Direct Classification of Type 2 Diabetes From Retinal Fundus Images in a Population-based Sample From The Maastricht Study

Type 2 Diabetes (T2D) is a chronic metabolic disorder that can lead to blindness and cardiovascular disease. Information about early stage T2D might be present in retinal fundus images, but to what extent these images can be used for a screening setting is still unknown. In this study, deep neural networks were employed to differentiate between fundus images from individuals with and without T2D. We investigated three methods to achieve high classification performance, measured by the area under the receiver operating curve (ROC-AUC). A multi-target learning approach to simultaneously output retinal biomarkers as well as T2D works best (AUC = 0.746 [$\pm$0.001]). Furthermore, the classification performance can be improved when images with high prediction uncertainty are referred to a specialist. We also show that the combination of images of the left and right eye per individual can further improve the classification performance (AUC = 0.758 [$\pm$0.003]), using a simple averaging approach. The results are promising, suggesting the feasibility of screening for T2D from retinal fundus images.Comment: to be published in the proceeding of SPIE - Medical Imaging 2020, 6 pages, 1 figur

Computer-aided diagnosis system for the assessment of retinal vascular changes

This paper presents an automatic application that provides several retinal image analysis functionalities, namely vessel segmentation, vessel width estimation, artery/vein classification and optic disc segmentation. A pipeline of these methods allows the computation of important vessel related indexes, namely the Central Retinal Arteriolar Equivalent (CRAE), Central Retinal Venular Equivalent (CRVE) and Arteriolar-to-Venular Ratio (AVR), as well as various geometrical features associated with vessel bifurcations. The results for AVR estimation were assessed using the images of INSPIRE-AVR dataset; for this dataset, the mean error of the measured AVR values with respect to the reference was identical to the one achieved by a medical expert. The estimation of the CRAE, CRVE and AVR values on 480 images from 120 subjects have shown a significant correlation between right and left eyes and also between images of same eye acquired with different camera fields of view

Classification of Human Retinal Microaneurysms Using Adaptive Optics Scanning Light Ophthalmoscope Fluorescein Angiography

Purpose. Microaneurysms (MAs) are considered a hallmark of retinal vascular disease, yet what little is known about them is mostly based upon histology, not clinical observation. Here, we use the recently developed adaptive optics scanning light ophthalmoscope (AOSLO) fluorescein angiography (FA) to image human MAs in vivo and to expand on previously described MA morphologic classification schemes. Methods. Patients with vascular retinopathies (diabetic, hypertensive, and branch and central retinal vein occlusion) were imaged with reflectance AOSLO and AOSLO FA. Ninety-three MAs, from 14 eyes, were imaged and classified according to appearance into six morphologic groups: focal bulge, saccular, fusiform, mixed, pedunculated, and irregular. The MA perimeter, area, and feret maximum and minimum were correlated to morphology and retinal pathology. Select MAs were imaged longitudinally in two eyes. Results. Adaptive optics scanning light ophthalmoscope fluorescein angiography imaging revealed microscopic features of MAs not appreciated on conventional images. Saccular MAs were most prevalent (47%). No association was found between the type of retinal pathology and MA morphology (P = 0.44). Pedunculated and irregular MAs were among the largest MAs with average areas of 4188 and 4116 μm2, respectively. Focal hypofluorescent regions were noted in 30% of MAs and were more likely to be associated with larger MAs (3086 vs. 1448 μm2, P = 0.0001). Conclusions. Retinal MAs can be classified in vivo into six different morphologic types, according to the geometry of their two-dimensional (2D) en face view. Adaptive optics scanning light ophthalmoscope fluorescein angiography imaging of MAs offers the possibility of studying microvascular change on a histologic scale, which may help our understanding of disease progression and treatment response

Integrating a Non-Uniformly Sampled Software Retina with a Deep CNN Model

We present a biologically inspired method for pre-processing images applied to CNNs that reduces their memory requirements while increasing their invariance to scale and rotation changes. Our method is based on the mammalian retino-cortical transform: a mapping between a pseudo-randomly tessellated retina model (used to sample an input image) and a CNN. The aim of this first pilot study is to demonstrate a functional retinaintegrated CNN implementation and this produced the following results: a network using the full retino-cortical transform yielded an F1 score of 0.80 on a test set during a 4-way classification task, while an identical network not using the proposed method yielded an F1 score of 0.86 on the same task. The method reduced the visual data by e×7, the input data to the CNN by 40% and the number of CNN training epochs by 64%. These results demonstrate the viability of our method and hint at the potential of exploiting functional traits of natural vision systems in CNNs

Classification of pathology in diabetic eye disease

Proliferative diabetic retinopathy is a complication of diabetes that can eventually lead to blindness. Early identification of this complication reduces the risk of blindness by initiating timely treatment. We report the utility of pattern analysis tools linked with a simple linear discriminant analysis that not only identifies new vessel growth in the retinal fundus but also localises the area of pathology. Ten fluorescein images were analysed using seven feature descriptors including area, perimeter, circularity, curvature, entropy, wavelet second moment and the correlation dimension. Our results indicate that traditional features such as area or perimeter measures of neovascularisation associated with proliferative retinopathy were not sensitive enough to detect early proliferative retinopathy (SNR = 0.76, 0.75 respectively). The wavelet second moment provided the best discrimination with a SNR of 1.17. Combining second moment, curvature and global correlation dimension provided a 100% discrimination (SNR = 1)

Ocular screening tests of elementary school children

This report presents an analysis of 507 abnormal retinal reflex images taken of Huntsville kindergarten and first grade students. The retinal reflex images were obtained by using an MSFC-developed Generated Retinal Reflex Image System (GRRIS) photorefractor. The system uses a 35 mm camera with a telephoto lens with an electronic flash attachment. Slide images of the eyes were examined for abnormalities. Of a total of 1835 students screened for ocular abnormalities, 507 were found to have abnormal retinal reflexes. The types of ocular abnormalities detected were hyperopia, myopia, astigmatism, esotropia, exotropia, strabismus, and lens obstuctions. The report shows that the use of the photorefractor screening system is an effective low-cost means of screening school children for abnormalities

A Smartphone-Based Tool for Rapid, Portable, and Automated Wide-Field Retinal Imaging.

Purpose:High-quality, wide-field retinal imaging is a valuable method for screening preventable, vision-threatening diseases of the retina. Smartphone-based retinal cameras hold promise for increasing access to retinal imaging, but variable image quality and restricted field of view can limit their utility. We developed and clinically tested a smartphone-based system that addresses these challenges with automation-assisted imaging. Methods:The system was designed to improve smartphone retinal imaging by combining automated fixation guidance, photomontage, and multicolored illumination with optimized optics, user-tested ergonomics, and touch-screen interface. System performance was evaluated from images of ophthalmic patients taken by nonophthalmic personnel. Two masked ophthalmologists evaluated images for abnormalities and disease severity. Results:The system automatically generated 100° retinal photomontages from five overlapping images in under 1 minute at full resolution (52.3 pixels per retinal degree) fully on-phone, revealing numerous retinal abnormalities. Feasibility of the system for diabetic retinopathy (DR) screening using the retinal photomontages was performed in 71 diabetics by masked graders. DR grade matched perfectly with dilated clinical examination in 55.1% of eyes and within 1 severity level for 85.2% of eyes. For referral-warranted DR, average sensitivity was 93.3% and specificity 56.8%. Conclusions:Automation-assisted imaging produced high-quality, wide-field retinal images that demonstrate the potential of smartphone-based retinal cameras to be used for retinal disease screening. Translational Relevance:Enhancement of smartphone-based retinal imaging through automation and software intelligence holds great promise for increasing the accessibility of retinal screening