The evidence for automated grading in diabetic retinopathy screening

Peer reviewedPostprin

Diabetic Macular Edema Grading Based on Deep Neural Networks

Diabetic Macular Edema (DME) is a major cause of vision loss in diabetes. Its early detection and treatment is therefore a vital task in management of diabetic retinopathy. In this paper, we propose a new featurelearning approach for grading the severity of DME using color retinal fundus images. An automated DME diagnosis system based on the proposed featurelearning approach is developed to help early diagnosis of the disease and thus averts (or delays) its progression. It utilizes the convolutional neural networks (CNNs) to identify and extract features of DME automatically without any kind of user intervention. The developed prototype was trained and assessed by using an existing MESSIDOR dataset of 1200 images. The obtained preliminary results showed accuracy of (88.8 %), sensitivity (74.7%) and specificity (96.5 %). These results compare favorably to state-of-the-art findings with the added benefit of an automatic feature-learning approach rather than a time-consuming handcrafted approach

Automatic Screening and Classification of Diabetic Retinopathy Eye Fundus Image

Diabetic Retinopathy (DR) is a disorder of the retinal vasculature. It develops to some degree in nearly all patients with long-standing diabetes mellitus and can result in blindness. Screening of DR is essential for both early detection and early treatment. This thesis aims to investigate automatic methods for diabetic retinopathy detection and subsequently develop an effective system for the detection and screening of diabetic retinopathy. The presented diabetic retinopathy research involves three development stages. Firstly, the thesis presents the development of a preliminary classification and screening system for diabetic retinopathy using eye fundus images. The research will then focus on the detection of the earliest signs of diabetic retinopathy, which are the microaneurysms. The detection of microaneurysms at an early stage is vital and is the first step in preventing diabetic retinopathy. Finally, the thesis will present decision support systems for the detection of diabetic retinopathy and maculopathy in eye fundus images. The detection of maculopathy, which are yellow lesions near the macula, is essential as it will eventually cause the loss of vision if the affected macula is not treated in time. An accurate retinal screening, therefore, is required to assist the retinal screeners to classify the retinal images effectively. Highly efficient and accurate image processing techniques must thus be used in order to produce an effective screening of diabetic retinopathy. In addition to the proposed diabetic retinopathy detection systems, this thesis will present a new dataset, and will highlight the dataset collection, the expert diagnosis process and the advantages of the new dataset, compared to other public eye fundus images datasets available. The new dataset will be useful to researchers and practitioners working in the retinal imaging area and would widely encourage comparative studies in the field of diabetic retinopathy research. It is envisaged that the proposed decision support system for clinical screening would greatly contribute to and assist the management and the detection of diabetic retinopathy. It is also hoped that the developed automatic detection techniques will assist clinicians to diagnose diabetic retinopathy at an early stage

A Method of Drusen Measurement Based on the Geometry of Fundus Reflectance

BACKGROUND: The hallmarks of age-related macular degeneration, the leading cause of blindness in the developed world, are the subretinal deposits known as drusen. Drusen identification and measurement play a key role in clinical studies of this disease. Current manual methods of drusen measurement are laborious and subjective. Our purpose was to expedite clinical research with an accurate, reliable digital method. METHODS: An interactive semi-automated procedure was developed to level the macular background reflectance for the purpose of morphometric analysis of drusen. 12 color fundus photographs of patients with age-related macular degeneration and drusen were analyzed. After digitizing the photographs, the underlying background pattern in the green channel was leveled by an algorithm based on the elliptically concentric geometry of the reflectance in the normal macula: the gray scale values of all structures within defined elliptical boundaries were raised sequentially until a uniform background was obtained. Segmentation of drusen and area measurements in the central and middle subfields (1000 μm and 3000 μm diameters) were performed by uniform thresholds. Two observers using this interactive semi-automated software measured each image digitally. The mean digital measurements were compared to independent stereo fundus gradings by two expert graders (stereo Grader 1 estimated the drusen percentage in each of the 24 regions as falling into one of four standard broad ranges; stereo Grader 2 estimated drusen percentages in 1% to 5% intervals). RESULTS: The mean digital area measurements had a median standard deviation of 1.9%. The mean digital area measurements agreed with stereo Grader 1 in 22/24 cases. The 95% limits of agreement between the mean digital area measurements and the more precise stereo gradings of Grader 2 were -6.4 % to +6.8 % in the central subfield and -6.0 % to +4.5 % in the middle subfield. The mean absolute differences between the digital and stereo gradings 2 were 2.8 +/- 3.4% in the central subfield and 2.2 +/- 2.7% in the middle subfield. CONCLUSIONS: Semi-automated, supervised drusen measurements may be done reproducibly and accurately with adaptations of commercial software. This technique for macular image analysis has potential for use in clinical research

Digital ocular fundus imaging: a review

Ocular fundus imaging plays a key role in monitoring the health status of the human eye. Currently, a large number of imaging modalities allow the assessment and/or quantification of ocular changes from a healthy status. This review focuses on the main digital fundus imaging modality, color fundus photography, with a brief overview of complementary techniques, such as fluorescein angiography. While focusing on two-dimensional color fundus photography, the authors address the evolution from nondigital to digital imaging and its impact on diagnosis. They also compare several studies performed along the transitional path of this technology. Retinal image processing and analysis, automated disease detection and identification of the stage of diabetic retinopathy (DR) are addressed as well. The authors emphasize the problems of image segmentation, focusing on the major landmark structures of the ocular fundus: the vascular network, optic disk and the fovea. Several proposed approaches for the automatic detection of signs of disease onset and progression, such as microaneurysms, are surveyed. A thorough comparison is conducted among different studies with regard to the number of eyes/subjects, imaging modality, fundus camera used, field of view and image resolution to identify the large variation in characteristics from one study to another. Similarly, the main features of the proposed classifications and algorithms for the automatic detection of DR are compared, thereby addressing computer-aided diagnosis and computer-aided detection for use in screening programs.Fundação para a Ciência e TecnologiaFEDErPrograma COMPET

Automated Diagnostic System for Grading of Diabetic Retinopathy Stages from Fundus Images Using Texture Features

Computational methodologies and medical imaging are become an important part of real time applications. These techniques transform medicine by providing effective health care diagnosis in all major disease areas. This will allow the clinicians to understand life-saving information using less invasive techniques. Diabetes is a rapidly increasing worldwide disease that occurs when the body is unable to metabolize glucose. It increases the risk of a range of eye diseases, but the main cause of blindness associated with diabetes is Diabetic retinopathy (DR). A new feature based automated technique for diagnosis and grading of normal, Nonproliferative diabetic retinopathy (NPDR) and Proliferative diabetic retinopathy (PDR) is proposed in this paper. This method involves preprocessing of retinal images, detection of lesions, extraction of blood vessels and extraction of texture features such as local binary pattern, Laws texture energy and Fractal Dimension. These features were used for classification of DR stages by means of supervised classifiers namely Support vector machine (SVM) and Extreme Learning Machine (ELM). In this work, in addition to morphological features, statistically significant texture features were also used for classification. It was found that the average classification accuracy of 98.88%, sensitivity and specificity of 100% respectively achieved using ELM classifier with texture features. The results were validated by comparing with expert ophthalmologists. This proposed automated diagnostic system reduces the work of professionals during mass screening of DR stages

Advanced image processing techniques for detection and quantification of drusen

Dissertation presented to obtain the degree of Doctor of Philosophy in Electrical Engineering, speciality on Perceptional Systems, by the Universidade Nova de Lisboa, Faculty of Sciences and TechnologyDrusen are common features in the ageing macula, caused by accumulation of extracellular materials beneath the retinal surface, visible in retinal fundus images as yellow spots. In the ophthalmologists’ opinion, the evaluation of the total drusen area, in a sequence of images taken during a treatment, will help to understand the disease progression and effectiveness. However, this evaluation is fastidious and difficult to reproduce when performed manually. A literature review on automated drusen detection showed that the works already published were limited to techniques of either adaptive or global thresholds which showed a tendency to produce a significant number of false positives. The purpose for this work was to propose an alternative method to automatically quantify drusen using advanced digital image processing techniques. This methodology is based on a detection and modelling algorithm to automatically quantify drusen. It includes an image pre-processing step to correct the uneven illumination by using smoothing splines fitting and to normalize the contrast. To quantify drusen a detection and modelling algorithm is adopted. The detection uses a new gradient based segmentation algorithm that isolates drusen and provides basic drusen characterization to the modelling stage. These are then fitted by Gaussian functions, to produce a model of the image, which is used to compute the affected areas. To validate the methodology, two software applications, one for semi-automated (MD3RI) and other for automated detection of drusen (AD3RI), were implemented. The first was developed for Ophthalmologists to manually analyse and mark drusen deposits, while the other implemented algorithms for automatic drusen quantification.Four studies to assess the methodology accuracy involving twelve specialists have taken place. These compared the automated method to the specialists and evaluated its repeatability. The studies were analysed regarding several indicators, which were based on the total affected area and on a pixel-to-pixel analysis. Due to the high variability among the graders involved in the first study, a new evaluation method, the Weighed Matching Analysis, was developed to improve the pixel-to-pixel analysis by using the statistical significance of the observations to differentiate positive and negative pixels. From the results of these studies it was concluded that the methodology proposed is capable to automatically measure drusen in an accurate and reproducible process. Also, the thesis proposes new image processing algorithms, for image pre-processing, image segmentation,image modelling and images comparison, which are also applicable to other image processing fields