ambrose, Kwesi N. Amissah-Arthur, Damara Andalia, Fares Antaki, Nomo Arlette Francine, Lucy Arnold, Louis Arnould, Simon Arunga, Tariq Aslam, Aamir Asrar, Olufemi Emmanuel Babalola, Vilma Jurate Balciuniene, Olivia Baldivieso, Ana Banc, Covadonga Bascaran, Christos Bergeles, Ciara Bergin, Carolina Bernal-Morales, Ansgar Beuse, Mukharram M. Bikbov, Guzel M. Bikbova, Iryna Blagun, Damir Bosnar, Rupert Bourne, Tasanee Braithwaite, Caroline Brandl, Andres Bravo, Antoine P. Brezin, Mohammed El Amine Brixi-Nigassa, Iva Bulat, Philip Burgess, Matthew J. Burton, Mladen Bušić, Jing Cao, Avshalom Caspi, Carmen Nayeli Castillo-Guzmán, Ling-Ping Cen, Robert T. Chang, Kao-Jung Chang, Varun Chaudhary, David Ziyou Chen, Haoyu Chen, Xi Chen, Xinjian Chen, Xuejing Chen, Youxin Chen, Qingyu Chen, Fred Chen, Jun Chen, Xiao Li Chen, Ching-Yu Cheng, Kai Xiong Cheong, Carol Y. Cheung, Emily Y. Chew, Nestor Chirinos, Soon Wai Ch'ng, Yu Jeat Chong, Kelvin Kam Lung Chong, Prakash Kumar Chowdhury, Pradipta Chowdhury, Itay Chowers, Maria Vittoria Cicinelli, Carlos Cifuentes-González, Charles R. Cleland, Yaacov Cnaany, Jeanine Condo, Sarah Coupland, Aude Couturier, Catherine Creuzot-Garcher, Iva Ćubela, Jinyue Dai, Dang Tran Dat, Alireza Dehgani, Luciano V. Del Priore, Alastair K. Denniston, Sebastian Dinesen, Amitha Domalpally, Alexander S.F. Doney, Pham Ngoc Dong, Yuchen Du, Ceren Durmaz Engin, Renaud Duval, Mostafa El Habib Daho, Dina El-Fayoumi, Mahmud Elshtewi, Luis Carlos Escaf, Rania Estawro, Nicole Eter, Ugochukwu Eze, Nnamdi Ezuma, Huiya Fan, Alaa E. Fayed, Álvaro Fernández-Vega González, Daniel Ferraz, Bassey Fiebai, Juan Pablo Figueroa Vercellino, Ramy R. Fikry, Noam Fradkin, Arnold Mofor Fru Mukete, Mohammed-Sherrif Napari Fuseini, Muchai Gachago, Orly Gal-Or, Prashant Garg, Zongyuan Ge, Musa General, Nicola Ghazi, Egide Gisagara, Jocelyn Hui Lin Goh, Jakob Grauslund, Carsten Grohmann, Andrzej Grzybowski, Ayse Gungor, Preeti Gupta, Michael Ekuoba Gyasi, Fatima Hamroush, Haslina Hamzah, Jinyoung Han, Akiko Hanyuda, Tyau-Tyau Harba, Lloyd C.M. Harrison-Williams, Murat Hasanreisoglu, Adekunle Hassan, Alireza Hayati, Mingguang He, Xiangui He, Wenwen He, Iris Heid, Colette Armelle Gaëlle Helles, Benet C. Henry, Margaret Ho, Sean Hogan, Wenyi Hu, Atharva Hudlikar, Daniel Duck-Jin Hwang, Sunjin Hwang, Aynur Ibrahimova, Qurban Ismayılov, Max Jackson, Tim Jackson, Thomas Jacobs, Daniel Jaramillo, Camilo A. Jaramillo, Yali Jia, Hongyang Jiang, Shuai Jiang, Jost B. Jonas, Rahul Jonas, Craig Jones, Rodrigo Jorge, Awum Joyce Ncheda, Lie Ju, Nelly Kabedi Ngoy, Tengku Ain Kamalden, Ryo Kawasaki, Petros Kayange, Gyulli M. Kazakbaeva, Pearse A. Keane, Tiarnán D.L. Keenan, Hagar Khalid, Muhammad Fahadullah Khan, Hina Khan, Rohit C. Khanna, Ahmed Essa Khatatbeh, Anadi Khatri, Young Kook Kim, Heesuk Kim, Yoonjeon Kim, Gatera Fiston Kitema, Caroline C.W. Klaver, Victor Teck Chang Koh, Godefroy Koki, Simon C. König, Joseph Koranteng, Igor Kozak, Mukhit Kulmaganbetov, Anthony Kuo, Teddy Kwaga, Dastan Kyrykbayev, Ecosse Lamoureux, Van Charles Lansingh, Mohammed El Amine Lazouni, Lucas Leardini, Aaron Y. Lee, Cecilia S. Lee, Eungjoo Lee, Kanggeon Lee, Theodore Leng, Christopher K.S. Leung, Jaime Levy, Min Li, Yuanbo Liang, Yichuan Liang, Gerald Liew, Lee-Ling Lim, Duoru Lin, Haotian Lin, Senlin Lin, T. Y. Alvin Liu, Xiaoxuan Liu, Thaddaeus Wai Soon Lo, Anat Loewenstein, Jing Luo, Savita Madhusudhan, John Maina, Fernando Korn Malerbi, Jayanth Kumar Mallapu, Lala Mammadova, Samantha S. Mann, Wanjiku Mathenge, Simeon Mayala, Alain N. M'Bongo Zindamoyen, Shaffi Mdala, Luis Mendes, Jiaqi Meng, Mohamed Amine Midoun, Alexandra Miere, Dan Milea, Chitaranjan Mishra, Paul Mitchell, Terrie E. Moffitt, Jibran Mohamed-Noriega, Susan Mollan, Diana Moukkadem, Magdy Moussa, Marion R. Munk, Ghulam Mustafa, Fred Mutisya, Danson Vasanthan Muttuvelu, Rodrigue Mwami, Annick Mwilambwe, Deogratias Mzurikwao, Luis Filipe Nakayama, Toru Nakazawa, Onnisa Nanegrungsunk, Vinay Nangia, Ritesh Narula, Paul Nderitu, Nnamdi Nd-Ezuma, Kazuno Negishi, Thanh Triet Nguyen, Truong X. Nguyen, Quan Dong Nguyen, Takahiro Ninomiya, Jason Pithuwa Nirwoth, Jean Claude Niyonzima, Josiane Mare Njoya, Henry Ebong Nkumbe, Britha Nlende Mengalle, Piet Noe, Baffour Kyei Ntiamoah, Ogugua Okonkwo, Adaora Chinwendu Okudo, Andrea Olenik, Katherin Olenik, Maximiliano Olivera, Lateefat Bukola Olokoba, Ogechi Sandra Onukogu, Arinze Onwuegbuna, Oscar Onyango, Darlingtess Abies Oronsaye, Mehdi Ounissi, Songhomitra Panda-Jonas, Michel Paques, Ki Ho Park, Direk Patikulsila, Charles Pierce, Mapa Prabhath Piyasena, Andreas Pollreisz, Mohsen Pourazizi, Mahsa Pourmahdi, Chaoxu Qian, Kunliang Qiu, Gwenolé Quellec, Giuseppe Querques, Hasib Rahman, Rajiv Raman, Sandhya Ramrakha, An Ran Ran, Chetan Rao, Polly Rawlinson, Caio Vinícius Saito Regatieri, Tyler Hyungtaek Rim, Hernan Rios, Armando Ernesto Lazo Rivas, Antonio Rivera-Real, Jose Roca, Francisco J. Rodriguez, Paisan Ruamviboonsuk, Felix Kitema Rubuga, Kairat Ruslanuly, Sarah Rwigema, Charumathi Sabanayagam, Danuta Sampson, Murielle Naomi Samyong Djengue, Àngel Sánchez Sanz, Rui Santos, Mario J. Saravia, Mariko Sasaki, Muhammad Bayu Sasongko, Jorge Eduardo Satizabal-García, Seang-Mei Saw, Norie Sawada, Friederike Schaub, Alexander K. Schuster, Philipp Schwember, Leo Sheck, Ruyue Shen, Danli Shi, Kendrick Co Shih, Dennis Sibanda, Rufino Silva, Sobha Sivaprasad, Gabor Mark Somfai, Su Jeong Song, Eric Souied, Sahana Srinivasan, Randall Stafford, Andreas Stahl, Ingeborg Stalmans, Jens Julian Storp, Niall Strang, Yousif Subhi, Manju L. Subramanian, Xiaodong Sun, Islam Y. Swaify, Simon KH. Szeto, Hitoshi Tabushi, Asrat Tadesse, Hidenori Takahashi, Toru Takebayashi, Leona Takeuchi, Alexandre Taleb, Gavin Tan, Marcus Chun Jin Tan, Qingqing Tang, Alice Cecilia Elsie Taylor, Clement C. Tham, Yih Chung Tham, Reremoana Theodore, Arun Thirunavakurasu, Rebecca Thomas, Darren Shu Jeng Ting, Alon Tiosano, Mattia Tomasoni, Paris Tranos, Kazuo Tsubota, Theophile Tuyisabe, Ulviyya Umudlu, Jan Van Eijgen, Raul Velez-Montoya, Aliénor Vienne-Jumeau, Oksana Vitovska, Stela Vujosevic, Siegfried K. Wagner, Sophia Y. Wang, Xiaofei Wang, Ya Xing Wang, Ningli Wang, Hongyu Wei, Andrew White, Felicia Widyaputri, Gwyn Williams, Graham Wilson, Tien Yin Wong, Dereje Woyessa, Zhichao Wu, Wei-Chi Wu, Bowen Xu, Guihua Xu, Jie Xu, Peifang Xu, Benjamin Xu, Jason C. Yam, Kazumasa Yamagishi, Hua Yan, Yasuo Yanagi, Gabriel Dawei Yang, Juan Ye, Caleb Ofosu Yeboah, Samantha Min Er Yew, Fabian Yii, Tae Keun Yoo, Siamak Yousefi, Honghua Yu, Linda Zangwill, Miguel Zapata, Javier Zarranz-Ventura, Meixia Zhang, Mingzhi Zhang, Xiayin Zhang, Shuyi Zhang, Juzhao Zhang, Xiu Juan Zhang, Chunwen Zheng, Yalin Zheng, Omurbek Zholdoshev, Hua Zhong, Yukun Zhou, Su Zhou, Zhuoting Zhu, Xiangjia Zhu, Ke Zou, Haidong Zou, Thokozani Zungu, Dinah Zur
Language: English
Topic: Retinal Imaging and Analysis
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,500
OpenAlex ID: W7204233161