Exudate-based diabetic macular edema detection in fundus images using publicly available datasets

Automated lesion detectors in retinal fundus images

Diabetic retinopathy (DR) is a sight-threatening condition occurring in persons with diabetes, which causes progressive damage to the retina. The early detection and diagnosis of DR is vital for saving the vision of diabetic persons. The early signs of DR which appear on the surface of the retina are the dark lesions such as microaneurysms (MAs) and hemorrhages (HEMs), and bright lesions (BLs) such as exudates. In this paper, we propose a novel automated system for the detection and diagnosis of these retinal lesions by processing retinal fundus images. We devise appropriate binary classifiers for these three different types of lesions. Some novel contextual/numerical features are derived, for each lesion type, depending on its inherent properties. This is performed by analysing several wavelet bands (resulting from the isotropic undecimated wavelet transform decomposition of the retinal image green channel) and by using an appropriate combination of Hessian multiscale analysis, variational segmentation and cartoon+texture decomposition. The proposed methodology has been validated on several medical datasets, with a total of 45,770 images, using standard performance measures such as sensitivity and specificity. The individual performance, per frame, of the MA detector is 93% sensitivity and 89% specificity, of the HEM detector is 86% sensitivity and 90% specificity, and of the BL detector is 90% sensitivity and 97% specificity. Regarding the collective performance of these binary detectors, as an automated screening system for DR (meaning that a patient is considered to have DR if it is a positive patient for at least one of the detectors) it achieves an average 95-100% of sensitivity and 70% of specificity at a per patient basis. Furthermore, evaluation conducted on publicly available datasets, for comparison with other existing techniques, shows the promising potential of the proposed detectors.

Classification of diabetes maculopathy images using data-adaptive neuro-fuzzy inference classifier

Prolonged diabetes retinopathy leads to diabetes maculopathy, which causes gradual and irreversible loss of vision. It is important for physicians to have a decision system that detects the early symptoms of the disease. This can be achieved by building a classification model using machine learning algorithms. Fuzzy logic classifiers group data elements with a degree of membership in multiple classes by defining membership functions for each attribute. Various methods have been proposed to determine the partitioning of membership functions in a fuzzy logic inference system. A clustering method partitions the membership functions by grouping data that have high similarity into clusters, while an equalized universe method partitions data into predefined equal clusters. The distribution of each attribute determines its partitioning as fine or coarse. A simple grid partitioning partitions each attribute equally and is therefore not effective in handling varying distribution amongst the attributes. A data-adaptive method uses a data frequency-driven approach to partition each attribute based on the distribution of data in that attribute. A data-adaptive neuro-fuzzy inference system creates corresponding rules for both finely distributed and coarsely distributed attributes. This method produced more useful rules and a more effective classification system. We obtained an overall accuracy of 98.55%.

A novel image recuperation approach for diagnosing and ranking retinopathy disease level using diabetic fundus image

Retinal fundus images are widely used in diagnosing and providing treatment for several eye diseases. Prior works using retinal fundus images detected the presence of exudation with the aid of publicly available dataset using extensive segmentation process. Though it was proved to be computationally efficient, it failed to create a diabetic retinopathy feature selection system for transparently diagnosing the disease state. Also the diagnosis of diseases did not employ machine learning methods to categorize candidate fundus images into true positive and true negative ratio. Several candidate fundus images did not include more detailed feature selection technique for diabetic retinopathy. To apply machine learning methods and classify the candidate fundus images on the basis of sliding window a method called, Diabetic Fundus Image Recuperation (DFIR) is designed in this paper. The initial phase of DFIR method select the feature of optic cup in digital retinal fundus images based on Sliding Window Approach. With this, the disease state for diabetic retinopathy is assessed. The feature selection in DFIR method uses collection of sliding windows to obtain the features based on the histogram value. The histogram based feature selection with the aid of Group Sparsity Non-overlapping function provides more detailed information of features. Using Support Vector Model in the second phase, the DFIR method based on Spiral Basis Function effectively ranks the diabetic retinopathy diseases. The ranking of disease level for each candidate set provides a much promising result for developing practically automated diabetic retinopathy diagnosis system. Experimental work on digital fundus images using the DFIR method performs research on the factors such as sensitivity, specificity rate, ranking efficiency and feature selection time.

Diagnosing and ranking retinopathy disease level using diabetic fundus image recuperation approach

Retinal fundus images are widely used in diagnosing different types of eye diseases. The existing methods such as Feature Based Macular Edema Detection (FMED) and Optimally Adjusted Morphological Operator (OAMO) effectively detected the presence of exudation in fundus images and identified the true positive ratio of exudates detection, respectively. These mechanically detected exudates did not include more detailed feature selection technique to the system for detection of diabetic retinopathy. To categorize the exudates, Diabetic Fundus Image Recuperation (DFIR) method based on sliding window approach is developed in this work to select the features of optic cup in digital retinal fundus images. The DFIR feature selection uses collection of sliding windows with varying range to obtain the features based on the histogram value using Group Sparsity Nonoverlapping Function. Using support vector model in the second phase, the DFIR method based on Spiral Basis Function effectively ranks the diabetic retinopathy disease level. The ranking of disease level on each candidate set provides a much promising result for developing practically automated and assisted diabetic retinopathy diagnosis system. Experimental work on digital fundus images using the DFIR method performs research on the factors such as sensitivity, ranking efficiency, and feature selection time.

Obtaining optic disc center and pixel region by automatic thresholding methods on morphologically processed fundus images

Development of automatic retinal disease diagnosis systems based on retinal image computer analysis can provide remarkably quicker screening programs for early detection. Such systems are mainly focused on the detection of the earliest ophthalmic signs of illness and require previous identification of fundal landmark features such as optic disc (OD), fovea or blood vessels. A methodology for accurate center-position location and OD retinal region segmentation on digital fundus images is presented in this paper. The methodology performs a set of iterative opening-closing morphological operations on the original retinography intensity channel to produce a bright region-enhanced image. Taking blood vessel confluence at the OD into account, a 2-step automatic thresholding procedure is then applied to obtain a reduced region of interest, where the center and the OD pixel region are finally obtained by performing the circular Hough transform on a set of OD boundary candidates generated through the application of the Prewitt edge detector. The methodology was evaluated on 1200 and 1748 fundus images from the publicly available MESSIDOR and MESSIDOR-2 databases, acquired from diabetic patients and thus being clinical cases of interest within the framework of automated diagnosis of retinal diseases associated to diabetes mellitus. This methodology proved highly accurate in OD-center location: average Euclidean distance between the methodology-provided and actual OD-center position was 6.08, 9.22 and 9.72 pixels for retinas of 910, 1380 and 1455 pixels in size, respectively. On the other hand, OD segmentation evaluation was performed in terms of Jaccard and Dice coefficients, as well as the mean average distance between estimated and actual OD boundaries. Comparison with the results reported by other reviewed OD segmentation methodologies shows our proposal renders better overall performance. Its effectiveness and robustness make this proposed automated OD location and segmentation method a suitable tool to be integrated into a complete prescreening system for early diagnosis of retinal diseases.

Retinal imaging as a source of biomarkers for diagnosis, characterization and prognosis of chronic illness or long-term conditions

The black void behind the pupil was optically impenetrable before the invention of the ophthalmoscope by von Helmholtz over 150 years ago. Advances in retinal imaging and image processing, especially over the past decade, have opened a route to another unexplored landscape, the retinal neurovascular architecture and the retinal ganglion pathways linking to the central nervous system beyond. Exploiting these research opportunities requires multidisciplinary teams to explore the interface sitting at the border between ophthalmology, neurology and computing science. It is from the detail and depth of retinal phenotyping that novel metrics and candidate biomarkers are likely to emerge. Confirmation that in vivo retinal neurovascular measures are predictive of microvascular change in the brain and other organs is likely to be a major area of research activity over the next decade. Unlocking this hidden potential within the retina requires integration of structural and functional data sets, that is, multimodal mapping and longitudinal studies spanning the natural history of the disease process. And with further advances in imaging, it is likely that this area of retinal research will remain active and clinically relevant for many years to come. Accordingly, this review looks at state-of-the-art retinal imaging and its application to diagnosis, characterization and prognosis of chronic illness or long-term conditions.

Advancing bag-of-visual-words representations for lesion classification in retinal images

Diabetic Retinopathy (DR) is a complication of diabetes that can lead to blindness if not readily discovered. Automated screening algorithms have the potential to improve identification of patients who need further medical attention. However, the identification of lesions must be accurate to be useful for clinical application. The bag-of-visual-words (BoVW) algorithm employs a maximum-margin classifier in a flexible framework that is able to detect the most common DR-related lesions such as microaneurysms, cotton-wool spots and hard exudates. BoVW allows to bypass the need for pre- and post-processing of the retinographic images, as well as the need of specific ad hoc techniques for identification of each type of lesion. An extensive evaluation of the BoVW model, using three large retinograph datasets (DR1, DR2 and Messidor) with different resolution and collected by different healthcare personnel, was performed. The results demonstrate that the BoVW classification approach can identify different lesions within an image without having to utilize different algorithms for each lesion reducing processing time and providing a more flexible diagnostic system. Our BoVW scheme is based on sparse low-level feature detection with a Speeded-Up Robust Features (SURF) local descriptor, and mid-level features based on semi-soft coding with max pooling. The best BoVW representation for retinal image classification was an area under the receiver operating characteristic curve (AUC-ROC) of 97.8% (exudates) and 93.5% (red lesions), applying a cross-dataset validation protocol. To assess the accuracy for detecting cases that require referral within one year, the sparse extraction technique associated with semi-soft coding and max pooling obtained an AUC of 94.2 ± 2.0%, outperforming current methods. Those results indicate that, for retinal image classification tasks in clinical practice, BoVW is equal and, in some instances, surpasses results obtained using dense detection (widely believed to be the best choice in many vision problems) for the low-level descriptors.

Quality evaluation of digital fundus images through combined measures

The evaluation of image quality is an important step before an automatic analysis of retinal images. Several conditions can impair the acquisition of a good image, and minimum image quality requirements should be present to ensure that an automatic or semiautomatic system provides an accurate diagnosis. A method to classify fundus images as low or good quality is presented. The method starts with the detection of regions of uneven illumination and evaluates if the segmented noise masks affect a clinically relevant area (around the macula). Afterwards, focus is evaluated through a fuzzy classifier. An input vector is created extracting three focus features. The system was validated in a large dataset (1454 fundus images), obtained from an online database and an eye clinic and compared with the ratings of three observers. The system performance was close to optimal with an area under the receiver operating characteristic curve of 0.9943.

Automated detection of circinate exudates in retina digital images using empirical mode decomposition and the entropy and uniformity of the intrinsic mode functions

This work presents a new automated system to detect circinate exudates in retina digital images. It operates as follows: the true color image is converted to gray levels, and contrast-limited adaptive histogram equalization (CLAHE) is applied to it before undergoing empirical mode decomposition (EMD) as intrinsic mode functions (IMFs). The entropies and uniformities of the first two IMFs are then computed to form a feature vector that is fed to a support vector machine (SVM) for classification. The experimental results using a set of 45 images (23 normal images and 22 images with circinate exudates taken from the STARE database) and tenfold cross-validation indicate that the proposed approach outperforms previous works found in the literature, with perfect classification. In addition, the image processing time was <4 min, making the presented circinate exudate detection system fit for use in a clinical environment.

Computer-aided diagnosis of diabetic retinopathy: a review

Diabetes mellitus may cause alterations in the retinal microvasculature leading to diabetic retinopathy. Unchecked, advanced diabetic retinopathy may lead to blindness. It can be tedious and time consuming to decipher subtle morphological changes in optic disk, microaneurysms, hemorrhage, blood vessels, macula, and exudates through manual inspection of fundus images. A computer aided diagnosis system can significantly reduce the burden on the ophthalmologists and may alleviate the inter and intra observer variability. This review discusses the available methods of various retinal feature extractions and automated analysis.

Automated analysis of diabetic retinopathy images: principles, recent developments, and emerging trends

Diabetic retinopathy (DR) is a vision-threatening complication of diabetes. Timely diagnosis and intervention are essential for treatment that reduces the risk of vision loss. A good color retinal (fundus) photograph can be used as a surrogate for face-to-face evaluation of DR. The use of computers to assist or fully automate DR evaluation from retinal images has been studied for many years. Early work showed promising results for algorithms in detecting and classifying DR pathology. Newer techniques include those that adapt machine learning technology to DR image analysis. Challenges remain, however, that must be overcome before fully automatic DR detection and analysis systems become practical clinical tools.

Statistical atlas based exudate segmentation

Diabetic macular edema (DME) is characterized by hard exudates. In this article, we propose a novel statistical atlas based method for segmentation of such exudates. Any test fundus image is first warped on the atlas co-ordinate and then a distance map is obtained with the mean atlas image. This leaves behind the candidate lesions. Post-processing schemes are introduced for final segmentation of the exudate. Experiments with the publicly available HEI-MED data-set shows good performance of the method. A lesion localization fraction of 82.5% at 35% of non-lesion localization fraction on the FROC curve is obtained. The method is also compared to few most recent reference methods.

Validating retinal fundus image analysis algorithms: issues and a proposal

This paper concerns the validation of automatic retinal image analysis (ARIA) algorithms. For reasons of space and consistency, we concentrate on the validation of algorithms processing color fundus camera images, currently the largest section of the ARIA literature. We sketch the context (imaging instruments and target tasks) of ARIA validation, summarizing the main image analysis and validation techniques. We then present a list of recommendations focusing on the creation of large repositories of test data created by international consortia, easily accessible via moderated Web sites, including multicenter annotations by multiple experts, specific to clinical tasks, and capable of running submitted software automatically on the data stored, with clear and widely agreed-on performance criteria, to provide a fair comparison.

Studying disagreements among retinal experts through image analysis

In recent years, many image analysis algorithms have been presented to assist Diabetic Retinopathy (DR) screening. The goal was usually to detect healthy examination records automatically, in order to reduce the number of records that should be analyzed by retinal experts. In this paper, a novel application is presented: these algorithms are used to 1) discover image characteristics that sometimes cause an expert to disagree with his/her peers and 2) warn the expert whenever these characteristics are detected in an examination record. In a DR screening program, each examination record is only analyzed by one expert, therefore analyzing disagreements among experts is challenging. A statistical framework, based on Parzen-windowing and the Patrick-Fischer distance, is presented to solve this problem. Disagreements among eleven experts from the Ophdiat screening program were analyzed, using an archive of 25,702 examination records.

Retina image analysis and ocular telehealth: the Oak Ridge National Laboratory-Hamilton Eye Institute case study

Automated retina image analysis has reached a high level of maturity in recent years, and thus the question of how validation is performed in these systems is beginning to grow in importance. One application of retina image analysis is in telemedicine, where an automated system could enable the automated detection of diabetic retinopathy and other eye diseases as a low-cost method for broad-based screening. In this work, we discuss our experiences in developing a telemedical network for retina image analysis, including our progression from a manual diagnosis network to a more fully automated one. We pay special attention to how validations of our algorithm steps are performed, both using data from the telemedicine network and other public databases.

Detecting flash artifacts in fundus imagery

In a telemedicine environment for retinopathy screening, a quality check is needed on initial input images to ensure sufficient clarity for proper diagnosis. This is true whether the system uses human screeners or automated software for diagnosis. We present a method for the detection of flash artifacts found in retina images. We have collected a set of retina fundus imagery from February 2009 to August 2011 from several clinics in the mid-South region of the USA as part of a telemedical project. These images have been screened with a quality check that sometimes omits specific flash artifacts, which can be detrimental for automated detection of retina anomalies. A multi-step method for detecting flash artifacts in the center area of the retina was created by combining characteristic colorimetric information and morphological pattern matching. The flash detection was tested on a dataset of 5218 images representative of the population. The system achieved a sensitivity of 96.54% and specificity of 70.16% for the detection of the flash artifacts. The flash artifact detection can serve as a useful tool in quality screening of retina images in a telemedicine network. The detection can be expected to improve automated detection by either providing special handling for these images in combination with a flash mitigation or removal method.