Artificial intelligence for ophthalmic vessel segmentation: from multimodal imaging to clinical translation
Year: 2026
Type: review
Abstract: Artificial intelligence (AI)-based vessel segmentation converts color fundus photographs, scanning laser ophthalmoscopy (SLO), optical coherence tomography angiography (OCTA), structural OCT, and anterior-segment images into quantitative vascular biomarkers. Strong performance within individual datasets has not consistently yielded reliable clinical measurements because errors can arise during acquisition, anatomical preprocessing, vessel extraction, biomarker calculation, and deployment. This structured narrative review compares segmentation tasks involving retinal vascular trees, OCTA capillary plexuses, the structural choroid and choriocapillaris, macular neovascularization, corneal neovascularization, and conjunctival microvasculature. We assess modern architectures in relation to vessel geometry, severe foreground-background imbalance, scale variation, crossings, and susceptibility to artifacts. The methods considered include multiscale feature pyramids, deformable and directional operators, Transformers, state-space models, diffusion approaches, and foundation models. We organize the synthesis around five evaluation levels: pixel overlap, centerline recovery, vascular topology, biomarker agreement, and clinical actionability. Public fundus and OCTA datasets are catalogued with their acquisition and annotation characteristics, and gaps in public anterior-segment vessel benchmarks are discussed. Because devices, data splits, labels, and post-processing differ substantially, reported metrics are summarized without ranking studies against one another. The review distinguishes structural OCT choroidal vascularity index from OCTA choriocapillaris flow-deficit mapping, as well as true vessel segmentation from global hyperemia grading. Clinical translation will require ocular-magnification correction, quality control of retinal layers and projection artifacts, external testing across devices and populations, out-of-distribution rejection, DICOM/PACS interoperability, prospective impact studies, and regulation as software as a medical device. We conclude that clinical utility depends on an auditable pipeline that measures structural error, biomarker uncertainty, and failure states throughout the workflow.
Source: Frontiers in Medicine
Authors: Lingyan Wu, Jiahao Tang, Shanping Zhao
Institutions: Hangzhou City University, Wenzhou Medical University
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: $3,801
OpenAlex ID: W7222918682