Enhancing Ophthalmological Diagnoses: An Adaptive Ensemble Learning Approach Using Fundus and OCT Imaging

Age-related macular degeneration (ARMD) is one of the most common retinal syndromes that occurs in elderly people. Different eye testing techniques such as fundus photography and optical coherence tomography (OCT) are used to clinically examine the ARMD-affected patients. Many researchers have worked on detecting ARMD from fundus images, few of them also worked on detecting ARMD from OCT images. However, there are only few systems that establish the correspondence between fundus and OCT images to give an accurate prediction of ARMD pathology. In this paper, we present fully automated decision support system that can automatically detect ARMD by establishing correspondence between OCT and fundus imagery. The proposed system also distinguishes between early, suspect and confirmed ARMD by correlating OCT B-scans with respective region of the fundus image. In first phase, proposed system uses different B-scan based features along with support vector machine (SVM) to detect the presence of drusens and classify it as ARMD or normal case. In case input OCT scan is classified as ARMD, region of interest from corresponding fundus image is considered for further evaluation. The analysis of fundus image is performed using contrast enhancement and adaptive thresholding to detect possible drusens from fundus image and proposed system finally classified it as early stage ARMD or advance stage ARMD. The proposed system is tested on local data set of 100 patients with100 fundus images and 6800 OCT B-scans. Proposed system detects ARMD with the accuracy, sensitivity, and specificity ratings of 98.0, 100, and 97.14%, respectively.

Early prediction and timely diagnosis of ocular diseases are of great significance for preventing vision loss and improving patients' quality of life. However, many eye diseases exhibit atypical symptoms in their early stages, leading to delays in clinical diagnosis and consequently postponing treatment opportunities, which may worsen the condition. Artificial intelligence (AI), particularly deep learning, has provided novel solutions for the automated detection and prediction of ophthalmic diseases. Methods such as convolutional neural networks (CNNs), transfer learning, generative adversarial networks (GANs), recurrent neural networks (RNNs), attention mechanisms, and interpretable deep learning have been widely applied in the analysis of fundus and optical coherence tomography (OCT) images. These approaches could extract subtle features that are difficult to capture using traditional techniques, achieving outstanding performance in the diagnosis and grading of diseases such as diabetic retinopathy, glaucoma, and macular degeneration. Therefore, a systematic analysis of the current applications and development trends of AI‐based methods in ocular disease prediction, along with a discussion of their advantages, limitations, and future improvement directions in alignment with clinical needs, will provide valuable insights for advancing intelligent diagnostic research and practice in retinal diseases.

Age-related macular degeneration (ARMD) is a degenerative eye disease among people over the age of 50. This disorder affects the retina and macula of the eye. The macula is the central part of the retina. The function of the macular region is to give a sharp and clear vision. ARMD is mainly identified by the presence of yellow deposits called drusen and the structural changes in the retinal pigment epithelium (RPE) layer of the retina. If ARMD is not identified at an early stage, it will lead to permanent blindness. The ARMD is mainly diagnosed using Color fundus and Optical coherence tomography (OCT) images of the retina. OCT is an imaging technique that makes use of low-coherence light to capture two-and three-dimensional images from within optical scattering media. OCT images usually are at a micrometer resolution, affected by a noise called speckle noise. If speckle noise is present in an OCT image, diagnosis of ARMD is very difficult, irrespective of whether it is manually or automatically. So, removal of speckle-noise is significant for the accurate diagnosis and early detection of ARMD. In this paper, we evaluate the performance of eight popular image noise reduction filters for its ability to remove speckle noise in terms of different performance measures on a publicly available OCT dataset. Our evaluation shows that, out of the filters selected for assessment, a fast non-local mean filter outperforms all other filters regarding all the performance measures used.

RETRACTED: Deep learning network (DL-Net) based classification and segmentation of multi-class retinal diseases using OCT scans

Deep learning models assist ophthalmologists in early detection of diseases from retinal images and timely treatment. Owing to robust and accurate results from deep learning models, we aim to use convolutional neural network (CNN) to provide a non-invasive method for early detection of eye diseases. We used a hybridized CNN with deep learning (DL) based on two separate CNN blocks, to identify multiple Optic Disc Cupping, Diabetic Retinopathy, Media Haze, and Healthy images. We used the RFMiD dataset, which contains various categories of fundus images representing different eye diseases. Data augmenting, resizing, coping, and one-hot encoding are used among other preprocessing techniques to improve the performance of the proposed model. Color fundus images have been analyzed by CNNs to extract relevant features. Two CCN models that extract deep features are trained in parallel. To obtain more noticeable features, the gathered features are further fused utilizing the Canonical Correlation Analysis fusion approach. To assess the effectiveness, we employed eight classification algorithms: Gradient boosting, support vector machines, voting ensemble, medium KNN, Naive Bayes, COARSE- KNN, random forest, and fine KNN. With the greatest accuracy of 93.39%, the ensemble learning performed better than the other algorithms. The accuracy rates suggest that the deep learning model has learned to distinguish between different eye disease categories and healthy images effectively. It contributes to the field of eye disease detection through the analysis of color fundus images by providing a reliable and efficient diagnostic system.

.Significance: Automatic and accurate classification of three-dimensional (3-D) retinal optical coherence tomography (OCT) images is essential for assisting ophthalmologist in the diagnosis and grading of macular diseases. Therefore, more effective OCT volume classification for automatic recognition of macular diseases is needed.Aim: For OCT volumes in which only OCT volume-level labels are known, OCT volume classifiers based on its global feature and deep learning are designed, validated, and compared with other methods.Approach: We present a general framework to classify OCT volume for automatic recognizing macular diseases. The architecture of the framework consists of three modules: B-scan feature extractor, two-dimensional (2-D) feature map generation, and volume-level classifier. Our architecture could address OCT volume classification using two 2-D image machine learning classification algorithms. Specifically, a convolutional neural network (CNN) model is trained and used as a B-scan feature extractor to construct a 2-D feature map of an OCT volume and volume-level classifiers such as support vector machine and CNN with/without attention mechanism for 2-D feature maps are described.Results: Our proposed methods are validated on the publicly available Duke dataset, which consists of 269 intermediate age-related macular degeneration (AMD) volumes and 115 normal volumes. Fivefold cross-validation was done, and average accuracy, sensitivity, and specificity of 98.17%, 99.26%, and 95.65%, respectively, are achieved. The experiments show that our methods outperform the state-of-the-art methods. Our methods are also validated on our private clinical OCT volume dataset, consisting of 448 AMD volumes and 462 diabetic macular edema volumes.Conclusions: We present a general framework of OCT volume classification based on its 2-D feature map and CNN with attention mechanism and describe its implementation schemes. Our proposed methods could classify OCT volumes automatically and effectively with high accuracy, and they are a potential practical tool for screening of ophthalmic diseases from OCT volume.

AimsTo investigate the efficacy of a bi-modality deep convolutional neural network (DCNN) framework to categorise age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) from colour fundus images and optical...

Retinal diseases become more complex for people at any age. In the early stages, many people suffering from retinal diseases have very mild symptoms. It is observed that retinal diseases mainly damage the blood vessels that cause the leakage of fluid. The accretion of fluid can impact the retina and cause vision changes. Retinal diseases such as diabetic retinopathy (DR), age-related macular degeneration (AMD), diabetic macular edema (DME), drusen, and choroidal neovascularization (CNV) are complex diseases that show a huge impact on human retinal health. If the patients are not detected with retinal diseases in the early stages, this may lead to permanent vision loss. These diseases have a lot of other side effects, such as brain disorders. Prevention of these diseases may stop permanent vision loss in patients. Machine learning (ML) algorithms are most widely used to detect retinal diseases in their early stages. The main disadvantage of ML is that these algorithms will take more time to process the data and select complex methods. In this paper, deep learning (DL) algorithms are discussed, and various optical coherence tomography (OCT) datasets are used for experiments. Experimental results show the performance of various ML and DL approaches applied to OCT and retinal image datasets. The performance and comparison of various algorithms is also discussed in this paper.

High-Definition and 3-dimensional Imaging of Macular Pathologies with High-speed Ultrahigh-Resolution Optical Coherence Tomography

In developed countries, age-related macular degeneration (AMD), a retinal disease, is the main cause of vision loss in the elderly. Optical Coherence Tomography (OCT) is currently the gold standard for assessing individuals for initial AMD diagnosis. In this paper, we look at how OCT imaging can be used to diagnose AMD. Our main aim is to examine and compare automated computer-aided diagnostic (CAD) systems for diagnosing and grading of AMD. We provide a brief summary, outlining the main aspects of performance assessment and providing a basis for current research in AMD diagnosis. As a result, the only viable alternative is to prevent AMD and stop both this devastating eye condition and unwanted visual impairment. On the other hand, the grading of AMD is very important in order to detect early AMD and prevent patients from reaching advanced AMD disease. In light of this, we explore the remaining issues with automated systems for AMD detection based on OCT imaging, as well as potential directions for diagnosis and monitoring systems based on OCT imaging and telemedicine applications.

We previously developed a technique to acquire a SLO (scanning laser ophthalmoscope) like fundus intensity image from the raw spectra measured with spectral-domain optical coherence tomography (OCT), the same spectra used to generate a 3D OCT data set. This technique offers simultaneous fundus and OCT images and, therefore, solves the problem of registering a cross sectional OCT image to fundus features. However, the registration of high density OCT images is still an unsolved problem because no useful fundus image can be generated from the high density scans. High density OCT images can significantly improve the image quality and enhance the visualization of retinal structure, especially the structure of small lesions. We have developed a feature-based algorithm, which can register a high density OCT image on the fundus image generated from normal density scans. The algorithm was successfully tested for both normal and diseased eyes.

Age-related macular degeneration (AMD) is a complex eye disorder affecting millions worldwide. This article uses deep learning techniques to investigate the relationship between AMD, genetics and optical coherence tomography (OCT) scans. The cohort consisted of 332 patients, of which 235 were diagnosed with AMD and 97 were controls with no signs of AMD. The genome-wide association studies summary statistics utilized to establish the polygenic risk score (PRS) in relation to AMD were derived from the GERA European study. A PRS estimation based on OCT volumes for both eyes was performed using a proprietary convolutional neural network (CNN) model supported by machine learning models. The method's performance was assessed using numerical evaluation metrics, and the Grad-CAM technique was used to evaluate the results by visualizing the features learned by the model. The best results were obtained with the CNN and the Extra Tree regressor (MAE = 0.55, MSE = 0.49, RMSE = 0.70, R2 = 0.34). Extending the feature vector with additional information on AMD diagnosis, age and smoking history improved the results slightly, with mainly AMD diagnosis used by the model (MAE = 0.54, MSE = 0.44, RMSE = 0.66, R2 = 0.42). Grad-CAM heatmap evaluation showed that the model decisions rely on retinal morphology factors relevant to AMD diagnosis. The developed method allows an efficient PRS estimation from OCT images. A new technique for analysing the association of OCT images with PRS of AMD, using a deep learning approach, may provide an opportunity to discover new associations between genotype-based AMD risk and retinal morphology.

Retinal disease classification is a significant problem in computer-aided diagnosis (CAD) for medical applications. This paper is focused on a 4-class classification problem to automatically detect choroidal neovascularization (CNV), diabetic macular edema (DME), DRUSEN, and NORMAL in optical coherence tomography (OCT) images. The proposed classification algorithm adopted an ensemble of four classification model instances to identify retinal OCT images, each of which was based on an improved residual neural network (ResNet50). The experiment followed a patient-level 10-fold cross-validation process, on development retinal OCT image dataset. The proposed approach achieved 0.973 (95% confidence interval [CI], 0.971-0.975) classification accuracy, 0.963 (95% CI, 0.960-0.966) sensitivity, and 0.985 (95% CI, 0.983-0.987) specificity at the B-scan level, achieving a matching or exceeding performance to that of ophthalmologists with significant clinical experience. Other performance measures used in the study were the area under receiver operating characteristic curve (AUC) and kappa value. The observations of the study implied that multi-ResNet50 ensembling was a useful technique when the availability of medical images was limited. In addition, we performed qualitative evaluation of model predictions, and occlusion testing to understand the decision-making process of our model. The paper provided an analytical discussion on misclassification and pathology regions identified by the occlusion testing also. Finally, we explored the effect of the integration of retinal OCT images and medical history data from patients on model performance.

Microaneurysms (MAs) are pathognomonic signs that help clinicians to detect diabetic retinopathy (DR) in the early stages. Automatic detection of MA in retinal images is an active area of research due to its application in screening processes for DR which is one of the main reasons of blindness amongst the working-age population. The focus of these works is on the automatic detection of MAs in en face retinal images like fundus color and Fluorescein Angiography (FA). On the other hand, detection of MAs from Optical Coherence Tomography (OCT) images has 2 main advantages: first, OCT is a non-invasive imaging technique that does not require injection, therefore is safer. Secondly, because of the proven application of OCT in detection of Age-Related Macular Degeneration, Diabetic Macular Edema, and normal cases, thanks to detecting MAs in OCT, extensive information is obtained by using this imaging technique. In this research, the concentration is on the diagnosis of MAs using deep learning in the OCT images which represent in-depth structure of retinal layers. To this end, OCT B-scans should be divided into strips and MA patterns should be searched in the resulted strips. Since we need a dataset comprising OCT image strips with suitable labels and such large labelled datasets are not yet available, we have created it. For this purpose, an exact registration method is utilized to align OCT images with FA photographs. Then, with the help of corresponding FA images, OCT image strips are created from OCT B-scans in four labels, namely MA, normal, abnormal, and vessel. Once the dataset of image strips is prepared, a stacked generalization (stacking) ensemble of four fine-tuned, pre-trained convolutional neural networks is trained to classify the strips of OCT images into the mentioned classes. FA images are used once to create OCT strips for training process and they are no longer needed for subsequent steps. Once the stacking ensemble model is obtained, it will be used to classify the OCT strips in the test process. The results demonstrate that the proposed framework classifies overall OCT image strips and OCT strips containing MAs with accuracy scores of 0.982 and 0.987, respectively.

HTC-retina: A hybrid retinal diseases classification model using transformer-Convolutional Neural Network from optical coherence tomography images