Edge-Deployable Lightweight Deep Learning for Hypertensive Retinopathy Grading from En-Face OCT: A Patient-Level Feasibility Study.

Background: Hypertensive retinopathy (HR) is an early marker of hypertension-related end-organ damage, and multi-grade classification is limited by overlap between the early stages. No prior study has reported edge-deployable HR grading from optical coherence tomography (OCT). We assess patient-level-validated four-grade HR classification from en-face OCT with on-device inference. Methods: MobileViT-XXS and EfficientNetV2-B0 were evaluated on 478 en-face OCT images from 221 patients. To avoid leakage, all partitions were patient-level: stratified group 5-fold cross-validation with a patient-disjoint test set. Each model was evaluated as a 5-fold soft-voting ensemble, with inference profiled on an NVIDIA Jetson Orin Nano. Accuracy, weighted F1, quadratic-weighted kappa, and ROC-AUC were reported; the models were compared by McNemar's test, and clinical utility by referable-HR (Grade ≥ 2) triage. Results: MobileViT-XXS achieved 84.4% accuracy, ROC-AUC 0.944, and quadratic-weighted kappa 0.916, significantly outperforming EfficientNetV2-B0 (McNemar p = 0.013). Mild-grade overlap limited four-class accuracy, but referable-HR triage reached 95.6% accuracy, 95.2% sensitivity, and 95.8% negative predictive value. MobileViT-XXS required only 3.83 MB versus 23.70 MB, and on-device TensorRT FP16 five-fold ensemble inference achieved 10.4 ms (96 FPS) at 8.9 W. Conclusions: Lightweight models enable feasible, power-efficient point-of-care HR triage from en-face OCT; broader multi-center validation is warranted.