Automatic extraction of retinal features from colour retinal images for glaucoma diagnosis: a review

Glaucoma is a group of eye diseases that have common traits such as, high eye pressure, damage to the Optic Nerve Head and gradual vision loss. It affects peripheral vision and eventually leads to blindness if left untreated. The current common methods of pre-diagnosis of Glaucoma include measurement of Intra-Ocular Pressure (IOP) using Tonometer, Pachymetry, Gonioscopy; which are performed manually by the clinicians. These tests are usually followed by Optic Nerve Head (ONH) Appearance examination for the confirmed diagnosis of Glaucoma. The diagnoses require regular monitoring, which is costly and time consuming. The accuracy and reliability of diagnosis is limited by the domain knowledge of different ophthalmologists. Therefore automatic diagnosis of Glaucoma attracts a lot of attention.This paper surveys the state-of-the-art of automatic extraction of anatomical features from retinal images to assist early diagnosis of the Glaucoma. We have conducted critical evaluation of the existing automatic extraction methods based on features including Optic Cup to Disc Ratio (CDR), Retinal Nerve Fibre Layer (RNFL), Peripapillary Atrophy (PPA), Neuroretinal Rim Notching, Vasculature Shift, etc., which adds value on efficient feature extraction related to Glaucoma diagnosis. © 2013 Elsevier Ltd

Artificial Intelligence Techniques in Medical Imaging: A Systematic Review

This scientific review presents a comprehensive overview of medical imaging modalities and their diverse applications in artificial intelligence (AI)-based disease classification and segmentation. The paper begins by explaining the fundamental concepts of AI, machine learning (ML), and deep learning (DL). It provides a summary of their different types to establish a solid foundation for the subsequent analysis. The prmary focus of this study is to conduct a systematic review of research articles that examine disease classification and segmentation in different anatomical regions using AI methodologies. The analysis includes a thorough examination of the results reported in each article, extracting important insights and identifying emerging trends. Moreover, the paper critically discusses the challenges encountered during these studies, including issues related to data availability and quality, model generalization, and interpretability. The aim is to provide guidance for optimizing technique selection. The analysis highlights the prominence of hybrid approaches, which seamlessly integrate ML and DL techniques, in achieving effective and relevant results across various disease types. The promising potential of these hybrid models opens up new opportunities for future research in the field of medical diagnosis. Additionally, addressing the challenges posed by the limited availability of annotated medical images through the incorporation of medical image synthesis and transfer learning techniques is identified as a crucial focus for future research efforts

Automatic extraction of retinal features to assist diagnosis of glaucoma disease

Glaucoma is a group of eye diseases that have common traits such as high eye pressure, damage to the Optic Nerve Head (ONH) and gradual vision loss. It affects the peripheral vision and eventually leads to blindness if left untreated. The current common methods of diagnosis of glaucoma are performed manually by the clinicians. Clinicians perform manual image operations such as change of contrast, zooming in zooming out etc to observe glaucoma related clinical indications. This type of diagnostic process is time consuming and subjective. With the advancement of image and vision computing, by automating steps in the diagnostic process, more patients can be screened and early treatment can be provided to prevent any or further loss of vision. The aim of this work is to develop a system called Glaucoma Detection Framework (GDF), which can automatically determine changes in retinal structures and imagebased pattern associated with glaucoma so as to assist the eye clinicians for glaucoma diagnosis in a timely and effective manner. In this work, several major contributions have been made towards the development of the automatic GDF consisting of the stages of preprocessing, optic disc and cup segmentation and regional image feature methods for classification between glaucoma and normal images. Firstly, in the preprocessing step, a retinal area detector based on superpixel classification model has been developed in order to automatically determine true retinal area from a Scanning Laser Ophthalmoscope (SLO) image. The retinal area detector can automatically extract artefacts out from the SLO image while preserving the computational effciency and avoiding over-segmentation of the artefacts. Localization of the ONH is one of the important steps towards the glaucoma analysis. A new weighted feature map approach has been proposed, which can enhance the region of ONH for accurate localization. For determining vasculature shift, which is one of glaucoma indications, we proposed the ONH cropped image based vasculature classification model to segment out the vasculature from the ONH cropped image. The ONH cropped image based vasculature classification model is developed in order to avoid misidentification of optic disc boundary and Peripapillary Atrophy (PPA) around the ONH of being a part of the vasculature area. Secondly, for automatic determination of optic disc and optic cup boundaries, a Point Edge Model (PEM), a Weighted Point Edge Model (WPEM) and a Region Classification Model (RCM) have been proposed. The RCM initially determines the optic disc region using the set of feature maps most suitable for the region classification whereas the PEM updates the contour using the force field of the feature maps with strong edge profile. The combination of PEM and RCM entitled Point Edge and Region Classification Model (PERCM) has significantly increased the accuracy of optic disc segmentation with respect to clinical annotations around optic disc. On the other hand, the WPEM determines the force field using the weighted feature maps calculated by the RCM for optic cup in order to enhance the optic cup region compared to rim area in the ONH. The combination of WPEM and RCM entitled Weighted Point Edge and Region Classification Model (WPERCM) can significantly enhance the accuracy of optic cup segmentation. Thirdly, this work proposes a Regional Image Features Model (RIFM) which can automatically perform classification between normal and glaucoma images on the basis of regional information. Different from the existing methods focusing on global features information only, our approach after optic disc localization and segmentation can automatically divide an image into five regions (i.e. optic disc or Optic Nerve Head (ONH) area, inferior (I), superior(S), nasal(N) and temporal(T)). These regions are usually used for diagnosis of glaucoma by clinicians through visual observation only. It then extracts image-based information such as textural, spatial and frequency based information so as to distinguish between normal and glaucoma images. The method provides a new way to identify glaucoma symptoms without determining any geometrical measurement associated with clinical indications glaucoma. Finally, we have accommodated clinical indications of glaucoma including the CDR, vasculature shift and neuroretinal rim loss with the RIFM classification and performed automatic classification between normal and glaucoma images. Since based on the clinical literature, no geometrical measurement is the guaranteed sign of glaucoma, the accommodation of the RIFM classification results with clinical indications of glaucoma can lead to more accurate classification between normal and glaucoma images. The proposed methods in this work have been tested against retinal image databases of 208 fundus images and 102 Scanning Laser Ophthalmoscope (SLO) images. These databases have been annotated by the clinicians around different anatomical structures associated with glaucoma as well as annotated with healthy or glaucomatous images. In fundus images, ONH cropped images have resolution varying from 300 to 900 whereas in SLO images, the resolution is 341 x 341. The accuracy of classification between normal and glaucoma images on fundus images and the SLO images is 94.93% and 98.03% respectively

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

Towards PACE-CAD Systems

Despite phenomenal advancements in the availability of medical image datasets and the development of modern classification algorithms, Computer-Aided Diagnosis (CAD) has had limited practical exposure in the real-world clinical workflow. This is primarily because of the inherently demanding and sensitive nature of medical diagnosis that can have far-reaching and serious repercussions in case of misdiagnosis. In this work, a paradigm called PACE (Pragmatic, Accurate, Confident, & Explainable) is presented as a set of some of must-have features for any CAD. Diagnosis of glaucoma using Retinal Fundus Images (RFIs) is taken as the primary use case for development of various methods that may enrich an ordinary CAD system with PACE. However, depending on specific requirements for different methods, other application areas in ophthalmology and dermatology have also been explored. Pragmatic CAD systems refer to a solution that can perform reliably in day-to-day clinical setup. In this research two, of possibly many, aspects of a pragmatic CAD are addressed. Firstly, observing that the existing medical image datasets are small and not representative of images taken in the real-world, a large RFI dataset for glaucoma detection is curated and published. Secondly, realising that a salient attribute of a reliable and pragmatic CAD is its ability to perform in a range of clinically relevant scenarios, classification of 622 unique cutaneous diseases in one of the largest publicly available datasets of skin lesions is successfully performed. Accuracy is one of the most essential metrics of any CAD system's performance. Domain knowledge relevant to three types of diseases, namely glaucoma, Diabetic Retinopathy (DR), and skin lesions, is industriously utilised in an attempt to improve the accuracy. For glaucoma, a two-stage framework for automatic Optic Disc (OD) localisation and glaucoma detection is developed, which marked new state-of-the-art for glaucoma detection and OD localisation. To identify DR, a model is proposed that combines coarse-grained classifiers with fine-grained classifiers and grades the disease in four stages with respect to severity. Lastly, different methods of modelling and incorporating metadata are also examined and their effect on a model's classification performance is studied. Confidence in diagnosing a disease is equally important as the diagnosis itself. One of the biggest reasons hampering the successful deployment of CAD in the real-world is that medical diagnosis cannot be readily decided based on an algorithm's output. Therefore, a hybrid CNN architecture is proposed with the convolutional feature extractor trained using point estimates and a dense classifier trained using Bayesian estimates. Evaluation on 13 publicly available datasets shows the superiority of this method in terms of classification accuracy and also provides an estimate of uncertainty for every prediction. Explainability of AI-driven algorithms has become a legal requirement after Europe’s General Data Protection Regulations came into effect. This research presents a framework for easy-to-understand textual explanations of skin lesion diagnosis. The framework is called ExAID (Explainable AI for Dermatology) and relies upon two fundamental modules. The first module uses any deep skin lesion classifier and performs detailed analysis on its latent space to map human-understandable disease-related concepts to the latent representation learnt by the deep model. The second module proposes Concept Localisation Maps, which extend Concept Activation Vectors by locating significant regions corresponding to a learned concept in the latent space of a trained image classifier. This thesis probes many viable solutions to equip a CAD system with PACE. However, it is noted that some of these methods require specific attributes in datasets and, therefore, not all methods may be applied on a single dataset. Regardless, this work anticipates that consolidating PACE into a CAD system can not only increase the confidence of medical practitioners in such tools but also serve as a stepping stone for the further development of AI-driven technologies in healthcare

Multi-modal classifier fusion with feature cooperation for glaucoma diagnosis

Background: Glaucoma is a major public health problem that can lead to an optic nerve lesion, requiring systematic screening in the population over 45 years of age. The diagnosis and classification of this disease have had a marked and excellent development in recent years, particularly in the machine learning domain. Multimodal data have been shown to be a significant aid to the machine learning domain, especially by its contribution to improving data driven decision-making. Method: Solving classification problems by combinations of classifiers has made it possible to increase the robustness as well as the classification reliability by using the complementarity that may exist between the classifiers. Complementarity is considered a key property of multimodality. A Convolutional Neural Network (CNN) works very well in pattern recognition and has been shown to exhibit superior performance, especially for image classification which can learn by themselves useful features from raw data. This article proposes a multimodal classification approach based on deep Convolutional Neural Network and Support Vector Machine (SVM) classifiers using multimodal data and multimodal feature for glaucoma diagnosis from retinal fundus images from RIM-ONE dataset. We make use of handcrafted feature descriptors such as the Gray Level Co-Occurrence Matrix, Central Moments and Hu Moments to co-operate with features automatically generated by the CNN in order to properly detect the optic nerve and consequently obtain a better classification rate, allowing a more reliable diagnosis of glaucoma. Results: The experimental results confirm that the combination of classifiers using the BWWV technique is better than learning classifiers separately. The proposed method provides a computerized diagnosis system for glaucoma disease with impressive results comparing them to the main related studies that allow us to continue in this research path

A retinal vasculature tracking system guided by a deep architecture

Many diseases such as diabetic retinopathy (DR) and cardiovascular diseases show their early signs on retinal vasculature. Analysing the vasculature in fundus images may provide a tool for ophthalmologists to diagnose eye-related diseases and to monitor their progression. These analyses may also facilitate the discovery of new relations between changes on retinal vasculature and the existence or progression of related diseases or to validate present relations. In this thesis, a data driven method, namely a Translational Deep Belief Net (a TDBN), is adapted to vasculature segmentation. The segmentation performance of the TDBN on low resolution images was found to be comparable to that of the best-performing methods. Later, this network is used for the implementation of super-resolution for the segmentation of high resolution images. This approach provided an acceleration during segmentation, which relates to down-sampling ratio of an input fundus image. Finally, the TDBN is extended for the generation of probability maps for the existence of vessel parts, namely vessel interior, centreline, boundary and crossing/bifurcation patterns in centrelines. These probability maps are used to guide a probabilistic vasculature tracking system. Although segmentation can provide vasculature existence in a fundus image, it does not give quantifiable measures for vasculature. The latter has more practical value in medical clinics. In the second half of the thesis, a retinal vasculature tracking system is presented. This system uses Particle Filters to describe vessel morphology and topology. Apart from previous studies, the guidance for tracking is provided with the combination of probability maps generated by the TDBN. The experiments on a publicly available dataset, REVIEW, showed that the consistency of vessel widths predicted by the proposed method was better than that obtained from observers. Moreover, very noisy and low contrast vessel boundaries, which were hardly identifiable to the naked eye, were accurately estimated by the proposed tracking system. Also, bifurcation/crossing locations during the course of tracking were detected almost completely. Considering these promising initial results, future work involves analysing the performance of the tracking system on automatic detection of complete vessel networks in fundus images.Open Acces

A Multi-Anatomical Retinal Structure Segmentation System For Automatic Eye Screening Using Morphological Adaptive Fuzzy Thresholding

Eye exam can be as efficacious as physical one in determining health concerns. Retina screening can be the very first clue to detecting a variety of hidden health issues including pre-diabetes and diabetes. Through the process of clinical diagnosis and prognosis; ophthalmologists rely heavily on the binary segmented version of retina fundus image; where the accuracy of segmented vessels, optic disc and abnormal lesions extremely affects the diagnosis accuracy which in turn affect the subsequent clinical treatment steps. This thesis proposes an automated retinal fundus image segmentation system composed of three segmentation subsystems follow same core segmentation algorithm. Despite of broad difference in features and characteristics; retinal vessels, optic disc and exudate lesions are extracted by each subsystem without the need for texture analysis or synthesis. For sake of compact diagnosis and complete clinical insight, our proposed system can detect these anatomical structures in one session with high accuracy even in pathological retina images. The proposed system uses a robust hybrid segmentation algorithm combines adaptive fuzzy thresholding and mathematical morphology. The proposed system is validated using four benchmark datasets: DRIVE and STARE (vessels), DRISHTI-GS (optic disc), and DIARETDB1 (exudates lesions). Competitive segmentation performance is achieved, outperforming a variety of up-to-date systems and demonstrating the capacity to deal with other heterogenous anatomical structures