{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T06:08:12Z","timestamp":1788761292900,"version":"build-2803163510"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004728","name":"VIT University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004728","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Teleophthalmology depends on secure exchange of retinal fundus images between primary care screening locations and referral centers. Current image-sharing systems remain vulnerable to quantum attacks on public-key cryptography and to centralized storage failures with limited auditability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This paper presents PQ-FundusChain, a consortium blockchain framework for quantum-resistant fundus image sharing. Each image is encrypted with an AES-256-GCM session key encapsulated using ML-KEM (FIPS 203). ML-DSA (FIPS 204) authenticates blockchain transactions. Encrypted images are stored in decentralized off-chain storage, while content hashes, metadata, and access policies are recorded on-chain. Access requests are evaluated through a risk-aware policy combining trust, access-history, and location scores with a fundus sensitivity score based on retinal anatomy and diabetic retinopathy severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Experimental evaluation on the public Messidor-2 dataset shows a share-side cryptographic and hashing cost of approximately 4.02 ms per image, an access-side cost of approximately 3.48 ms, smart-contract execution of approximately 0.25 ms for both AccessGrant and PolicyUpdate, and a per-image on-chain record of approximately 4.83 KB independent of image resolution. The additional latency introduced by postquantum mechanisms remains below 1 ms for image sharing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The results demonstrate that postquantum protection can be incorporated into teleophthalmology workflows with modest computational overhead, with security analysis confirming confidentiality, integrity, authentication, non-repudiation, fine-grained access control, and resistance to harvest-now, decrypt-later attacks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fdgth.2026.1933562","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T05:33:19Z","timestamp":1788759199000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["PQ-FundusChain: a postquantum blockchain framework for secure and privacy-preserving retinal fundus image sharing in teleophthalmology"],"prefix":"10.3389","volume":"8","author":[{"given":"M.","family":"Kirubakaran","sequence":"first","affiliation":[{"name":"School of Computer Science and Engineering, Vellore Institute of Technology","place":["Vellore, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Vijayarajan","sequence":"additional","affiliation":[{"name":"School of Computer Science and Engineering, Vellore Institute of Technology","place":["Vellore, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1580","DOI":"10.1016\/j.ophtha.2021.04.027","article-title":"Global prevalence of diabetic retinopathy and projection of burden through 2045: systematic review and meta-analysis","volume":"128","author":"Teo","year":"2021","journal-title":"Ophthalmology"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2402","DOI":"10.1001\/jama.2016.17216","article-title":"Development and validation of a deep learning algorithm for detection of diabetic retinopathy in retinal fundus photographs","volume":"316","author":"Gulshan","year":"2016","journal-title":"JAMA"},{"key":"B3","doi-asserted-by":"publisher","first-page":"5200","DOI":"10.1167\/iovs.16-19964","article-title":"Improved automated detection of diabetic retinopathy on a publicly available dataset through integration of deep learning","volume":"57","author":"Abr\u00e0moff","year":"2016","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"B4","doi-asserted-by":"publisher","first-page":"9","DOI":"10.21037\/aes-23-10","article-title":"Advances in teleophthalmology and artificial intelligence for diabetic retinopathy screening: a narrative review","volume":"9","author":"Chokshi","year":"2024","journal-title":"Ann Eye Sci."},{"key":"B5","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1016\/j.ophtha.2024.02.017","article-title":"Effectiveness of conventional digital fundus photography-based teleretinal screening for diabetic retinopathy and diabetic macular edema: a report by the American Academy of Ophthalmology","volume":"131","author":"Weng","year":"2024","journal-title":"Ophthalmology"},{"key":"B6","first-page":"1","article-title":"HIPAA Privacy rule and public health guidance from CDC and the US department of health and human services.","volume":"52","year":"2003","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"B7","first-page":"1","article-title":"2016\/679 (General Data Protection Regulation): on the protection of natural persons with regard to the processing of personal data and on the free movement of such data","volume":"59","year":"2016","journal-title":"Off J Eur Union"},{"key":"B8","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1109\/SFCS.1994.365700","article-title":"Algorithms for quantum computation: discrete logarithms and factoring","volume-title":"Proceedings 35th Annual Symposium on Foundations of Computer Science.","author":"Shor","year":"1994"},{"key":"B9","volume-title":"203: Module-Lattice-Based Key-Encapsulation Mechanism Standard","author":"Fips","year":"2024"},{"key":"B10","volume-title":"204: Module-Lattice-Based Digital Signature Standard","author":"Fips","year":"2024"},{"key":"B11","year":"2024"},{"key":"B12","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1109\/MSP.2018.3761723","article-title":"Cybersecurity in an era with quantum computers: will we be ready?","volume":"16","author":"Mosca","year":"2018","journal-title":"IEEE Secur. 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