Abstract
Diabetic retinopathy (DR) is a sight threatening complication due to diabetes mellitus that affects the retina. In this article, a computerised DR grading system, which digitally analyses retinal fundus image, is used to measure foveal avascular zone. A v-fold cross-validation method is applied to the FINDeRS database to evaluate the performance of the DR system. It is shown that the system achieved sensitivity of >84%, specificity of >97% and accuracy of >95% for all DR stages. At high values of sensitivity (>95%), specificity (>97%) and accuracy (>98%) obtained for No DR and severe NPDR/PDR stages, the computerised DR grading system is suitable for early detection of DR and for effective treatment of severe cases.




Similar content being viewed by others
References
Ahmad Fadzil MH, Izhar LI (2008) A non-Invasive method for analysing the retina for ocular manifested diseases. Patent filing no. PI20083503 September, 2008 ed. Malaysia, v. patent filing no. PI20083503 September, 2008
Ahmad Fadzil MH, Lila Iznita I (2009) A non-Invasive method for analysing the retina for ocular manifested diseases. Patent filing no. PCT/MY2009/000025 2009 ed. Malaysia, v. patent filing no. PCT/MY2009/000025 2009
Ahmad Fadzil MH, Lila Iznita I (2009) An apparatus for monitoring and grading diabetic retinopathy. Patent filing no. PI20091936 May, 2009 ed. Malaysia, v. patent filing no. PI20091936 May, 2009
Ahmad Fadzil MH, Nugroho HA, Venkatachalam PA, et al (2008) Determination of retinal pigments from fundus images using independent component analysis. In: Proceeding of biomed 2008 4th Kuala Lumpur international conference on biomedical engineering vol 21. Springer, Berlin Heidelberg, 2008
Ahmad Fadzil MH, Nugroho HA (2009) Retinal vasculature enhancement using independent component analysis. J Biomed Sci Eng 2:543–549
Ahmad Fadzil MH, Izhar LI, Venkatachalam PA, Karunakar TVN (2007) Extraction and reconstruction of retinal vasculature. J Med Eng Tech 31:435–442
Ahmad Fadzil MH, Lila Iznita I, Nugroho HA (2009) Analysis of foveal avascular zone in color fundus image for grading of diabetic retinopathy. Int J Recent Trends Eng 2:101–104
American academy of ophthalmology retina panel. Preferred practice pattern guidelines. Diabetic retinopathy. American Academy of Ophthalmology San Francisco, CA. http://www.aao.org/ppp
Bradley A, Applegate RA, Zeffren BS, Heuven WAJ (1992) Psychophysical measurement of the size and shape of the human foveal avascular zone. Ophthal Physiol Opt 12:18–23
Bresnick GH, Condit R, Syrjala S et al (1984) Abnormalities of the foveal avascular zone in diabetic retinopathy. Arch Ophthalmol 102:1286–1293
Comon P (1994) Independent component analysis, a new concept? Signal Process 36:287
Conrath J, Giorgi R, Raccah D, Ridings B (2004) Foveal avascular zone in diabetic retinopathy: quantitative vs qualitative assessment. Eye 19:322–326
Conrath J, Valat O, Giorgi R et al (2006) Semi-automated detection of the foveal avascular zone in fluorescein angiograms in diabetes mellitus. Clin Exp Ophthalmol 34:119–123
Duda RO, Hart PE, Stork DG (2001) Pattern classification. Wiley, New York
Fadzil MHA, Lila Iznita I, Hanung Adi N (2010) Determination of foveal avascular zone in diabetic retinopathy digital fundus images. Comput Biol Med 40:657–664
Goh PP (2008) Status of diabetic retinopathy among diabetics registered to the diabetic eye registry, National eye database, 2007. Med J Malaysia 63:24–28
Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36
Hyvarinen A, Oja E (2000) Independent component analysis: algorithms and applications. Neural Networks 13:411
Izenman AJ (2008) Modern multivariate statistical techniques: regression, classification, and manifold learning. Springer New York, Berlin
Iznita L (2006) Analysis of retinal vasculature and foveal avascular zone for grading of diabetic retinopathy. M.Sc. Thesis, Universiti Teknologi PETRONAS, Electrical and electronics engineering programme. Bandar Seri Iskandar, Malaysia
Jelinek HF, Cree MJ, Leandro JJG et al (2007) Automated segmentation of retinal blood vessels and identification of proliferative diabetic retinopathy. J Opt Soc Am A 24:1448–1456
John D, Braganza A, Kuriakose T (2006) A study of the foveal avascular zone using the Heidelberg retina angiogram-2 in normal eyes. In: Proceedings 34th all India optometry conference (AIOC 2008) Amritsar, India
Kahai P, Namuduri KR, Thompson H (2004) Decision support for automated screening of diabetic retinopathy. Conference on signals, systems and computers, vol 2. Conference record of the thirty-eighth asilomar
Kahai P, Namuduri KR, Thompson H (2006) A decision support framework for automated screening of diabetic retinopathy. Int J Biomed Imaging 2006:1–7
Khurana AK (2003) Ophthalmology. New Age International Publishers, New Delhi
Mansour AM (1990) Measuring fundus landmark. Invest Ophthalmol Vis Sci 31:41–42
Metz C (2008) ROC analysis in medical imaging: a tutorial review of the literature. Radiol Phys Technol 1:2–12
Micheli-Tzanakou E (2000) Supervised and unsupervised pattern recognition: feature extraction and computational intelligence. CRC Press, Boca Raton
Mitchell TM (1997) Machine Learning. McGraw-Hill, New York
Nayak J, Bhat P, Acharya UR et al (2008) Automated identification of diabetic retinopathy stages using digital fundus images. J Med Syst 32:107–115
Otsu N (1979) A threshold selection method from gray-level histograms. IEEE Transactions on Systems, Man and Cybernetics 9:62–66
Parodi MB, Visintin F, Rupe PD, Ravalico G (1995) Foveal avascular zone in macular branch retinal vein occlusion. Int Ophthalmol 19:25–28
Pratt WK (1978) Digital image processing. Wiley, New York
Rasmussen CE, Williams CKI (2006) Gaussian processes for machine learning. MIT, Cambridge, Mass
Richard G, Soubrane Gl, Yannuzzi LA, Courland S (1998) Fluorescein and ICG angiography. Thieme Medical, New York
Saini VK, Varma P, Bhaisare V, et al. Foveal Avascular Zone Calculation and its Variation with Different Posterior Segment Diseases and Analysis of its Impact on Best Corrected Visual Acuity. In: Bhattacharyya DD, AIOC 2006. Bhopal, India, 2006; v. 4
Sopharak A, Uyyanonvara B, Barman S, Williamson TH (2008) Automatic detection of diabetic retinopathy exudates from non-dilated retinal images using mathematical morphology methods. Comput Med Imaging Graph 32:720–727
Stone M (1974) Cross-validatory choice and assessment of statistical predictions. J Royal Stat Soc B 36:111–147
Walter T, Klein J-C, Massin P, Erginay A (2002) A contribution of image processing to the diagnosis of diabetic retinopathy-detection of exudates in color fundus images of the human retina. IEEE Trans Med Imaging 21:1236–1243
Yun WL, Rajendra Acharya U, Venkatesh YV et al (2008) Identification of different stages of diabetic retinopathy using retinal optical images. Inf Sci 178:106–121
Zeffren B, Applegate R, Bradley A, van Heuven W (1990) Retinal fixation point location in the foveal avascular zone. Invest Ophthalmol Vis Sci 31:2099–2105
Zweig MH, Campbell G (1993) Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 39:561–577
Acknowledgment
The authors would like to acknowledge the contributions of Dr. Nor Fariza Ngah, Dr. Tara Mary George, Dr. Mariam Ismail, Dr. Elias Hussein and Dr. Goh Pik Pin from Department of Ophthalmology, Hospital Selayang for their suggestions and contributions in providing the retinal fundus image data. The research study was funded by the Ministry of Science, Technology and Innovation under the Techno Fund grant TF0206C129. The Clinical Observational Study NMRR–08–942–1997 was approved by the Clinical Research Centre, Ministry of Health, Malaysia.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ahmad Fadzil, M.H., Izhar, L.I., Nugroho, H. et al. Analysis of retinal fundus images for grading of diabetic retinopathy severity. Med Biol Eng Comput 49, 693–700 (2011). https://doi.org/10.1007/s11517-011-0734-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11517-011-0734-2