Fundus diseases are major causes of visual impairment and blindness worldwide, especially in underdeveloped regions, where the shortage of ophthalmologists hinders timely diagnosis. AI-assisted fundus image analysis has several advantages, such as high accuracy, reduced workload, and improved accessibility, but it requires a large amount of expert-annotated data to build reliable models. To address this dilemma, we propose a general self-supervised machine learning framework that can handle diverse fundus diseases from unlabeled fundus images. Our method's AUC surpasses existing supervised approaches by 15.7%, and even exceeds performance of a single human expert. Furthermore, our model adapts well to various datasets from different regions, races, and heterogeneous image sources or qualities from multiple cameras or devices. Our method offers a label-free general framework to diagnose fundus diseases, which could potentially benefit telehealth programs for early screening of people at risk of vision loss.
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