Incorporating spatial information for microaneurysm detection in retinal images

The presence of microaneurysms(MAs) in retinal images is a pathognomonic sign of Diabetic Retinopathy (DR). This is one of the leading causes of blindness in the working population worldwide. This paper introduces a novel algorithm that combines information from spatial views of the retina for the purpose of MA detection. Most published research in the literature has addressed the problem of detecting MAs from single retinal images. This work proposes the incorporation of information from two spatial views during the detection process. The algorithm is evaluated using 160 images from 40 patients seen as part of a UK diabetic eye screening programme which contained 207 MAs. An improvement in performance compared to detection from an algorithm that relies on a single image is shown as an increase of 2% ROC score, hence demonstrating the potential of this method

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

CAD system for early diagnosis of diabetic retinopathy based on 3D extracted imaging markers.

This dissertation makes significant contributions to the field of ophthalmology, addressing the segmentation of retinal layers and the diagnosis of diabetic retinopathy (DR). The first contribution is a novel 3D segmentation approach that leverages the patientspecific anatomy of retinal layers. This approach demonstrates superior accuracy in segmenting all retinal layers from a 3D retinal image compared to current state-of-the-art methods. It also offers enhanced speed, enabling potential clinical applications. The proposed segmentation approach holds great potential for supporting surgical planning and guidance in retinal procedures such as retinal detachment repair or macular hole closure. Surgeons can benefit from the accurate delineation of retinal layers, enabling better understanding of the anatomical structure and more effective surgical interventions. Moreover, real-time guidance systems can be developed to assist surgeons during procedures, improving overall patient outcomes. The second contribution of this dissertation is the introduction of a novel computeraided diagnosis (CAD) system for precise identification of diabetic retinopathy. The CAD system utilizes 3D-OCT imaging and employs an innovative approach that extracts two distinct features: first-order reflectivity and 3D thickness. These features are then fused and used to train and test a neural network classifier. The proposed CAD system exhibits promising results, surpassing other machine learning and deep learning algorithms commonly employed in DR detection. This demonstrates the effectiveness of the comprehensive analysis approach employed by the CAD system, which considers both low-level and high-level data from the 3D retinal layers. The CAD system presents a groundbreaking contribution to the field, as it goes beyond conventional methods, optimizing backpropagated neural networks to integrate multiple levels of information effectively. By achieving superior performance, the proposed CAD system showcases its potential in accurately diagnosing DR and aiding in the prevention of vision loss. In conclusion, this dissertation presents novel approaches for the segmentation of retinal layers and the diagnosis of diabetic retinopathy. The proposed methods exhibit significant improvements in accuracy, speed, and performance compared to existing techniques, opening new avenues for clinical applications and advancements in the field of ophthalmology. By addressing future research directions, such as testing on larger datasets, exploring alternative algorithms, and incorporating user feedback, the proposed methods can be further refined and developed into robust, accurate, and clinically valuable tools for diagnosing and monitoring retinal diseases

Potential Imaging Biomarkers in the Development and Progression of Diabetic Retinopathy

Diabetic retinopathy (DR) is the most prevalent microvascular complication of diabetes and a leading cause of preventable blindness in the working-age population. However, due to a lack of suitable biomarkers, its prediction in asymptomatic patients is insufficient. Currently, DR is diagnosed at a stage when typical morphologic lesions become fundoscopically visible. Yet, chronically elevated blood glucose levels lead to characteristic alterations in retinal vessel caliber, blood flow, oxygen saturation, and the capillary network, which precede DR lesions. Furthermore, emerging evidence suggests that retinal neurodegenerative changes occur early in diabetes, initiating a disintegration of the retinal neurovascular unit prior to the appearance of microvasculopathy in DR. This chapter will discuss recent research achievements toward understanding the complexities of DR pathophysiology. It will focus on the nomination of potential imaging biomarkers for the prediction of DR development and progression using innovative structural, functional, and metabolic imaging techniques, including optical coherence tomography angiography (OCTA), retinal oximetry, ultra-wide field FA, and corneal confocal microscopy (CCM). Validation of these biomarkers would allow the identification of patients at high risk of developing DR and might initiate a swift move to early diagnosis and individualized care

Cardiovascular Risk Stratification in Diabetic Retinopathy via Atherosclerotic Pathway in COVID-19/non-COVID-19 Frameworks using Artificial Intelligence Paradigm: A Narrative Review

Diabetes is one of the main causes of the rising cases of blindness in adults. This microvascular complication of diabetes is termed diabetic retinopathy (DR) and is associated with an expanding risk of cardiovascular events in diabetes patients. DR, in its various forms, is seen to be a powerful indicator of atherosclerosis. Further, the macrovascular complication of diabetes leads to coronary artery disease (CAD). Thus, the timely identification of cardiovascular disease (CVD) complications in DR patients is of utmost importance. Since CAD risk assessment is expensive for lowincome countries, it is important to look for surrogate biomarkers for risk stratification of CVD in DR patients. Due to the common genetic makeup between the coronary and carotid arteries, lowcost, high-resolution imaging such as carotid B-mode ultrasound (US) can be used for arterial tissue characterization and risk stratification in DR patients. The advent of artificial intelligence (AI) techniques has facilitated the handling of large cohorts in a big data framework to identify atherosclerotic plaque features in arterial ultrasound. This enables timely CVD risk assessment and risk stratification of patients with DR. Thus, this review focuses on understanding the pathophysiology of DR, retinal and CAD imaging, the role of surrogate markers for CVD, and finally, the CVD risk stratification of DR patients. The review shows a step-by-step cyclic activity of how diabetes and atherosclerotic disease cause DR, leading to the worsening of CVD. We propose a solution to how AI can help in the identification of CVD risk. Lastly, we analyze the role of DR/CVD in the COVID-19 framework

Accelerating precision ophthalmology: recent advances

Introduction: The future of ophthalmology is precision medicine. With a growing incidence of lifestyle-associated ophthalmic disease such as diabetic retinopathy, the use of technology has the potential to overcome the burden on clinical specialists. Advances in precision medicine will help improve diagnosis and better triage those with higher clinical need to the appropriate experts, as well as providing a more tailored approach to treatment that could help transform patient management. Areas covered: A detailed literature review was conducted using OVID Medline and PubMed databases to explore advances in precision medicine within the areas of retinal disease, glaucoma, cornea, cataracts and uveitis. Over the last three years [2019–2022] are explored, particularly discussing technological and genomic advances in screening, diagnosis, and management within these fields. Expert opinion: Artificial intelligence and its subspecialty deep learning provide the most substantial ways in which diagnosis and management of ocular diseases can be further developed within the advancing field of precision medicine. Future challenges include optimal training sets for algorithms and further developing pharmacogenetics in more specialized areas

Detection and removal of dust artifacts in retinal images via sparse-based inpainting

Dust particle artifacts are present in all imaging modalities but have more adverse consequences in medical images like retinal images. They could be mistaken as small lesions, such as microaneurysms. We propose a method for detecting and accurately segmenting dust artifacts in retinal images based on multi-scale template-matching on several input images and an iterative segmentation via an inpainting approach. The inpainting is done through dictionary learning and sparse-based representation. The artifact segmentation is refined by comparing the original image to the initial restoration. On average, 90% of the dust artifacts were detected in the test images, with state-of-theart restoration results. All detected artifacts were accurately segmented and removed. Even the most challenging artifacts located on top of blood vessels were removed. Thus, ensuring the continuity of the retinal structures. The proposed method successfully detects and removes dust artifacts in retinal images, which could be used to avoid false-positive lesion detections or as an image quality criterion. An implementation of the proposed algorithm can be accessed and executed through a Code Ocean compute capsule.The authors acknowledge the financial support from the Centre de Cooperació i Desenvolupament (CCD) at the Universitat Politècnica de Catalunya under project ref. CCD 2019-B004, and from the Universidad Tecnológica de Bolívar. Authors are grateful to Juan Luís Fuentes from the Miguel Servet University Hospital (Zaragoza, Spain) for providing the real images from clinical practice. E. Barrios thanks Minciencias and Sistema General de Regalías (Programa de Becas de Excelencia) for a PhD scholarship. E. Sierra thanks the Universidad Tecnológica de Bolívar for a post-graduate scholarship. Parts of this work were presented at the Pattern Recognition and Tracking XXX - SPIE DCS, 2019 [39]. L. Romero, A. Marrugo, and M.S. Millán thank the funds provided by the Spanish Ministerio de Ciencia e Innovación under the project reference PID2020-114582RB-I00.Peer ReviewedPostprint (published version

Hybrid Multilevel Thresholding and Improved Harmony Search Algorithm for Segmentation

This paper proposes a new method for image segmentation is hybrid multilevel thresholding and improved harmony search algorithm. Improved harmony search algorithm which is a method for finding vector solutions by increasing its accuracy. The proposed method looks for a random candidate solution, then its quality is evaluated through the Otsu objective function. Furthermore, the operator continues to evolve the solution candidate circuit until the optimal solution is found. The dataset used in this study is the retina dataset, tongue, lenna, baboon, and cameraman. The experimental results show that this method produces the high performance as seen from peak signal-to-noise ratio analysis (PNSR). The PNSR result for retinal image averaged 40.342 dB while for the average tongue image 35.340 dB. For lenna, baboon and cameramen produce an average of 33.781 dB, 33.499 dB, and 34.869 dB. Furthermore, the process of object recognition and identification is expected to use this method to produce a high degree of accuracy

Machine Learning Approaches for Automated Glaucoma Detection using Clinical Data and Optical Coherence Tomography Images

Glaucoma is a multi-factorial, progressive blinding optic-neuropathy. A variety of factors, including genetics, vasculature, anatomy, and immune factors, are involved. Worldwide more than 80 million people are affected by glaucoma, and around 300,000 in Australia, where 50% remain undiagnosed. Untreated glaucoma can lead to blindness. Early detection by Artificial intelligence (AI) is crucial to accelerate the diagnosis process and can prevent further vision loss. Many proposed AI systems have shown promising performance for automated glaucoma detection using two-dimensional (2D) data. However, only a few studies had optimistic outcomes for glaucoma detection and staging. Moreover, the automated AI system still faces challenges in diagnosing at the clinicians’ level due to the lack of interpretability of the ML algorithms and integration of multiple clinical data. AI technology would be welcomed by doctors and patients if the "black box" notion is overcome by developing an explainable, transparent AI system with similar pathological markers used by clinicians as the sign of early detection and progression of glaucomatous damage. Therefore, the thesis aimed to develop a comprehensive AI model to detect and stage glaucoma by incorporating a variety of clinical data and utilising advanced data analysis and machine learning (ML) techniques. The research first focuses on optimising glaucoma diagnostic features by combining structural, functional, demographic, risk factor, and optical coherence tomography (OCT) features. The significant features were evaluated using statistical analysis and trained in ML algorithms to observe the detection performance. Three crucial structural ONH OCT features: cross-sectional 2D radial B-scan, 3D vascular angiography and temporal-superior-nasal-inferior-temporal (TSNIT) B-scan, were analysed and trained in explainable deep learning (DL) models for automated glaucoma prediction. The explanation behind the decision making of DL models were successfully demonstrated using the feature visualisation. The structural features or distinguished affected regions of TSNIT OCT scans were precisely localised for glaucoma patients. This is consistent with the concept of explainable DL, which refers to the idea of making the decision-making processes of DL models transparent and interpretable to humans. However, artifacts and speckle noise often result in misinterpretation of the TSNIT OCT scans. This research also developed an automated DL model to remove the artifacts and noise from the OCT scans, facilitating error-free retinal layers segmentation, accurate tissue thickness estimation and image interpretation. Moreover, to monitor and grade glaucoma severity, the visual field (VF) test is commonly followed by clinicians for treatment and management. Therefore, this research uses the functional features extracted from VF images to train ML algorithms for staging glaucoma from early to advanced/severe stages. Finally, the selected significant features were used to design and develop a comprehensive AI model to detect and grade glaucoma stages based on the data quantity and availability. In the first stage, a DL model was trained with TSNIT OCT scans, and its output was combined with significant structural and functional features and trained in ML models. The best-performed ML model achieved an area under the curve (AUC): 0.98, an accuracy of 97.2%, a sensitivity of 97.9%, and a specificity of 96.4% for detecting glaucoma. The model achieved an overall accuracy of 90.7% and an F1 score of 84.0% for classifying normal, early, moderate, and advanced-stage glaucoma. In conclusion, this thesis developed and proposed a comprehensive, evidence-based AI model that will solve the screening problem for large populations and relieve experts from manually analysing a slew of patient data and associated misinterpretation problems. Moreover, this thesis demonstrated three structural OCT features that could be added as excellent diagnostic markers for precise glaucoma diagnosis