{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T13:30:39Z","timestamp":1774445439914,"version":"3.50.1"},"reference-count":43,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002713","name":"Imam Mohammad ibn Saud Islamic University\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t              https:\/\/ror.org\/05gxjyb39","doi-asserted-by":"publisher","award":["IMSIU-DDRSP2601"],"award-info":[{"award-number":["IMSIU-DDRSP2601"]}],"id":[{"id":"10.13039\/501100002713","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>To perform screening of the retina on a population scale, an automated procedure is required that incorporates accurate, reproducible, interpretable, and computationally costeffective models. Existing approaches using convolutional or transformer architectures typically do not adequately represent both fine-grained pathology and large-scale retinal context simultaneously, which could adversely affect their reliability if used for large-scale applications in clinical practice. In this paper, we propose a hierarchical transformer-based screening framework for retinal fundus images that incorporates patch-based tokenization, global transformer encoding, and hierarchical aggregation of contextual information. We also developed a lightweight prediction head that supports screening for both single and multiple diseases. The framework has been evaluated using standard screening metrics, robustness, and cross-dataset generalization analyses on two eye retinopathy image databases: EyePACS and RFMiD. With regard to screening for a binary outcome of diabetic retinopathy, our method provided an accuracy of 89.4% and an area under the receiver operating characteristic (AUROC) curve of 93.6% on EyePACS and attained an accuracy of 95.2% and a macro-averaged F1 score of 82.7% on RFMiD. Our hierarchical transformer achieved improved robustness to degraded images and increased generalizability across datasets compared with all current state-of-the-art models. The proposed hierarchical transformer demonstrates strong potential for large-scale retinal screening and provides a promising foundation for future clinically validated deployment.<\/jats:p>","DOI":"10.3390\/bioengineering13040377","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T10:07:13Z","timestamp":1774433233000},"page":"377","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transformer-Based Deep Learning for Population-Scale Retinal Image Screening of Ophthalmic Disorders"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0798-2831","authenticated-orcid":false,"given":"Wiem","family":"Abdelbaki","sequence":"first","affiliation":[{"name":"College of Engineering and Technology, American University of the Middle East, Egaila 54200, Kuwait"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3620-6924","authenticated-orcid":false,"given":"Wided","family":"Bouchelligua","sequence":"additional","affiliation":[{"name":"Applied College, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11432, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3578-0081","authenticated-orcid":false,"given":"Inzamam Mashood","family":"Nasir","sequence":"additional","affiliation":[{"name":"Human-Environment-Technology (HET) Systems Centre, Mykolas Romeris University, 08303 Vilnius, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7302-413X","authenticated-orcid":false,"given":"Sara","family":"Tehsin","sequence":"additional","affiliation":[{"name":"Faculty of Informatics, Kaunas University of Technology, 51368 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1441-694X","authenticated-orcid":false,"given":"Hend","family":"Alshaya","sequence":"additional","affiliation":[{"name":"Applied College, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11432, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e130","DOI":"10.1016\/S2214-109X(20)30425-3","article-title":"Trends in prevalence of blindness and distance and near vision impairment over 30 years: An analysis for the Global Burden of Disease Study","volume":"9","author":"Bourne","year":"2021","journal-title":"Lancet Glob. 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