HierarchiRetina: A Diabetic Retinopathy Screening and Grading Cascade with Heterogeneous Mixture-of-Experts Lesion Segmentation

Md Asif Uddin, Niloy Farhan, Rafeed Rahman, Md. Golam Rabiul Alam

Clinical screening for diabetic retinopathy proceeds in stages, yet most automated systems grade fundus images with a single black-box network. Three gaps remain: (i) lesions differ widely in size and contrast, but segmenters typically apply the same blocks to all; (ii) ungradable images are usually excluded or treated as an extra class, and lesion-aware graders seldom test whether lesions drive the grade; (iii) staged systems often report each stage only on the images reaching it, leaving propagated errors unmeasured. HierarchiRetina, a screening, segmentation and grading cascade with inspectable stage outputs, addresses each gap. First, HSMoE-AUNet is a U-Net whose skip, bottleneck and decoder blocks are sparse mixtures of heterogeneous experts, with lesion-matched types, counts and losses; SwinHRUNetPP, a dual-encoder vessel segmenter, uses a field-of-view-restricted loss. Second, LG-DRG separates gradability from ordinal severity and lets lesion masks query the image through gated cross-attention. Third, an end-to-end evaluation counts screening misses as errors and traces each error to its stage. Pooled Dice ranged from 0.184 (microaneurysms) to 0.579 (exudates); vessel Dice…