The tessellation of the retina is of clinical importance, especially in the study of myopia. This paper presents an automated grading algorithm for tessellation based on the calculation of three Tessellated Fundus Indices (TFIs). Our new algorithm utilizes the red (R), green (G), and blue (B) color components of the region of interest (ROI) surrounding the fovea in fundus images to determine the degree of tessellation, categorized into grades 0, 1, and 2. Excessive brightness in fundus images can result in overexposure, which in turn can introduce inaccuracies when calculating TFI values in the region of interest (ROI) using the red, green, and blue (R, G, B) components. Prior to calculating the TFIs, the method applies luminosity and contrast variation correction to the fundus images automatically. This correction process is achieved through a series of steps: first, applying row-wise and column-wise 1-dimensional low-pass filtering (1DLF); then, computing the luminosity surface by subtracting the smoothed image from the original grayscale image. To maintain luminosity consistency, the original image channels are equalized using the luminosity surface, followed by histogram stretching for enhanced contrast. Finally, the algorithm computes B/R (Blue/Red) and G/R (Green/Red) ratios for each pixel in the original image and multiplies them by the red channel of the contrast-stretched image. The proposed algorithm was evaluated on a dataset of 60 fundus images from varying degrees of myopia, demonstrating its effectiveness in grading tessellation accurately. The automated approach streamlines the grading process, offering potential benefits in clinical settings and facilitating large-scale screenings for myopic eyes.
There has been considerable progress in implicit neural representation to upscale an image to any arbitrary resolution. However, existing methods are based on defining a function to predict the RGB value from just four specific loci. Relying on just four loci is insufficient as it leads to losing fine details from the neighboring region(s). We show that by taking into account the semi-local region leads to an improvement in performance. In this paper, a new technique called Overlapping Windows on Semi-Local Region (OW-SLR) is applied to an image to obtain any arbitrary resolution by taking the coordinates of the semi-local region around a point in the latent space. This extracted detail is used to predict the RGB value of a point. We illustrate the technique by applying the algorithm to the Optical Coherence Tomography-Angiography (OCT-A) images and show that it can upscale them to random resolution. This technique outperforms the existing state-of-the-art methods when applied to the OCT500 dataset. OW-SLR provides better results for classifying healthy and diseased retinal images such as diabetic retinopathy and normals from the given set of OCT-A images. The project page is available at https://rishavbb.github.io/ow-slr/index.html
It is estimated that by the year 2050, approximately 50.0 % of the world’s population will be myopic. It has been suggested that the thickening sub-foveal choroidal thickness (SFChT) is a precursor for reduced eye growth and slowed myopia progression. Hence, it is highly important to identify structural changes, during myopia management. Literature suggests that the SFChT show short-term changes and has been proposed as an ocular marker for many ocular conditions including pathological myopia. A major limitation to its use is that none of the commercially available instruments give a direct measure of SFChT. This paper describes a new semi-automated method for quantification of the SFChT using ocular biometry. This image processing method is used on healthy pediatric myopes to quantify the SFChT. Both axial length (AXL) and SFChT were quantified from a 2-D A-scan graph generated from an ocular biometer (ARGOS, Aichi, Japan). An experienced clinician manually selected three peak points corresponding to anterior corneal, retinal, and choroidal peaks which were used as the input to the algorithm. Using the pixel properties, the overall AXL was calculated by subtracting the distance between the anterior corneal and retinal peak. Similarly, the SFChT was calculated as the distance difference between retinal and choroidal peaks. These calculated values were compared with a standard clinical method. The intraclass correlation coefficient ICC showed a good (κ=0.79, CI: 0.63 – 0.87) agreement between the methods. Similarly, the Bland-Altman plot showed a good agreement (The mean difference between the two methods was -21.28 μm) with a wide limit of agreement (LOA: 79.08 & -121.64 μm). Compared to SS-OCT method and new-semi automated method, there is significant overestimation of SFChT (p<0.001). However, there is moderate agreement between these two methods.
Quantum machine learning by superposition and entanglement, for disease categorization utilizing OCT images will be discussed in this paper. To the best of our knowledge, this is the first application of the quantum computing element in a neural network model for classifying ophthalmological disease. The model was built and tested with PennyLane (PennyLane.ai), an open-source software tool based on the concept of quantum differentiable programming. The model training circuit functioning was tested on an IBM 5 qubits system “ibmq_belem” and a 32 qubits simulator “ibmq. qasm_simulator”. A hybrid quantum and classical model with a 2 qubit QNode converted layer with operations such as Angle Embedding, BasicEntanglerLayers and measurements were the internal operations of the qlayer. Drusen, Choroidal neovascularization (CNV), and Diabetic macular edema (DME) OCT images formed the abnormal/disease class. The model was trained using 414 normal and 504 abnormal labelled OCT scans and the validation used 97 and 205 OCT scans. The resulting model had an accuracy of 0.95 in this preliminary 2-class classifier. This study aims to develop a 4-class classifier with 4 qubits and explore the potential of quantum computing for disease categorization. A preliminary performance analysis of quantum Machine Learning, the steps involved, and operational details will be discussed.
Optics concepts are fundamental to optometry. Currently, there is no published data on the status of conceptual optics among Indian optometrists. The results indicate the need for optics continuing education throughout their career.
One of the leading causes of irreversible vision loss is Diabetic Retinopathy (DR). The International Clinical Diabetic Retinopathy scale (ICDRS) provides grading criteria for DR. Deep Convolutional Neural Networks (DCNNs) have high performance in DR grading in terms of classification evaluation metrics; however, these metrics are not sufficient for evaluation. The eXplainable Artificial Intelligence (XAI) methodology provides insight into the decisions made by networks by producing sparce, generic heat maps highlighting the most critical DR features. XAI also could not satisfy clinical criteria due to the lack of explanation on the number and types of lesions. Hence, we propose a computational tool box that provides lesion-based explanation according to grading system criteria for determining severity levels. According to ICDRS, DR has 10 major lesions and 4 severity levels. Experienced clinicians annotated 143 DR fundus images and we developed a toolbox containing 9 lesion-specified segmentation networks. Networks should detect lesions with high annotation resolution and then compute DR severity grade according to ICDRS. The network that was employed in this study is the optimized version of Holistically Nested Edge Detection Network (HEDNet). Using this model, the lesions such as hard exudates (Ex), cotton wool spots (CWS), microaneurysms (MA), intraretinal haemorrhages (IHE) and vitreous preretinal haemorrhages (VPHE) were properly detected but the prediction of lesions such as venous beading (VB), neovascularization (NV), intraretinal microvascular abnormalities (IRMA) and fibrous proliferation (FP) had low specificity. Consequently,this will affect the value of grading which uses the segmented masks of all contributing lesions.
Optic disc tilt (ODT), increased ovality, peripapillary atrophy, and abnormally large or small optic discs are the earliest known reported changes in myopic eyes. Studies of these early changes may lead to a better understanding of the pathophysiology of myopia progression. The study aims to investigate if there is a relationship between the ODT and ovality in myopes. ODT. The ovality index was quantified in myopic eyes (n=33) and compared with 21 emmetropic eyes. The myopic OCT images were labelled based on a severity scale as low-moderate (between -0.50 D to -6.00 D SE) and high-myopia (worse than -6.00 D SE) using standard myopia classifications. From segmented OCT images of the optic nerve head, the optic disc boundary was extracted by traversing all the pixels of the image and selecting only those pixels with an intensity value lower than 30 in all 3 color channels. Then, an ellipse was fit to the extracted optic disc boundaries using an automated image processing method. From these the long and short axes of the ellipses were measured. Using this measurement ODT and ovality were calculated. Higher ODT was observed with the shorter axis in low-moderate myopic eyes 18.15 (IQR 15.83 – 23.81) and smaller ODT was observed in the high-myopic eye’s longer axis 11.83 (IQR 7.20 – 14.39). A significantly altered ovality index was observed with increase in degree of myopia.
The foveal avascular zone (FAZ), as visualized by optical coherence tomography angiography (OCTA), has distinct parametric characteristics. These metrics can help us understand FAZ variations in various ophthalmic conditions such as diabetic retina, retinopathy of prematurity, glaucoma, and pathological myopia. One of the several factors that influence the accuracy of these measures is the eye's axial length (AXL). Even though the OCTA is designed to image the retina with a standard AXL of 23.95 mm, there is considerable variation even in normal healthy eyes; for example, the average Indian's AXL is 23.34 ± 1.12 mm, which would result in retinal image magnification changes It has been reported that, if the FAZ area is not corrected for AXL, there can be up to a 51.0 % deviation in the measured parameters. Bennett's correction (and variations) are commonly employed to determine axial magnification. This study compares the effects of magnification in emmetropic Indian eyes with and without Bennett's correction. The FAZ dimensions were measured in healthy normal Indian subjects with a mean ± SD of 27.38 ± 11.62 years, AXL 23.40 ± 0.88 mm, and mean spherical equivalent of 0.08 ± 0.24 D using a newly designed automated image processing approach. Our results indicate no need to correct axial length variations over a 23.18 to 24.01 mm range in emmetropic eyes. This implies that any AXL longer than 24.01 mm and smaller than 23.18 mm may require axial magnification correction to precisely measure FAZ parameters.
The Foveal Avascular Zone (FAZ) is of clinical importance since the retinal vascular arrangement around the fovea changes with retinal vascular diseases and in high myopic eyes. Therefore, it is important to segment and quantify the FAZs accurately. Using a novel location-aware deep learning method the FAZ boundary was segmented in en-face optical coherence tomography angiography (OCTA) images. The FAZ dimensions were compared the parameters determined using four methods: (1) device in-built software (Cirrus 5000 Angioplex), (2) manual segmentation using Image J software by an experienced clinician, and (4) the new method (new location-aware deep-learning method). The parameters were measured from OCTA data from healthy subjects (n=34) and myopic patients (n=66). For this purpose, FAZ location was manually delineated in en-face OCTA images of dimensions 420x420 pixels corresponding to 6mm x 6mm. A modified UNet segmentation with an additional channel from a Gaussian distribution around the likely location of the FAZ was designed and trained using 100 manually segmented OCTA images. The predicted FAZ and the related parameters were then obtained using a test dataset consisting of 100 images. For analysis, two strategies were applied. The segmentation of FAZ was compared using the Dice coefficient and Structural Similarity Index (SSIM) to determine the effectiveness of the proposed deep learning method when compared to the other three methods. Furthermore, to provide deeper insight, a set of FAZ dimensions namely area, perimeter, circularity index, eccentricity, perimeter, major axis, minor axis, inner circle radius, circumcircle radius, the maximum and minimum boundary dimensions, and orientation of major axis were compared between the 3 methods. Finally, vessel-related parameters including tortuosity, vessel diameter index (VDI) and vessel avascular density (VAD) were calculated and compared. The high myopic eyes exhibited a narrowing the FAZ area and perimeter. The currently developed algorithm does not correct for axial length variations. This analysis should be extended with a larger number of images in each group of myopia as well as correcting for axial length variations.
Age-related Macular Degeneration (AMD) is a progressive, irreversible retinal disorder, and one of the leading causes of severe visual impairment or even blindness in the elderly population. The choroid plays a vital role in the pathophysiology of AMD. It is known that abnormal choroidal blood flow leads to retinal photoreceptor dysfunction and eventual death. We propose a new automated algorithm that can be used to quantify choroidal thickness (CT) from Optical Coherence Tomography (OCT) images of the retina. This thickness evaluation procedure includes image contrast enhancement, localization around the fovea centralis, segmentation of Retinal Pigment Epithelium (RPE) and choroidal layer, followed by CT measurement at multiple locations in the sub-foveal region at intervals of 0.5 mm on both nasal and temporal sides up to a distance of 1 mm from the center of the foveal pit. The horizontal radial scan OCT images (Cirrus 5000, Carl Zeiss Meditec Inc., Dublin, CA) of both healthy and AMD patients were used to measure the CT using the new algorithm. The statistical tests convey that the CT of AMD patients is relatively smaller than the normal condition. Furthermore, t-Test conducted between the proposed approach and clinical approach of extracting CT measurements confirm that the proposed method is in good agreement with the clinical measurements. On an average, the thickness of the choroid is found to be 0.32 ± 0.10 mm for the normal category and 0.21 ± 0.06 mm for the AMD category, in the central sub-foveal region, as obtained from the proposed automatic CT measurement method. The clinical significance and the results of automated choroid extraction are discussed in this paper.
The Pupillary Light Reflex (PLR) refers to the change in pupil size due to changes in illumination. The PLR is used by clinicians for the non-invasive assessment of the pupillary pathway. Typically, Infrared (IR) illumination based pupillometers are used to measure the PLR. Researchers have explored the problem of robust pupil detection and reconstruction with algorithms based on traditional computer vision techniques. These techniques do not generalize well when tested with visible light (VL) images. The current study presents a novel approach to pupillometry that uses deeplearning (DL) methodology which is applied to VL images. We used public iris datasets (e.g., UBIRISv2) and data augmentation techniques to train our models for robustness. Noise in the images can be due to different lighting conditions, iris colors, pupil shapes, etc. Ellipses were fit to the pupil images and the parameters were extracted. We evaluated a UNet model and its quantized version. A. non-deep learning model (PuRe) was also evaluated. This study also reports the accuracy of these models with real-world experimental data. This work is the first step toward a VL smartphone-based pupillometer that is fast, accurate, and relies on on-device computing. Such a device can be useful in areas where internet access is unavailable and, more importantly, can be used in the field by paramedics for telemedicine purposes.
Retinal vasculature is affected in many ocular conditions including diabetic retinopathy, glaucoma and age-related macular degeneration and these alterations can be used as biomarkers. Therefore, it is important to segment and quantify retinal blood vessel characteristics (RBVC) accurately. Using a new automated image processing method applied to optical coherence tomography angiography (OCTA) images we computed the RBVC and compared them between emmetropic (n=40) and ametropic (n=97) subjects. All 137 OCTA images had dimensions of 420x420 pixels corresponding to 6mm x 6mm. The myopia OCTA images were labelled based on a severity scale as mild, moderate, high and very high using standard refractive error classifications. Before image processing, all the images were cropped to 210 X 210 pixels keeping the foveal avascular zone (FAZ) at the centre to quantify the RBVC. The mean ± standard deviation of the Grisan index, a measure of retinal blood vessel tortuosity in the emmetropic, and myopic eye were 0.05 ± 0.02 and 0.05 ± 0.03 respectively. The total vessel distance measures were calculated and the largest were found in emmetropic eyes (45.95 ± 19.54) and shortest in myopic eyes (6.50 ± 5.17). The total number of turning points and inflection points were found to be statistically significant (p<0.05) between control and myopic eyes. However, other RBVC parameters were not statistically different (p=<0.05). We found qualitatively that RBVC changes with increasing severity of the refractive power. Among RBVC parameters, average number of turning points (NTP) decreasing trend with degree of myopia increases.
Optic disc tilt (ODT), peripapillary atrophy (PPA), and abnormally large or small optic discs are the earliest known changes in myopic eyes and may precede the development of pathological myopia. Increasing ODT and distance between the macula and optic nerve head have been reported as being associated with progressive myopia. Therefore, it is important to segment and quantify the ODT accurately. Using a newly developed automated image processing method we measured the ODT in both myopes and emmetropes. We determined the ODT from myopic eyes (n= 90) and compared the results with emmetropia (n=14). All 104 optical coherence tomography (OCT) images had dimensions of 200x200 pixels corresponding to 6mm x 6mm. The myopic OCT images were labeled based on a severity scale based on the spherical error (SE) as low (-0.5 to -3.00 D SE), moderate (-3.12 to -6.00 D SE), high (-6.12 to -9.00 D SE), and very high (worse than -9.00 D SE) using standard myopia classifications. Each OCT image was segmented by a clinician (CEM) and by the newly proposed method (NAM). The NAM used 8-bit grayscale OCT images which was preprocessed by applying Gaussian blur and Contrast Limited Adaptive Histogram Equalization based thresholding to remove noise and locate regions of interest. Then the images were split into two halves to fit straight lines separately. Morphological erosion and dilation were performed on the images to remove artifacts. They were tested with three combinations of erosion and dilation iterations. Univariate linear regression Lines were fit to trace the white band on each half and angle between the lines was determined. Both the methods showed higher horizontal ODT than vertical. The mean ± SD horizontal ODT (in degrees) in the myopic eye was 18.47 ± 7.67 and 15.84± 6.61 by the NAM and CEM methods. The vertical ODT in the myopic eyes (in degrees) was 16.32 ± 7.10, and 14.52 ± 7.05 by the NAM and CEM methods respectively. However, the NAM showed a maximum difference (2.26 ± 5.68) between horizontal and vertical ODT. The study results show that the ODT in very high myopic eyes (26.33±8.99)is significantly different (p<0.05) when compared to emmetropic eyes (19.47±3.99).
Uniform and quantitative grading of retinal vessel characteristics are replacing subjective and qualitative schemes. However clinically accurate blood vessel extraction is very important. The tortuosity of these vessels is an important metric to study the curvature variations in normal and diseased eyes. In this study we provide a new unsupervised and fully automated approach for studying curvature variation of the blood vessels. We then pro- vide tortuosity quantification of these extracted vessels. In this study we used optical coherence tomography angiographic fundus images of dimensions 420x420 pixels corresponding to 6mm x 6mm were used in this study. We focused on the central circular 210x210 pixel region around the foveal avascular zone (FAZ) for tortuosity quantification. Our segmentation approach starts with a 3mm x 3mm central circular region extraction surrounding the FAZ. We then use a multi-scale, multi-span line detection filter to smoothen out the high noise in the background and at the same time increase the intensity of target vessels. This is followed by a K-means procedure to filter out the noise and target vessels into two categories. Next steps are morphological closing and noise removal and iterative erosion of pixels to skeletonize the vessels. The final extracted vessels are of the form of single pixel piecewise continuous fragments. These are finer than human annotations and at the same time free of noise. We then provide accurate standard tortuosity measures - Distance Measure, Inflection Points, Turning Points, etc. for these OCTA images using the extracted vessels through mathematical modelling.
The Foveal Avascular Zone (FAZ) is of clinical importance since the vascular arrangement around the fovea changes with disease and refractive state of the eye. Therefore, it is important to segment and quantify the FAZ accurately. Studies done to date have achieved reasonable segmentation but there is a need for considerable improvement. In order to test and validate newly developed automated segmentation algorithms, we have created a public dataset of these retinal fundus images. The 304 images in the dataset are classified into: diabetic (107), myopic (109) and normal (88) eyes. The images were classified by a clinical expert and include clinical grading of diabetic retinopathy and myopia. The images are of dimensions 420 x 420 pixels (6mm x 6mm of retina). Both clear and manually segmented by a clinical expert (ground truth) images are available (608 total images). In these images, the FAZ is the green region marked in manually segmented image. The images can be used to test newly developed techniques and the manual segmentation images can be used as a ground truth for making performance comparisons and validation. It should also be noted there are only a few studies using supervised learning to segment the FAZ and this dataset will potentially be useful for machine learning training and validation. The image database, The Foveal Avascular Zone Image Database (FAZID) dataset can be accessed from the ICPSR website at the University of Michigan (https://doi.org/10.3886/E117543V2).
The Foveal Avascular Zone (FAZ) is of clinical importance since the vascular arrangement around the fovea changes with disease and refractive state of the eye. Therefore, it is important to segment and quantify the FAZs accurately. Here we provide a new methodology for this measurement. Eighty normal fundus images of dimensions 420x420 pixels corresponding to 6mm x 6mm were used in this study. Each fundus image was manually segmented by a clinical expert (ground truth), the new methodology and an existing technique provided by the image acquisition device (Cirrus 5000 Carl Zeiss Meditec Inc., Dublin, CA). The images were first processed by a Difference of Gaussian (DoG) filter iteratively 25 times after being complemented. This is followed by a Prewitt edge detection and repeated image dilation at angles of 0,45 and 90 degrees. Image closure was then applied followed by noise and small object removal which resulted in the segmented boundary. For deeper insight into shape change, besides the diameter of the FAZ other parameters - eccentricity, perimeter, major axis, minor axis, incircle, circumcircle, Fmin, Fmax, tortuosity, vessel diameter index and vessel avascular density - were calculated. The mean diameter by manual segmentation was 673.04 ± 86.92 μm compared to 688.42 ± 72.18 μm by our technique. The corresponding value generated by the instrument was 623.60 ± 121.50 μm. This technique shows considerable improvement in accuracy (the mean value as well as the standard deviation) when compared to system segmentation and the ground truth. These aspects will be discussed in the paper.
To quantitatively describe and evaluate a new image processing technique for estimating the Foveal Avascular Zone (FAZ) in subjects with Diabetic Retinopathy and myopes. From a total of 328 images obtained from Diabetic Retinopathy (113), myopes (120) and normal (93), the FAZ dimensions were quantified using a new image processing algorithm. These parameters were also determined manually and by the OCT manufacturer’s inbuilt algorithm. In the new technique, the images were first pre-processed by using a DOG filter iteratively before being complemented followed by a Prewitt edge detection and repeated image dilation at angles of 00, 450 and 900. Image closure was then applied followed by noise and small object removal which resulted in the segmented boundary. For deeper insight into shape change, in addition to the diameter of the FAZ other parameters such as the area, diameter, major axis, minor axis, orientation, perimeter vessel avascular density (VAD), Vessel diameter Index (VDI), etc. were obtained. The circularity index was calculated using the FAZ area and perimeter parameters. The mean FAZ diameter (mm) by the new automated technique, manual-segmentation (ground truth), and inbuilt instrument algorithm were 0.67 ± 0.87, 0.67 ± 0.72 and 0.61 ± 0.14. The mean of FAZ area (mm2) was 0.36 ± 0.10, 0.33 ± 0.09 and 0.43 ± 0.14 in normal, myopia and diabetic subjects respectively. The new technique shows considerable improvement in accuracy (mean ± SD) when compared to the inbuilt system segmentation and the ground truth (manual marking by an expert clinician). The study results show that the FAZ area in Diabetic Retinopathy is significantly different (p=0.003) when compared to myopic eyes (p=0.016) and normals.
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