Response-Aware Multimodal Learning for Post-Treatment Visual Acuity Forecasting

Long-term visual acuity (VA) forecasting after anti-VEGF therapy is important for counseling and follow-up planning in diabetic macular edema (DME), yet remains challenging when only early post-treatment findings are available. While prior OCT-based methods mainly focus on short-term response or single-endpoint prediction, multi-horizon VA forecasting from early longitudinal data remains insufficiently under-explored. In this study, we assembled a real-world cohort of 188 anti-VEGF–treated DME patients with paired baseline and month-1 OCT scans, along with tabular OCT-derived biomarkers and non-imaging clinical variables. Using only these early data, we formulate a multi-horizon VA forecasting problem aimed at predicting visual outcomes at 3, 6, 12, 18, and 24 months, reflecting clinically meaningful follow-up intervals. We propose ReVA, a response-aware multimodal framework that combines baseline and month-1 OCT features with tabular variables to capture disease status and early treatment response. ReVA integrates spatial OCT attention, dependency-aware tabular encoding, and cross-modal fusion to predict patient-specific long-term VA trajectories. The proposed framework achieves MAE=0.1246, RMSE=0.1621, and R^2=0.6064 for 24-month VA prediction, with consistent performance across all forecast horizons. Our findings show that incorporating early treatment-response signals enables clinically meaningful long-term visual acuity forecasting, supporting data-driven decision support for routine anti-VEGF management. Code and pretrained models will be released on https://github.com/nguyenpbui/ReVA.