{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T04:04:41Z","timestamp":1784261081872,"version":"3.55.0"},"reference-count":72,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Innovation and Training Center in Artificial Intelligence (NCIA) at the Paulo Feitosa Foundation"},{"name":"Foxconn Brasil"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Diabetic retinopathy (DR) grading requires reliable five-grade severity assessment under substantial acquisition variability and cross-dataset distribution shift. We propose PRISM-DR, a multi-objective five-grade DR grading framework trained under a gradient-partitioned strategy. The architecture is organized as a feedforward pipeline: a data-driven preprocessing stage followed by a ConvNeXtV2-Base backbone, a Recurrent BiFPN neck for multi-scale feature fusion, a Frequency-Aware Fusion module, a lightweight multi-scale reasoning transformer, dual classification heads with gradient-isolated pathways (categorical and ordinal), and a prototype memory module for embedding regularization. The CORAL ordinal head operates through a dedicated projection layer and is gradient-isolated from the backbone; the backbone is shaped by the cross-entropy, prototype contrastive, and view-consistency objectives, which carry indirect ordinal signal through severity-weighted class penalties and grade-indexed cluster regularization. The model is trained in a multi-crop setting with a phased loss curriculum designed for severely imbalanced DR datasets. Evaluated across six datasets under Fixed-Source, Multi-Target (FSMT) protocols, PRISM-DR trained on EyePACS + DDR achieves QWK of 0.835 on IDRiD, 0.865 on APTOS2019, and 0.720 on Messidor-2, with in-domain QWK = 0.920 and AUC-PR = 0.941 on EyePACS, outperforming RETFound, RETFound-Green, and MedGemma-4B in AUC-PR across all evaluated datasets. Quantitative interpretability evaluation against 755 expert-annotated lesion images yields 8.0\u00d7 Energy Ratio Enrichment and a FAF gate retention ratio of 4.4\u00d7 inside lesion regions, confirming that anatomically plausible spatial priors emerge from grade-level supervision alone, without pixel-level annotation. PRISM-DR establishes a superior accuracy\u2013robustness\u2013capacity trade-off for scalable, automated DR screening.<\/jats:p>","DOI":"10.3390\/s26144515","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T03:12:38Z","timestamp":1784257958000},"page":"4515","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Toward Reliable Diabetic Retinopathy Screening"],"prefix":"10.3390","volume":"26","author":[{"given":"Hendrio","family":"Bragan\u00e7a","sequence":"first","affiliation":[{"name":"N\u00facleo de Capacita\u00e7\u00e3o em Intelig\u00eancia Artificial (NCIA), Funda\u00e7\u00e3o Paulo Feitoza\u2014FPFtech, Av. Danilo de Matos Areosa, 1170, Distrito Industrial, Manaus 69075-351, Amazonas, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00cdtalo P.","family":"Caliari","sequence":"additional","affiliation":[{"name":"N\u00facleo de Capacita\u00e7\u00e3o em Intelig\u00eancia Artificial (NCIA), Funda\u00e7\u00e3o Paulo Feitoza\u2014FPFtech, Av. Danilo de Matos Areosa, 1170, Distrito Industrial, Manaus 69075-351, Amazonas, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1634-4441","authenticated-orcid":false,"given":"Wington L.","family":"Vital","sequence":"additional","affiliation":[{"name":"N\u00facleo de Capacita\u00e7\u00e3o em Intelig\u00eancia Artificial (NCIA), Funda\u00e7\u00e3o Paulo Feitoza\u2014FPFtech, Av. Danilo de Matos Areosa, 1170, Distrito Industrial, Manaus 69075-351, Amazonas, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5078-1902","authenticated-orcid":false,"given":"Antonio","family":"Fontenele","sequence":"additional","affiliation":[{"name":"N\u00facleo de Capacita\u00e7\u00e3o em Intelig\u00eancia Artificial (NCIA), Funda\u00e7\u00e3o Paulo Feitoza\u2014FPFtech, Av. Danilo de Matos Areosa, 1170, Distrito Industrial, Manaus 69075-351, Amazonas, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Cavalcante","sequence":"additional","affiliation":[{"name":"N\u00facleo de Capacita\u00e7\u00e3o em Intelig\u00eancia Artificial (NCIA), Funda\u00e7\u00e3o Paulo Feitoza\u2014FPFtech, Av. Danilo de Matos Areosa, 1170, Distrito Industrial, Manaus 69075-351, Amazonas, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glaucio","family":"Messias","sequence":"additional","affiliation":[{"name":"N\u00facleo de Capacita\u00e7\u00e3o em Intelig\u00eancia Artificial (NCIA), Funda\u00e7\u00e3o Paulo Feitoza\u2014FPFtech, Av. Danilo de Matos Areosa, 1170, Distrito Industrial, Manaus 69075-351, Amazonas, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S253","DOI":"10.1016\/S0039-6257(02)00387-9","article-title":"Diabetic retinopathy: More than meets the eye","volume":"47","author":"Gardner","year":"2002","journal-title":"Surv. 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