{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:12:45Z","timestamp":1782839565854,"version":"3.54.5"},"reference-count":77,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,3,23]],"date-time":"2025-03-23T00:00:00Z","timestamp":1742688000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Eye Institute of the National Institutes of Health","award":["R21EY030619"],"award-info":[{"award-number":["R21EY030619"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Optical coherence tomography angiography (OCTA) is a noninvasive imaging technique used to visualize retinal blood flow and identify changes in vascular density and enlargement or distortion of the foveal avascular zone (FAZ), which are indicators of various eye diseases. Although several automated FAZ detection and segmentation algorithms have been developed for use with OCTA, their performance can vary significantly due to differences in data accessibility of OCTA in different retinal pathologies, and differences in image quality in different subjects and\/or different OCTA devices. For example, data from subjects with direct macular damage, such as in age-related macular degeneration (AMD), are more readily available in eye clinics, while data on macular damage due to systemic diseases like Alzheimer\u2019s disease are often less accessible; data from healthy subjects may have better OCTA quality than subjects with ophthalmic pathologies. Typically, segmentation algorithms make use of convolutional neural networks and, more recently, vision transformers, which make use of both long-range context and fine-grained detail. However, transformers are known to be data-hungry, and may overfit small datasets, such as those common for FAZ segmentation in OCTA, to which there is limited access in clinical practice. To improve model generalization in low-data or imbalanced settings, we propose a multi-condition transformer-based architecture that uses four teacher encoders to distill knowledge into a shared base model, enabling the transfer of learned features across multiple datasets. These include intra-modality distillation using OCTA datasets from four ocular conditions: healthy aging eyes, Alzheimer\u2019s disease, AMD, and diabetic retinopathy; and inter-modality distillation incorporating color fundus photographs of subjects undergoing laser photocoagulation therapy. Our multi-condition model achieved a mean Dice Index of 83.8% with pretraining, outperforming single-condition models (mean of 83.1%) across all conditions. Pretraining on color fundus photocoagulation images improved the average Dice Index by a small margin on all conditions except AMD (1.1% on single-condition models, and 0.1% on multi-condition models). Our architecture demonstrates potential for broader applications in detecting and analyzing ophthalmic and systemic diseases across diverse imaging datasets and settings.<\/jats:p>","DOI":"10.3390\/bioengineering12040334","type":"journal-article","created":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T07:46:50Z","timestamp":1742802410000},"page":"334","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Automated Foveal Avascular Zone Segmentation in Optical Coherence Tomography Angiography Across Multiple Eye Diseases Using Knowledge Distillation"],"prefix":"10.3390","volume":"12","author":[{"given":"Peter","family":"Racioppo","sequence":"first","affiliation":[{"name":"Doheny Image Analysis Laboratory, Doheny Eye Institute, 150 North Orange Grove Blvd, Pasadena, CA 91103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aya","family":"Alhasany","sequence":"additional","affiliation":[{"name":"Doheny Image Analysis Laboratory, Doheny Eye Institute, 150 North Orange Grove Blvd, Pasadena, CA 91103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nhuan Vu","family":"Pham","sequence":"additional","affiliation":[{"name":"Doheny Image Analysis Laboratory, Doheny Eye Institute, 150 North Orange Grove Blvd, Pasadena, CA 91103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziyuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Doheny Image Analysis Laboratory, Doheny Eye Institute, 150 North Orange Grove Blvd, Pasadena, CA 91103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9213-5575","authenticated-orcid":false,"given":"Giulia","family":"Corradetti","sequence":"additional","affiliation":[{"name":"Doheny Image Reading and Research Laboratory, Doheny Eye Institute, 150 North Orange Grove Blvd, Pasadena, CA 91103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Mikaelian","sequence":"additional","affiliation":[{"name":"Hedgefog Research Inc., 1891 N Gaffey St. Ste 224, San Pedro, CA 90731, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0615-628X","authenticated-orcid":false,"given":"Yannis M.","family":"Paulus","sequence":"additional","affiliation":[{"name":"Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SriniVas R.","family":"Sadda","sequence":"additional","affiliation":[{"name":"Doheny Image Reading and Research Laboratory, Doheny Eye Institute, 150 North Orange Grove Blvd, Pasadena, CA 91103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8307-0298","authenticated-orcid":false,"given":"Zhihong","family":"Hu","sequence":"additional","affiliation":[{"name":"Doheny Image Analysis Laboratory, Doheny Eye Institute, 150 North Orange Grove Blvd, Pasadena, CA 91103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.preteyeres.2017.11.003","article-title":"Optical Coherence Tomography Angiography","volume":"64","author":"Spaide","year":"2018","journal-title":"Prog. 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