Generative artificial intelligence for fundus fluorescein angiography interpretation and human expert evaluation

Fundus fluorescein angiography (FFA) is the gold standard for diagnosing chorioretinal diseases, but its interpretation requires significant expertise and time. Despite generative AI's enormous potential in medical report generation, automatic FFA interpretation lacks robust models and sufficient evaluation metrics. This study introduces InterpreFFA, a diagnosis-supervised contrastive learning framework, to emulate ophthalmologists' decision-making process in FFA report generation. Validated on multi-center datasets, InterpreFFA demonstrated superior performance and generalization compared to baseline models. In a simulated clinical setting, two residents used InterpreFFA to diagnose and report FFA cases, with six board-certified ophthalmologists rating the generated reports based on a five-point Likert scale. InterpreFFA significantly improved diagnostic accuracy (85.55 to 90.34%, p < 0.05) and shortened reporting time (153.93 to 108.08 s, p < 0.001). Although AI-generated reports scored slightly lower than manual reports (4.12 vs. 4.38, p < 0.01), InterpreFFA proves to be a promising and cost-effective ancillary tool for enhancing clinical efficiency.