Equity and Generalizability of Radiomics in Orbital Disease: Challenges for Ophthalmology, Otolaryngology, and Plastic Surgery.
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Background/Objectives: Radiomics-based machine learning models have demonstrated high accuracy in differentiating benign from malignant orbital masses, with early studies suggesting performance comparable to expert radiologists. However, translation into clinical practice remains limited due to dataset constraints, including retrospective study designs, single-center cohorts, and underrepresentation of diverse patient populations. This review aims to evaluate the current evidence supporting radiomics in orbital disease while critically examining barriers to generalizability and equity across ophthalmology, otolaryngology, and plastic surgery. Methods: A narrative literature review was conducted to assess radiomics applications in orbital oncology and reconstruction. Studies evaluating diagnostic accuracy, margin assessment, postoperative surveillance, and surgical planning across ophthalmology, head and neck surgery, and reconstructive surgery were analyzed, with particular attention paid to dataset composition, validation strategies, and imaging standardization. Results: Radiomics models demonstrated high diagnostic performance in differentiating orbital tumors, optimizing surgical planning, and aiding postoperative monitoring. However, most studies relied on small, homogeneous datasets lacking racial, ethnic, and pediatric representation. External validation was uncommon, and imaging heterogeneity limited reproducibility. These deficiencies restrict the clinical translation of radiomics and risk exacerbating healthcare disparities, particularly among underrepresented populations. Conclusions: Radiomics holds promise as a precision medicine tool for orbital diagnosis, surgical navigation, and postoperative care. Nevertheless, its clinical adoption is constrained by dataset bias, lack of standardization, and limited prospective validation. Future progress requires multi-institutional, demographically diverse datasets and standardized imaging protocols to ensure equitable and generalizable implementation across specialties.