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arXiv · 2606.09249

DECIS: Dual-Evidence Corrective Verification for Interpretable Strabismus Diagnostic Decision-Making

Xikai Tang·Yifan Wang·Jiafan Zhuang·Li Luo·Jinming Guo·Xiaoling Xie·Jiacheng Liu·Peiwei Wei·Lihao Zhong·Xiaoli Kang·Jie Cen·Guangqiang Yin·Kunliang Qiu·Ce Zheng·Zhun Fan
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Abstract

Strabismus is a common ocular disorder that requires fine-grained subtype diagnosis for individualized treatment planning. However, existing deep learning methods mainly provide diagnostic predictions without transparent reasoning, while recent large vision-language models (LVLMs), although promising for joint image understanding and report generation, remain highly prone to hallucination in this evidence-sensitive and rule-driven medical task. To address these challenges, we propose DECIS, a Dual-Evidence Corrective verification for Interpretable Strabismus diagnostic decision-making framework. DECIS transforms black-box end-to-end generation into a structured diagnostic process consisting of candidate hypothesis generation, dual-evidence constrained context, evidence-based corrective verification, and report generation. Specifically, we introduce a Dual-Evidence Constrained Context (DECC) mechanism that jointly organizes visual evidence from the photograph of the nine cardinal positions of gaze and evidence-based clinical diagnostic rules into a constrained context for reliable diagnostic reasoning. We further develop an Evidence-Based Corrective Verification (EBCV) mechanism that verifies whether the current diagnostic hypothesis is supported by visual evidence, heatmap-based visual cues, and evidence-based clinical diagnostic rules. Hypothesis refinement is triggered when inconsistency is detected. Experiments on a fine-grained strabismus benchmark demonstrate that DECIS not only outperforms other state-of-the-art diagnostic systems, improving the weighted F1 score from 72.0% to 91.3%, but also improves the clinical reliability (consistency, alignment, and completeness) of generated diagnostic reports. These results demonstrate that DECIS provides an effective solution for building accurate, evidence-based, and clinically interpretable strabismus diagnosis systems.

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Xikai Tang, Yifan Wang, Jiafan Zhuang, Li Luo, Jinming Guo, Xiaoling Xie, Jiacheng Liu, Peiwei Wei, Lihao Zhong, Xiaoli Kang, Jie Cen, Guangqiang Yin, Kunliang Qiu, Ce Zheng, Zhun Fan. 2026-06-08. DECIS: Dual-Evidence Corrective Verification for Interpretable Strabismus Diagnostic Decision-Making. https://arxiv.org/abs/2606.09249

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