Current and future roles of artificial intelligence in retinopathy of prematurity

Retinopathy of prematurity (ROP) is a severe condition affecting premature infants, leading to abnormal retinal blood vessel growth, retinal detachment, and potential blindness. While semi-automated systems have been used in the past to diagnose ROP-related plus disease by quantifying retinal vessel features, traditional machine learning (ML) models face challenges like accuracy and overfitting. Recent advancements in deep learning (DL), especially convolutional neural networks (CNNs), have significantly improved ROP detection and classification. The i-ROP deep learning (i-ROP-DL) system also shows promise in detecting plus disease, offering reliable ROP diagnosis potential. This research comprehensively examines the contemporary progress and challenges associated with using retinal imaging and artificial intelligence (AI) to detect ROP, offering valuable insights that can guide further investigation in this domain. Based on 89 original studies in this field (out of 1487 studies that were comprehensively reviewed), we concluded that traditional methods for ROP diagnosis suffer from subjectivity and manual analysis, leading to inconsistent clinical decisions. AI holds great promise for improving ROP management. This review explores AI's potential in ROP detection, classification, diagnosis, and prognosis.Comment: 28 pages, 8 figures, 2 tables, 235 references, 1 supplementary tabl

PREMATURE INFANT BLOOD VESSEL SEGMENTATION OF RETINAL IMAGES BASED ON HYBRID METHOD FOR THE DETERMINATION OF TORTUOSITY

For the retinal blood vessels segmentation, we used a method, which is based on the morphological operations. The output of this process is extracted retinal binary image, where is situated main blood vessels. In this paper is used dataset of images (2800 images) from device RetCam3. Before applying the image processing, it was selected 30 images with diagnosed pre-plus diseases, and it is divided into two groups with low contrast and good contrast images. In the next part of the analysis, it was analyzing and showing blood vessels with tortuosity. Tortuosity is a symptom of ROP (retinopathy of prematurity). The clinical physicians evaluate tortuosity by visual comparison of the retinal images images. For this reason, it was suggested model which can automatically indicate the tortuosity of the retinal blood vessels by setting a threshold of the blood vessels curvature

Retinal vasculature analysis: tuning and optimization for RETCAM images

This work is focused on tuning an algorithm for the automatic detection of the retinal blood vessels. Such optimization and adaptation are aimed to allow the analysis of the vessel network in preterm babies affected by Retinophathy of Prematurity. In the first chapter, the anatomical structure of the human eye is described and special attention is paid to the retina. The second chapter deals with ROP . The third chapter focuses on the segmentation of retinal images, especially in premature babies, and introduces the RetCam imaging system. In the fourth chapter the applied algorithm is defined, and the changes that have been applied to it are carefully explained. Finally, the fifth chapter presents the search results with the related conclusions and recommendations for the futur

Segmentation of the retinal vasculature of the infant eye fundus: a comparison among vesselness measures

La Retinopatia del Prematuro (ROP) è una malattia grave che colpisce i bambini nati prematuri. I primi segnali del manifestarsi della malattia sono un'eccessiva tortuosità e dilatazione dei vasi della retina. Al giorno d'oggi, i clinici basano la propria diagnosi sull'esperienza diretta che hanno sulla malattia attraverso l'analisi visiva. La segmentazione automatica della vascolarizzazione in immagini retiniche può essere un valido aiuto per supportare le decisioni del personale sanitario durante la diagnosi e le relative cure. Questa tesi descrive le varie “misure di vesselness” per immagini di neonato e mostra un confronto fra differenti approcci alla corretta segmentazione. Come algoritmi di vessel tracking si sono utilizzati Line Strength, Matched Filter e Eigen-decomposition of the Hessian. Di queste misure, si tengono conto in seguito dei migliori risultati in termini di accuratezza. Viene poi proposta una misura di coerenza legata alla direzionalità di ciascun pixel dell'immagine per migliorare le prestazioni dei precedenti metodi. In futuro, questo nuovo algoritmo può essere migliorato e fornire risultati più performant

Deep learning in ophthalmology: The technical and clinical considerations

The advent of computer graphic processing units, improvement in mathematical models and availability of big data has allowed artificial intelligence (AI) using machine learning (ML) and deep learning (DL) techniques to achieve robust performance for broad applications in social-media, the internet of things, the automotive industry and healthcare. DL systems in particular provide improved capability in image, speech and motion recognition as well as in natural language processing. In medicine, significant progress of AI and DL systems has been demonstrated in image-centric specialties such as radiology, dermatology, pathology and ophthalmology. New studies, including pre-registered prospective clinical trials, have shown DL systems are accurate and effective in detecting diabetic retinopathy (DR), glaucoma, age-related macular degeneration (AMD), retinopathy of prematurity, refractive error and in identifying cardiovascular risk factors and diseases, from digital fundus photographs. There is also increasing attention on the use of AI and DL systems in identifying disease features, progression and treatment response for retinal diseases such as neovascular AMD and diabetic macular edema using optical coherence tomography (OCT). Additionally, the application of ML to visual fields may be useful in detecting glaucoma progression. There are limited studies that incorporate clinical data including electronic health records, in AL and DL algorithms, and no prospective studies to demonstrate that AI and DL algorithms can predict the development of clinical eye disease. This article describes global eye disease burden, unmet needs and common conditions of public health importance for which AI and DL systems may be applicable. Technical and clinical aspects to build a DL system to address those needs, and the potential challenges for clinical adoption are discussed. AI, ML and DL will likely play a crucial role in clinical ophthalmology practice, with implications for screening, diagnosis and follow up of the major causes of vision impairment in the setting of ageing populations globally

Algorithms for the automatic tracking of the blood vessels network in retinal images acquired by RetCam in newborns

L’obiettivo di questo lavoro di tesi è la realizzazione di una serie di algoritmi capaci di tracciare automaticamente i vasi retinici in immagini acquisite tramite RetCam (field of view=130°) da neonati prematuri. I neonati prematuri rischiano infatti di sviluppare una patologia (Retinopatia del Prematuro) che se non correttamente trattata può portare al distacco retinico e alla cecità. L’analisi del fondo oculare è l’unico modo per determinare la condizione del paziente ma decidere se intervenire o meno in un neonato dovrebbe essere una decisione basata su dati oggettivi e su un protocollo ben definito. Il tracciamento automatico dei vasi retinici in immagini RetCam è un processo complicato data la scarsa qualità delle immagini da elaborare, soprattutto per la trasparenza della retina nei neonati e per il basso contrasto delle immagini, ma rappresenta uno step fondamentale per la successiva valutazione automatica della condizione della retina sotto esame. In questo lavoro sono state considerate 20 immagini, di cui è stato realizzato il tracciamento manuale per determinare la performance del sistema implementato. Fra le 20 immagini ne sono state scelte 6 per allenare un classificatore che , a partire dalle immagini filtrate, distingueva ogni segmento dell’immagine come appartenente o meno alla rete di vasi retinici. il risultato finale è dato dalla combinazione delle 2 classificazioni disponibili per ogni immagine ed è caratterizzato da un’immagine binaria avente i vasi retinici bianchi su sfondo ner

Automated classification of retinopathy of prematurity in newborns

La Retinopatia de l'Prematur (ROP) és una malaltia que afecta els nadons prematurs mostrant-se com un subdesenvolupament dels vasos retinians. El diagnòstic precoç d'aquesta malaltia és un tot un repte ja que requereix de professionals altament qualificats amb coneixements molt específics. Actualment a Espanya, només uns pocs hospitals compten amb els equipaments especialitzats per al tractament i diagnòstic d'aquesta patologia. Aquest projecte final de màster, té com a objectiu final desenvolupar una eina preliminar per a la classificació de l'extensió aquesta malaltia. Aquesta applicació, ha estat disenyada per a ser integrada en una plataforma de suport a la diagnosi de la Retinopatia i poder evaluar la malaltia, proporcionant informació detallada sobre les imatge analitzades. Aquest projecte, també estableix les bases per a la comparació entre l'enfocament clínic, que utilitzen els metges, i la naturalesa "Black-Box" natural de la Xarxa Neuronal Artificial per classificar l'extensió de la malaltia. L'algoritme desenvolupat és capaç de: segmentar els vasos oculars utilitzant una xarxa neuronal convolucional U-Net; extreure les característiques representatives de la malaltia a partir de la segmentació; i classificar aquestes característiques en casos ROP i casos ROP Plus, mitjançant l'ús d'una gamma de classificadors. Les principals característiques analitzades són la tortuositat i el gruix dels vasos, indicadors de la malaltia emprats pels patolegs experts. La xarxa de segmentació ha obtingut una precisió global de l'96,15%. Els resultats dels diferents classificadors indiquen un trade-off entre la precisió i el volum d'imatges analitzades. S'ha obtingut una precisió de l'100% emprant un classificador de doble threshold en el analisis de l'12,5% de les imatges. En canvi, mitjançant l'ús d'un classificador "decision tree", s'ha obtingut una precisió del 70,8% analitzant el 100% de les imatges.La Retinopatía del Prematuro (ROP) es una enfermedad que afecta a los bebés prematuros mostrándose como el subdesarrollo de los vasos retinianos. El diagnóstico precoz de dicha enfermedad es un desafío ya que requiere de profesionales altamente capacitados con conocimientos muy específicos. Actualmente en España, solo unos pocos hospitales están dotados con los equipamientos especializados para el tratamiento y diagnóstico de esta patología Este proyecto final de master, tiene como objetivo final desarrollar una herramienta preliminar para la clasificación de la extensión dicha enfermedad. Esta aplicación, ha sido diseñada para ser integrada en una plataforma de soporte al diagnóstico de la Retinopatía y evaluar la enfermedad, proporcionando información detallada sobre las imágenes analizadas. Este proyecto también sienta las bases para la comparación entre el enfoque clínico, que utilizan los médicos, y la naturaleza "Black-Box" natural de la Red Neuronal Artificial para clasificar la extensión de la enfermedad. El algoritmo desarrollado es capaz de: segmentar los vasos oculares utilizando una red neuronal convolucional U-Net; extraer las características representativas de la enfermedad a partir de la segmentación; y clasificar estas características en casos ROP y casos ROP Plus, mediante el empleo de una gama de clasificadores. Las principales características analizadas son la tortuosidad y el grosor de los vasos, indicadores cauterizantes de la enfermedad empleados por los patólogos expertos. La red de segmentación ha logrado una precisión global del 96,15%. Los resultados de los diferentes clasificadores indican un trade-off entre la precisión y el volumen de imágenes analizadas. Se ha obtenido una precisión del 100% empleando un clasificador de doble threshold en el análisis del 12,5% de las imágenes. En cambio, mediante el uso de un clasificador “decision tree”, se ha obtenido una precisión del 70,8% analizando el 100% de las imágenes.Retinopathy of Prematurity (ROP) is a disease in preterm babies with underdevelopment in retinal vessels. Early diagnosis of the disease is challenging and requires skilled professionals with very specific knowledge. Currently, in Spain, only a few hospitals have departments specialized in this pathology and, therefore, are able to diagnose and treat it accordingly. This master project aims to develop the first preliminary instrument for the classification of the extent of Retinopathy disease. This tool has been built to be integrated into a diagnostic support platform to detect the presence of retinopathy and evaluate the sickness, providing insightful information regarding the specific image. This project also lays the base for the comparison between the clinical approach that the doctors use and the “black box” approach the Artificial Neural Network uses to predict the extent of the disease. The developed algorithm is able to: segment ocular vessels using a U-Net Convolutional Neural Network; extract the critical features from the segmentation; and classify those features into ROP cases and ROP Plus cases by employing a range of different classifiers. The main features analyzed by the related specialists and thus selected are tortuosity and thickness of the vessels. The segmentation Network achieved a global accuracy of 96.15%. The results of the different classifiers indicate a trade-off between accuracy and the volume of computed images. An accuracy of 100% was achieved with a Double Threshold classifier on 12.5% of the images. Instead, by using a Decision tree classifier, an accuracy of 70.8% was achieved when computing 100% of the images

Global tortuosity estimation of retinal vessel network in wide-field images taken from infants with retinopathy of prematurity

Determinare ed implementare un criterio automatico di tortuosità consistente con il giudizio dei clinici per ottenere una misura che possa fornire un ordinamento coerente con quelli degli espert