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Image Processing Techniques for Glaucoma Detection

Conference Paper in Communications in Computer and Information Science · July 2011

DOI: 10.1007/978-3-642-22720-2_38 · Source: DBLP

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 Image Processing Techniques for Glaucoma Detection

Mishra Madhusudhan, Nath Malay, S.R. Nirmala, and Dandapat Samerendra

Indian Institute of Technology Guwahati, Department of Electronics and Electrical

Engineering, Guwahati, India
{m.mishra,malaya,nirmala,samaren}@iitg.ernet.in

Abstract. Glaucoma is a disease caused due to neurodegeneration of the optic

nerve which leads to blindness. It can be evaluated by monitoring intra ocular
pressure (IOP), visual field and the optic disc appearance (cup-to-disc ratio).
Glaucoma increases the cup to disc ratio (CDR), affecting the peripheral vision
loss. This paper addresses the various image processing techniques to diagnose
the glaucoma based on the CDR evaluation of preprocessed fundus images.
These algorithms are tested on publicly available fundus images and the results
are compared. The accuracy of these algorithms is evaluated by sensitivity and
specificity. The sensitivity and specificity for these algorithms are found to be
very favorable.

Keywords: Glaucoma risk index, cup to disc ratio, multi-thresholding, active

contours, region growing segmentation.

1 Introduction
Glaucoma is a progressive optic neuropathy leading to visual field changes due to the
damage retinal ganglion cells and axons [1]. From the survey it is found that nearly 1-
million Indians, age 40 and over, have glaucoma [2].With disease progression the
interconnection between the photo receptors and the visual cortex is reduced. This
reduces the functional capabilities of the retina and changes the size of the cup. So
cup-to-disc ratio (CDR) is used for measuring glaucoma progression. Fig.1 shows
how the objects are perceived by normal vision and a patient having glaucoma.
Raised intra-ocular pressure (IOP) is classified as a risk factor but is not part of the
definition. However it causes typical structural changes of the optic nerve head
(ONH) and the nerve fiber layer affecting the visual field of the subject [3]. The
structural changes are the outcome of the slowly diminishing neuroretinal rim
manifesting a degeneration of axons and astrocytes of the optic nerve resulting in
expansion of cup size of the optic disc, as shown in fig. 2. However blood vessels are
least affected.
The CDR expresses the proportion of the disc occupied by the cup and it is widely
accepted index for the assessment of glaucoma [3]. For Normal eye it is found to be
0.3 to 0.5 [14] .The CDR value increases with the increase in neuro-retinal
degeneration and the vision is lost completely at the CDR value of 0.8. Several
methods of feature extraction from fundus images are reported in the literature [1, 3, 5,
6, 9, 10, and 11]. Techniques described in the literature for optic disk localization are

A. Abraham et al. (Eds.): ACC 2011, Part III, CCIS 192, pp. 365–373, 2011.
© Springer-Verlag Berlin Heidelberg 2011
366 M. Madhusudhan et al.

Fig. 1. Normal vision vs. patient having glaucoma Fig. 2. Major Structures of the ONH
where peripheral vision is lost.[7] visible in color fundus image

typically aimed at either identifying the approximate center of the optic disk or placing
the disk within a specific region such as a circle or square. Lalonde et al., uses canny
edge detector and Ghafar et al., uses Circular Hough-transform to detect the optic
disc(OD)[5][6]. By analyzing the various local maxima in the Hough space, one can
find the best fitting circular approximation of the optic disk. Walter and Klein uses
color space transformation and morphological filtering for optic disk localization. Here
luminance channel of hue-luminance-saturation color space is used for localizing optic
disk. Then thresholding is applied to locate locus of optic disk. Precise contour is
determined using green channel of RGB color space via watershed transformation. In
this method slight distortion occurs due to outgoing vessels or low contrast. Youssif et
al., detects OD by using the blood vessel's direction matched filter where a mask is
generated [1]. The mask labels the pixels belonging to the region of interest and
excludes the background for further processing. Then opening, closing and erosion are
applied respectively using small kernel to obtain final ROI. These methods are based
on exploiting the edge characteristics. These papers do not discuss about the glaucoma
progression or classification. Bock et al., uses the concept of principal component
analysis (PCA), bitsplines and fourier analysis for feature extraction and support vector
machine (SVM) classifier for glaucoma predication[3]. This method attains an
accuracy of 88 %. However different methods for features extraction and use of
classifiers make this system more complex. Our proposed methods for glaucoma
detection are simple, easy to implement and give favorable results.
In this paper three different image processing techniques namely multi-
thresholding, active contour model and region based segmentation methods are
proposed for detection of glaucoma. The comparative study of these proposed
techniques are done with respect to their approaches and results. The rest of this paper
is organized as follows. Section 2 introduces all the three methods for glaucoma
detection. Experimental results are shown in Section 3 and conclusions are presented
in Section 4.

2 Proposed Methods for Glaucoma Detection

In this section, we discuss our work on retinal image analysis for glaucoma detection.
We have developed a scheme for automated processing and classification of the
acquired images based on the usual practice in the clinic. Fig. 3 shows our proposed
 Image Processing Techniques for Glaucoma Detection 367

system which follows a standard 3-step image analysis pipeline consisting of (i)
preprocessing; (ii) segmentation of preprocessed image and (iii) classification based
on evaluation of CDR. Three different techniques i.e. multi thresholding, active
contours and region growing methods are applied for the segmentation of pre-
processed fundus image in order to detect the disease by computing CDR.

Fig. 3. Processing pipeline in detail: glaucoma risk calculation comprises of steps: (i)
Preprocessing of input images for eliminating disease independent variations, (ii) Segmentation
of preprocessed image and (iii) Classification based on CDR for generating Glaucoma Risk
Index (GRI)

2.1 Pre Processing

The variations not related to the glaucoma disease are excluded from the images in a
preprocessing step for emphasizing the desired characteristics. This includes
variations due to image acquisition, such as inhomogeneous illumination and the
blood vessels which are not directly linked to glaucoma. The main objective of
preprocessing is to attenuate image variation by normalizing the original retinal image
against a reference model or data set for subsequent viewing, processing or analysis
[12]. The preprocessing retinal images may be classified in terms of the correction for
non-uniform illumination, contrast enhancement and color normalization.

2.1.1 Illumination Correction

The peripheral part of the retina often appears darker than the central region because
of the curved retinal surface and the geometrical configuration of the light source and
camera. These interferences affect the illumination of the ONH and would have an
influence to the subsequent statistical analysis, though they are not originated through
glaucoma [3]. Homogeneously illuminated fundus image is obtained by subtracting
the estimated retinal background from the original image. Various techniques for
illumination correction like morphological operations, homomorphic filtering and
median filtering have been published in the literature [13]. We implemented a
correction method based on morphological operations as it has certain advantages
over other techniques. The benefits of this technique over linear approaches include
direct geometric interpretation, simplicity and efficiency in hardware implementation
[14]. Uniformly illuminated image is obtained by subtracting the estimated
background image from original image. Morphological opening is used to estimate
the background illumination. Fig.4 shows the different steps needed to obtain an
illumination corrected image. Original fundus image (i) is first converted into grey
image (ii) and then background is estimated (iii). Image obtained from subtracting
(iii) from (ii) is added with fixed dc level to get the final illumination corrected image
shown in (v).
368 M. Madhusudhan et al.

(i) (ii) (iii) (iv) (v)

Fig. 4. Result of illumination correction using morphological operations

2.1.2 Blood Vessels Removal

Blood vessels are minimally affected by glaucoma disease; hence blood vessels need
to be removed from the fundus images [15]. Blood vessel removal consists of two
steps: (i) extraction of blood vessels and after that (ii) inpainting of extracted blood
vessels. Image inpainting is the technique of filling in a region of an image based on
the information outside the region [16]. The major blood vessel branches rising from
the ONH hide large portions of the rim and their existence makes analysis of the
visible parts of the ONH more difficult [3]. This can hinder the accurate segmentation
of OD. Therefore, inpainting technique is applied to remove these blood vessel
structures after the extraction blood vessels before further processing. The extracted
blood vessels act as a mask and the region covered by the mask is inpainted. In this
implementation, the vessel regions are filled iteratively layer by layer from outside
inwards while the missing pixels get a weighted average of the already known
neighboring values [17] [18]. Morphological operations are also used for removal of
blood vessels from fundus image. Morphological closing consisting of dilation
followed by erosion is applied to remove the blood vessels. Fig.5 shows the result of
morphological operations for blood vessels removal.

(a) Fundus image (b) Illumination corrected (c) Blood vessels removed

Fig. 5. Result of morphological operations for blood vessels removal

Inpainting technique gives better results in comparison to morphological

operations for blood vessels removal. However the major drawback of inpainting
technique lies in the fact that it requires extracted vessels as the mask and iterations
process increases the computational time.

2.1.3 Normalization of the ONH Region

Papilla (ONH) is the most important structure for observing changes in order to detect
glaucoma. It appears as an extremely bright, mostly circular region in fundus images.
The image obtained after blood vessels removal is normalized for better analysis.
 Image Processing Techniques for Glaucoma Detection 369

2.2 Segmentation from the Preprocessed Image

The preprocessed images are used for the segmentation of optic disc and cup which
helps in classification of glaucoma. In this subsection, the three different techniques
for glaucoma detection are discussed.

2.2.1 Multi-thresholding Technique

Multi-thresholding technique is one of the simplest methods and natural way to
segment cup and disc of preprocessed fundus image. The preprocessed image
containing the optic disc is converted to binary image and than multi-thresholding
technique is applied. This technique allows the detection of cup, the brighter region of
the optic disc with higher threshold value and the whole disc with lower threshold
value. Fig.6 shows the detection of optic disc and cup from preprocessed image for
glaucoma classification.

(a) Blood vessels removed (b) Optic disc detection (c) Cup detection

Fig. 6. Result of multi-thresholding for disc and cup detection

It has shown correct segmentation for 19 images out of 25 set of images. The
accurate segmentation was not possible for rest of 6 images as the optic disc and some
portions of background image have similar illumination level. The quality of original
images was also one of the reasons for improper segmentation. The major demerit of
the method is the manual thresholding based on the pixel intensity values. Hence
other techniques like active counter method based on adaptive thresholding and
region growing segmentation methods are applied for cup and disc segmentations
from the preprocessed fundus image for glaucoma classification.

2.2.2 Snakes: Active Contours Method

A snake is an energy minimizing spline guided by external forces and influenced by
image forces that pull it toward features such as lines and edges in order to localize
the object accurately [19]. Contours stops at nearby edges detecting the desired
boundary, where the external energy is the minimum. Classical snakes and active
contour models, uses an edge-detector, based on the gradient of the image, to stop the
evolving curve on the boundary of the desired object. However in practical situations,
the discrete gradients are bounded hence the stopping function is never zero on the
edges, and the curve may cross the desired boundary. Therefore, we have used a
different active contour model which is not based on the gradient of the image like
classical methods for the stopping process but is instead related to a particular
370 M. Madhusudhan et al.

segmentation of the image [20]. Fig.7 shows the results of successful implementation
of this technique, used in detecting cup and disc of fundus images for evaluation of
CDR, a measure for glaucoma detection.

Fig. 7. Results of Active contour methods for cup and disc detection

2.2.3 Region Growing Segmentation

Region growing is a an approach to image segmentation based on selecting initial
seed points and adding neighboring pixels to the region depending on certain feature
such as intensity value, color similarity[8]. In our proposed method the maximum
value in the green channel image serves as the seed for the region growing algorithm
to be employed in the cup identification. The neighborhood pixels are iteratively
connected if they fall below a certain threshold value. The centroid of the resulting
region is calculated and a disk is estimated that can circumscribe the entire region.
The radius of this estimated disk is noted as the radius of the cup. The area of the cup
is hence known. The disk is further grown outwards till the point when a sharp
intensity change is observed. This change marks the periphery of the disk and the
radius at this juncture is noted as the radius for the disk. Thus we have a disk whose
area is known. The ratio of area of cup to disk is evaluated and checked and if it falls
below the value of 0.5 the eye can be concluded as a healthy one. If however, the
value exceeds the limit, it is concluded to be defected with glaucoma. Experimental
results on a 25 number of images demonstrate the effectiveness of the technique.

3 Results and Discussions of Glaucoma Detection Techniques

Based on CDR Evaluation
The above discussed methods are applied to the publicly available Optic-disc
databases, which consist of normal and pathological fundus images. The criteria that
CDR for normal fundus images lies between 0.3-0.5 and is higher for glaucomous
fundus images are used for the classification. In this section we mainly focus on the
comparative approaches and results of the all three proposed systems namely multi-
thresholding, active contour methods and region based segmentation techniques used
for glaucoma classification.

3.1 Glaucoma Detection Based on Multi-thresholding

The processed image obtained as discussed earlier is used to determine the CDR by
finding the number of ones present in the cup region to that of number of ones in disc
 Image Processing Techniques for Glaucoma Detection 371

region of binary image. CDR of 25 fundus images downloaded from

www.opticdisc.org (7 normal and 18 abnormal images) is determined in order to
detect glaucoma. Efficiency of the proposed method in identifying true positive and
true negative is shown the column-I of the table-1. The performance measure of this
method with sensitivity (classify abnormal fundus images as abnormal) of 80% and
specificity (classify normal fundus image as normal) of 60 % is summarized in
column-I of table-2.

Table 1. Shows the comparative results of three methods namely (i) Multi-thresholding; (ii)
Active contours and (iii) Region growing segmentation

SL. Performance parameter Efficiency (percentage)

No. Method I Method II Method III
1 True Positive 88.89 94.44 100
2 True Negative 42.85 57.17 85.71
3 False Positive 11.11 5.56 0
4 False Negative 57.17 42.85 14.29

Table 2. Shows the comparative accuracy of three methods namely (i) Multi-thresholding; (ii)
Active contours and (iii) Region growing segmentation

SL. Accuracy parameter Efficiency (percentage)

No. Method I Method II Method III
1 Sensitivity 80 89.47 94.73
2 Specificity 60 83.33 100

3.2 Glaucoma Detection Based on Active Contour Method

Active contour method is applied for detecting the cup and disc from the preprocessed
fundus images as discussed in the subsection 2.2.2. Their effective radii are calculated
for evaluation of CDR needed for the classification. The obtained results are found to
be better in-comparison to multi thresholding technique as it is based on adaptive
thresholding. Efficiency of this method in identifying true positive and true negative
is shown the column-II of the table-I. The accuracy measure of this second proposed
method with sensitivity and specificity of 89.47 and 83.33 % respectively is
summarized in column-II of table-II.

3.3 Glaucoma Detection Based on Region Growing Segmentation Technique

Region growing segmentation technique is applied to estimate radius of cup and disc
from the pre processed fundus image as discussed in subsection 2.2.3. Like the other
two methods, CDR evaluation was the criteria for the classification of the disease.
The results obtained by this third proposed method are better compared to other two
mentioned techniques as it is based on clustering of homogeneous regions. It is able to
classify all eighteen abnormal images as abnormal but two images were misclassified
out of seven normal images. Efficiency of this method in identifying true positive and
372 M. Madhusudhan et al.

true negative is shown the column-III of the table-I. The performance measure of this
method with sensitivity and specificity of 94.73% and 100% respectively is
summarized in column-III of table-II.

4 Conclusion
In this paper, an efficient framework for early detection of glaucoma has been
developed. The CDR, an important glaucoma parameter of fundus images publically
available from messidor and optic data bases were evaluated using three different
methods namely morphological operations based on multi-thresholding techniques,
active contour models and region growing segmentation techniques. As a comparative
study to these methods for glaucoma classification, we observed that region growing
segmentation technique gives better result in comparisons to other two methods. The
proposed methods are simple and easy to implement. The results obtained can be used
as an initial investigation step in the automated diagnosis of glaucoma especially in
the screening programs. These proposed methods may further be combined with some
other techniques for achieving better results with large databases.

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