A novel automatic image processing algorithm for detection of hard exudates based on retinal image analysis

We present an automatic image processing algorithm to detect hard exudates. Automatic detection of hard exudates from retinal images is an important problem since hard exudates are associated with diabetic retinopathy and have been found to be one of the most prevalent earliest signs of retinopathy. The algorithm is based on Fisher's linear discriminant analysis and makes use of colour information to perform the classification of retinal exudates. We prospectively assessed the algorithm performance using a database containing 58 retinal images with variable colour, brightness, and quality. Our proposed algorithm obtained a sensitivity of 88% with a mean number of 4.83+/-4.64 false positives per image using the lesion-based performance evaluation criterion, and achieved an image-based classification accuracy of 100% (sensitivity of 100% and specificity of 100%).     

Decision support system for the detection and grading of hard exudates from color fundus photographs

Diabetic retinopathy is a major cause of blindness, and its earliest signs include damage to the blood vessels and the formation of lesions in the retina. Automated detection and grading of hard exudates from the color fundus image is a critical step in the automated screening system for diabetic retinopathy. We propose novel methods for the detection and grading of hard exudates and the main retinal structures. For exudate detection, a novel approach based on coarse-to-fine strategy and a new image-splitting method are proposed with overall sensitivity of 93.2% and positive predictive value of 83.7% at the pixel level. The average sensitivity of the blood vessel detection is 85%, and the success rate of fovea localization is 100%. For exudate grading, a polar fovea coordinate system is adopted in accordance with medical criteria. Because of its competitive performance and ability to deal efficiently with images of variable quality, the proposed technique offers promising and efficient performance as part of an automated screening system for diabetic retinopathy.     

Progress towards automated diabetic ocular screening: A review of image analysis and intelligent systems for diabetic retinopathy

Patients with diabetes require annual screening for effective timing of sight-saving treatment. However, the lack of screening and the shortage of ophthalmologists limit the ocular health care available. This is stimulating research into automated analysis of the reflectance images of the ocular fundus. Publications applicable to the automated screening of diabetic retinopathy are summarised. The review has been structured to mimic some of the processes that an ophthalmologist performs when examining the retina. Thus image processing tasks, such as vessel and lesion location, are reviewed before any intelligent or automated systems. Most research has been undertaken in identification of the retinal vasculature and analysis of early pathological changes. Progress has been made in the identification of the retinal vasculature and the more common pathological features, such as small aneurysms and exudates. Ancillary research into image preprocessing has also been identified. In summary, the advent of digital data sets has made image analysis more accessible, although questions regarding the assessment of individual algorithms and whole systems are only just being addressed.     

Automated clarity assessment of retinal images using regionally based structural and statistical measures

An automated image analysis system for application in mass medical screening must assess the clarity of the images before analysing their content. This is the case in grading for diabetic retinopathy screening where the failure to assess clarity could result in retinal images of people with retinopathy being erroneously classed as normal. This paper compares methods of clarity assessment based on the degradation of visible structures and based on the deviation of image properties outside expected norms caused by clarity loss. Vessel visibility measures and statistical measures were determined at locations in the image which have high saliency and these were used to obtain an image clarity assessment using supervised classification. The usefulness of the measures as indicators of image clarity was assessed. Tests were performed on 987 disc-centred and macula-centred retinal photographs (347 with inadequate clarity) obtained from the English National Screening Programme. Images with inadequate clarity were detected with 92.6% sensitivity at 90% specificity. In a set of 2000 macula-centred images (200 with inadequate clarity) from the Scottish Screening Programme, inadequate clarity was detected with 96.7% sensitivity at 90% specificity. This study has shown that structural and statistical measures are equally useful for retinal image clarity assessment.     

Automatic detection of retinal anatomy to assist diabetic retinopathy screening

Screening programmes for diabetic retinopathy are being introduced in the United Kingdom and elsewhere. These require large numbers of retinal images to be manually graded for the presence of disease. Automation of image grading would have a number of benefits. However, an important prerequisite for automation is the accurate location of the main anatomical features in the image, notably the optic disc and the fovea. The locations of these features are necessary so that lesion significance, image field of view and image clarity can be assessed. This paper describes methods for the robust location of the optic disc and fovea. The elliptical form of the major retinal blood vessels is used to obtain approximate locations, which are refined based on the circular edge of the optic disc and the local darkening at the fovea. The methods have been tested on 1056 sequential images from a retinal screening programme. Positional accuracy was better than 0.5 of a disc diameter in 98.4% of cases for optic disc location, and in 96.5% of cases for fovea location. The methods are sufficiently accurate to form an important and effective component of an automated image grading system for diabetic retinopathy screening.     

Telemedicine screening of diabetic retinopathy using a hand-held fundus camera.

The objective was to evaluate digital images of the retina from a handheld fundus camera (Nidek NM-100) for suitability in telemedicine screening of diabetic retinopathy. A handheld fundus camera (Nidek) and a standard fundus camera (Zeiss) were used to photograph 49 eyes from 25 consecutive patients attending our diabetic clinic. One patient had cataracts, making it impossible to get a quality image of one of the eyes (retina). The Nidek images were digitized, compressed, and stored in a Fujix DF-10M digitizer supplied with the camera. The digital images and the photographs were presented separately in a random order to three ophthalmologists. The quality of the images was ranked as good, acceptable or unacceptable for diabetic retinopathy diagnosis. The images were also evaluated for the presence of microaneurysms, blot hemorrhages, exudates, fibrous tissue, previous photocoagulation, and new vessel formation. kappa Values were computed for agreement between the photographs and digital images. Overall agreement between the photographs and digital images was poor (kappa < 0.30). On average, only 24% of the digital images were graded as being good quality and 56% as having an acceptable quality. However, 93% of the photographs were graded as good-quality images for diagnosis. The results indicate that the digital images from the handheld fundus camera may not be suitable for diagnosis of diabetic retinopathy. The images shown on the liquid crystal display (LCD) screen of the camera were of good quality. However, the images produced by the digitizer (Fujix DF-10M) attached to the camera were not as good as the images shown on the LCD screen. A better digitizing system may produce better quality images from the Nidek camera.     

Detection of Hard Exudates in Colour Fundus Images Using Fuzzy Support Vector Machine-Based Expert System

Diabetic retinopathy is a major cause of vision loss in diabetic patients. Currently, there is a need for making decisions using intelligent computer algorithms when screening a large volume of data. This paper presents an expert decision-making system designed using a fuzzy support vector machine (FSVM) classifier to detect hard exudates in fundus images. The optic discs in the colour fundus images are segmented to avoid false alarms using morphological operations and based on circular Hough transform. To discriminate between the exudates and the non-exudates pixels, colour and texture features are extracted from the images. These features are given as input to the FSVM classifier. The classifier analysed 200 retinal images collected from diabetic retinopathy screening programmes. The tests made on the retinal images show that the proposed detection system has better discriminating power than the conventional support vector machine. With the best combination of FSVM and features sets, the area under the receiver operating characteristic curve reached 0.9606, which corresponds to a sensitivity of 94.1 % with a specificity of 90.0 %. The results suggest that detecting hard exudates using FSVM contribute to computer-assisted detection of diabetic retinopathy and as a decision support system for ophthalmologists.     

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 Quality Assessment of Colour Fundus Images for Diabetic Retinopathy Screening in Telemedicine

Fundus images obtained in a telemedicine program are acquired at different sites that are captured by people who have varying levels of experience. These result in a relatively high percentage of images which are later marked as unreadable by graders. Unreadable images require a recapture which is time and cost intensive. An automated method that determines the image quality during acquisition is an effective alternative. To determine the image quality during acquisition, we describe here an automated method for the assessment of image quality in the context of diabetic retinopathy. The method explicitly applies machine learning techniques to access the image and to determine ‘accept’ and ‘reject’ categories. ‘Reject’ category image requires a recapture. A deep convolution neural network is trained to grade the images automatically. A large representative set of 7000 colour fundus images was used for the experiment which was obtained from the EyePACS that were made available by the California Healthcare Foundation. Three retinal image analysis experts were employed to categorise these images into ‘accept’ and ‘reject’ classes based on the precise definition of image quality in the context of DR. The network was trained using 3428 images. The method shows an accuracy of 100% to successfully categorise ‘accept’ and ‘reject’ images, which is about 2% higher than the traditional machine learning method. On a clinical trial, the proposed method shows 97% agreement with human grader. The method can be easily incorporated with the fundus image capturing system in the acquisition centre and can guide the photographer whether a recapture is necessary or not.     

Detection of Neovascularization in Diabetic Retinopathy

Diabetic retinopathy has become an increasingly important cause of blindness. Nevertheless, vision loss can be prevented from early detection of diabetic retinopathy and monitor with regular examination. Common automatic detection of retinal abnormalities is for microaneurysms, hemorrhages, hard exudates, and cotton wool spot. However, there is a worse case of retinal abnormality, but not much research was done to detect it. It is neovascularization where new blood vessels grow due to extensive lack of oxygen in the retinal capillaries. This paper shows that various combination of techniques such as image normalization, compactness classifier, morphology-based operator, Gaussian filtering, and thresholding techniques were used in developing of neovascularization detection. A function matrix box was added in order to classify the neovascularization from natural blood vessel. A region-based neovascularization classification was attempted as a diagnostic accuracy. The developed method was tested on images from different database sources with varying quality and image resolution. It shows that specificity and sensitivity results were 89.4% and 63.9%, respectively. The proposed approach yield encouraging results for future development.     

基于背景估计和SVM分类器的眼底图像硬性渗出物检测方法

硬性渗出物是糖尿病视网膜病变(DR)的早期病症,是糖尿病性黄斑水肿的最主要表现,因此对硬性渗出物的准确检测具有重要的临床意义。提出一种基于背景估计和SVM分类器的眼底图像硬性渗出物检测方法。首先通过背景估计,得到包含亮目标的前景图;然后利用基于Kirsch算子的边缘信息确定硬性渗出物的候选区域,再移除视盘;最后对候选区域进行形状特征、直方图统计特征以及相位特征的提取,采用SVM对候选区域进行分类,完成硬性渗出物的精确提取。对DIARETDB1和HEI MED公共数据库中共248幅眼底图像进行实验,图像水平达到灵敏度97.3%和特异性90%,病灶水平达到灵敏度84.6%和阳性预测值944%。实验表明,所提出的方法能够实现眼底图像中硬性渗出物的自动检测。     

Detection of Optic Disc Localization from Retinal Fundus Image Using Optimized Color Space

Optic disc localization offers an important clue in detecting other retinal components such as the macula, fovea, and retinal vessels. With the correct detection of this area, sudden vision loss caused by diseases such as age-related macular degeneration and diabetic retinopathy can be prevented. Therefore, there is an increase in computer-aided diagnosis systems in this field. In this paper, an automated method for detecting optic disc localization is proposed. In the proposed method, the fundus images are moved from RGB color space to a new color space by using an artificial bee colony algorithm. In the new color space, the localization of the optical disc is clearer than in the RGB color space. In this method, a matrix called the feature matrix is created. This matrix is obtained from the color pixel values of the image patches containing the optical disc and the image patches not containing the optical disc. Then, the conversion matrix is created. The initial values of this matrix are randomly determined. These two matrices are processed in the artificial bee colony algorithm. Ultimately, the conversion matrix becomes optimal and is applied over the original fundus images. Thus, the images are moved to the new color space. Thresholding is applied to these images, and the optic disc localization is obtained. The success rate of the proposed method has been tested on three general datasets. The accuracy success rate for the DRIVE, DRIONS, and MESSIDOR datasets, respectively, is 100%, 96.37%, and 94.42% for the proposed method.

     

基于改进的模糊C-均值聚类算法及支持向量机的眼底图像中硬性渗出检测方法

目的提出一种基于改进的模糊C-均值(improved fuzzy C-means,IFCM)聚类算法及支持向量机(support vector machine,SVM)的检测算法,以实现对眼底图像中硬性渗出的自动识别。方法首先利用改进的FCM算法对由江苏省中医院眼科提供的120幅彩色眼底图像进行粗分割以获取硬性渗出候选区域;其次,利用Logistic回归对候选区域提取出的特征进行选择,并利用候选区域的优化特征集及相应判定结果建立SVM分类器,实现眼底图像中硬性渗出的自动检测;最后利用该方法对65幅眼底图像进行硬性渗出自动检测。结果硬性渗出自动检测得到的病灶区域水平灵敏度96.47%,阳性预测值90.13%;图像水平灵敏度100%,特异性95.00%,准确率98.46%;平均一幅图像处理时间4.56 s。结论利用改进的FCM算法与识别率较高的SVM分类器相结合的方法能够高效自动地识别出眼底图像中的硬性渗出。     

糖尿病性视网膜病变图像黄斑水肿等级自动分析方法

糖尿病性黄斑水肿（DME）可以出现在糖尿病性视网膜病变（DR）的任何阶段,是导致糖尿病患者视力损伤的主要原因,因此DME自动分析是DR筛查的关键内容。依据DME国际临床分级标准,通过检测并判断硬性渗出（HEs）是否接近或涉及黄斑中心,可对眼底图像进行DME等级的自动分析。HEs检测选择基于现有的数学形态学方法的综合改进;黄斑中心定位则引入定向局部对比度滤波结合局部血管密度的新方法,可同步确定并去除视盘区域,以消除对HEs检测的影响,其中血管密度仅需提取粗血管网络。经开放的HEI MED数据集中169幅眼底图像的测试,HEs检测在图像水平上获得100%敏感性和922%特异性;黄斑中心定位正确率982%;各DME等级评价正确率均在88%以上,具有重要的临床参考和应用价值。     

Computer-aided diabetic retinopathy detection using trace transforms on digital fundus images

Diabetic retinopathy (DR) is a leading cause of vision loss among diabetic patients in developed countries. Early detection of occurrence of DR can greatly help in effective treatment. Unfortunately, symptoms of DR do not show up till an advanced stage. To counter this, regular screening for DR is essential in diabetic patients. Due to lack of enough skilled medical professionals, this task can become tedious as the number of images to be screened becomes high with regular screening of diabetic patients. An automated DR screening system can help in early diagnosis without the need for a large number of medical professionals. To improve detection, several pattern recognition techniques are being developed. In our study, we used trace transforms to model a human visual system which would replicate the way a human observer views an image. To classify features extracted using this technique, we used support vector machine (SVM) with quadratic, polynomial, radial basis function kernels and probabilistic neural network (PNN). Genetic algorithm (GA) was used to fine tune classification parameters. We obtained an accuracy of 99.41 and 99.12 % with PNN–GA and SVM quadratic kernels, respectively.     

An Automated Blood Vessel Segmentation Algorithm Using Histogram Equalization and Automatic Threshold Selection

This paper focuses on the detection of retinal blood vessels which play a vital role in reducing the proliferative diabetic retinopathy and for preventing the loss of visual capability. The proposed algorithm which takes advantage of the powerful preprocessing techniques such as the contrast enhancement and thresholding offers an automated segmentation procedure for retinal blood vessels. To evaluate the performance of the new algorithm, experiments are conducted on 40 images collected from DRIVE database. The results show that the proposed algorithm performs better than the other known algorithms in terms of accuracy. Furthermore, the proposed algorithm being simple and easy to implement, is best suited for fast processing applications.     

基于定向局部对比度的眼底图像视盘检测方法

视盘作为眼底图像的一个重要特征,其自动检测方法在眼底病变图像分析中有着重要的作用。提出一种基于定向局部对比度滤波的方法,有效地提取眼底图像中的局部亮度区域;结合视盘区域的局部血管特征,选择定位出正确的视盘感兴趣区域;采用数学形态学方法和区域主动轮廓模型,可较准确地检测出视盘轮廓。对开放的STARE数据库上的81幅眼底图像进行测试,其中含31幅正常和50幅病变图像（含严重病理图像）,用该方法正确检测出视盘73幅,准确率约为90.1%。结果表明,该方法有效地克服大块亮斑病灶对视盘检测的影响,且仅需提取粗血管,计算较为简单,说明了算法的有效性。     

Deep CNN with Hybrid Binary Local Search and Particle Swarm Optimizer for Exudates Classification from Fundus Images

Diabetic retinopathy is a chronic condition that causes vision loss if not detected early. In the early stage, it can be diagnosed with the aid of exudates which are called lesions. However, it is arduous to detect the exudate lesion due to the availability of blood vessels and other distractions. To tackle these issues, we proposed a novel exudates classification from the fundus image known as hybrid convolutional neural network (CNN)-based binary local search optimizer–based particle swarm optimization algorithm. The proposed method from this paper exploits image augmentation to enlarge the fundus image to the required size without losing any features. The features from the resized fundus images are extracted as a feature vector and fed into the feed-forward CNN as the input. Henceforth, it classifies the exudates from the fundus image. Further, the hyperparameters are optimized to reduce the computational complexities by utilization of binary local search optimizer (BLSO) and particle swarm optimization (PSO). The experimental analysis is conducted on the public ROC and real-time ARA400 datasets and compared with the state-of-art works such as support vector machine classifiers, multi-modal/multi-scale, random forest, and CNN for the performance metrics. The classification accuracy is high for the proposed work, and thus, our proposed outperforms all the other approaches.

     

An exudate detection method for diagnosis risk of diabetic macular edema in retinal images using feature-based and supervised classification

The present paper aims at presenting the methodology and first results of a detection system of risk of diabetic macular edema (DME) in fundus images. The system is based on the detection of retinal exudates (Ex), whose presence in the image is clinically used for an early diagnosis of the disease. To do so, the system applies digital image processing algorithms to the retinal image in order to obtain a set of candidate regions to be Ex, which are validated by means of feature extraction and supervised classification techniques. The diagnoses provided by the system on 1058 retinographies of 529 diabetic patients at risk of having DME show that the system can operate at a level of sensitivity comparable to that of ophthalmological specialists: it achieved 0.9000 sensitivity per patient against 0.7733, 0.9133 and 0.9000 of several specialists, where the false negatives were mild clinical cases of the disease. In addition, the level of specificity reached by the system was 0.6939, high enough to screen about 70% of the patients with no evidence of DME. These values show that the system fulfils the requirements for its possible integration into a complete diabetic retinopathy pre-screening tool for the automated management of patients within a screening programme.

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Graphical Abstract Diagnosis system of risk of diabetic macular edema (DME) based on exudate (Ex) detection in fundus images.

     

Measurement of retinal vascular tortuosity and its application to retinal pathologies

The tortuosity of retinal blood vessels is an important diagnostic indicator for a number of retinal pathologies. We applied robust quantitative tortuosity metrics, which are well suited to automated detection and measurement, to retinal fluorescein images of normal and diseased vessels exhibiting background diabetic retinopathy, retinitis pigmentosa and retinal vasculitis. We established the validity of the mean tortuosity (M) and the normalized root-mean-square tortuosity (K) by their strong correlation with the ranking of tortuosity by an expert panel of ophthalmologists. The low prevalences of the diseased conditions in the general population affect the classification process, and preclude the use of tortuosity for screening for all of these conditions simultaneously in the general population. Tortuosity may be useful as a screening test for retinitis alone, and may be useful for distinguishing diabetic retinopathy or vasculitis from normal in a discretionary (i.e. referred) population.