Automatic Detection of Exudates in Retinal Images

Using Histogram Analysis

Sharath Kumar P N , Rajesh Kumar R
Health Informatics and Software Technology Group
Centre for Development of Advanced Computing
Thiruvananthapuram, India
sharath_kumar_pn@yahoo.co.in
Dr. Anuja Sathar , Dr. Sahasranamam V
Department of Ophthalmology
Regional Institute of Ophthalmology
Thiruvananthapuram, India
anujasathar@gmail.com


Abstract Diabetic Retinopathy (DR) is the major cause of
blindness caused by the damage to the blood vessels in the retina
from diabetes. It cannot be prevented but early detection through
fundus imaging by an ophthalmologist can prevent further vision
loss. Presence of microaneurysms, hemorrhages, cotton-wool
spots and exudates are the symptoms of mild DR. Of these, the
detection of exudates is one of the important factors in the early
diagnosis of DR. Exudates are fatty deposits on the retina which
appear as yellowish regions in fundus image. Fundus images
show considerable variation in brightness which makes
automatic detection of exudates difficult. In this study, we are
proposing a new method for preprocessing and false positive
elimination towards the reliable detection of exudates. The
brightness of the fundus image was changed by the nonlinear
curve with brightness values of the hue saturation value (HSV)
space. To emphasize brighter yellow regions (exudates), gamma
correction was performed on each red and green components of
the image. Subsequently, the histograms of each red and green
component were extended. After that, the exudates candidates
were detected using histogram analysis. Finally, false positives
were removed by using multi-channel histogram analysis. To
evaluate the new method for the detection of exudates, we
examined 158 fundus images, including 84 abnormal images with
exudates and 74 normal images. The sensitivity and specificity for
the detection of abnormal and normal cases were 88.45% and
95.5% respectively.
Keywordsdiabetic retinopathy; fundus images; exudates;
histogram analysis; preprocessing; false positive elimination.
I. INTRODUCTION
In India, there are approximately 31.7 million patients with
diabetes and every year 1.7 million new patients with diabetes
are recorded [1]. Approximately 5.6 million are thought to
suffer from diabetic retinopathy (DR). This disease can be
detected and prevented from developing into blindness if it is
treated at an early stage. However, it has been recorded that
people losing their vision following the onset of DR are
increasing year by year. Retinal photographs obtained by the
fundus camera are used to diagnose DR. Ophthalmologists
examine the presence of hemorrhages, microaneurysms, and
exudates in order to diagnose DR. By using fluorescein
angiograms, ophthalmologist can detect changes in blood
vessels. However, it is difficult to use fluorescein as a contrast
medium for diagnosing all the medical examinees subjected to
mass screening.
In past, many studies have been reported on the use of
fundus images in the detection of DR [27]. Hatanaka et al.
proposed a CAD scheme for the detection of hemorrhages and
exudates in ocular fundus images [2]. Niemeijer et al. proposed
a method to describe and evaluate a machine learning-based
automated system to detect exudates and cotton-wool spots in
retinal photographs and differentiate them from drusen for
early diagnosis of DR [3]. Sopharak et al. presented a method
for detecting exudates using fuzzy C-means clustering [4].
Grisan et al. proposed a method for the segmentation of dark
lesions in fundus images based on local thresholding and pixel
density [5]. They reported a mean detection rate of 94% of the
lesions present in an image based on a dataset of 60 annotated
images. Yazid et al. proposed a method to sharpen the edge to
simplify the segmentation process for cotton wool spots and
exudates through ramp width reduction [6]. Xiaohui and Opas
have presented a two way strategy method for the detection of
lesions [7]. Based on different properties of bright lesions and
dark lesions, bottom-up and top-down strategies are applied
respectively to cope with the main difficulties in lesions
detection such as inhomogeneous illumination. In bright lesion
detection, a three-stage, bottom-up approach is applied. After
local contrast enhancement preprocessing stage, two step
Improved Fuzzy C-Means is applied in Luv color space to
segment candidate bright lesion areas. Finally, a hierarchical
SVM classification structure is applied to classify bright non-
lesion areas, exudates and cotton wool spots.
In the above methods, authors have also mentioned about
two problems along with the detection of exudates. One is the
wide variation in the brightness and image resolution other one
is the high percentage of false positives (FPs). Fig. 1 (a) and (b)
shows the typical fundus images without and with exudates
respectively. In this study, we also address these by developing
methods for fundus image normalization and FPs elimination.

Fig. 1. Typical fundus images. (a) Normal retina. (b) Retina having exudates.
2013 IEEE Recent Advances in Intelligent Computational Systems (RAICS)
978-1-4799-2178-2/13/$31.00 2013 IEEE 277
II. METHODS
A. Overall Scheme
Our overall detection scheme consists
(1) image acquisition, (2) image normalizati
of optic disc, (4) detection of exudates
elimination of FPs using multi-channel hi
Further details are described as follows.














Fig. 2. Flowchart for detecting exudates in fundus imag
B. Image acquisition
A dataset of 158 fundus images were
fundus camera. 89 fundus images were obta
size of 1,500 1,152 pixels and 24-bit color,
were obtained with an array size of 2,144
24-bit color and 29 fundus images were obta
size of 4,288 2,848 pixels with 24-bit
images were annotated by an ophthalmolog
89 fundus images were taken from the D
which was already annotated [8]. An example
image is shown in Fig. 3 (a). Subsequently
matrix was first standardized to 640 x 480 p
detailed subsamples from the original imag
processing efficiency.
C. Image normalization
Due to the flash light used in obtaining t
there is an atypical change in the color of th
To bring uniform change in the color of the f
applied a scheme of brightness correction us
value (HSV) space. First, the brightness va
space were calculated. Second, the calculate
was then smoothened using 9 x 9 median
global correction was performed on the smoo
value of HSV space and the finally ob
correction value Bc(i, j) is given by the follow
Bc(i, ]) = 1 - {I(i, ]) - 1
Image Acquisition
Image Normalization
Extraction of optic
disc
Detection of Exudates
Elimination of false
positives in optic disc
Finally detected
exudates
s of five stages:
ion, (3) extraction
s candidates, (5)
istogram analysis.
ges.
captured using a
ined with an array
, 40 fundus images
1,424 pixels with
ained with an array
color. 69 fundus
gist and remaining
Diaretdb1 database
e of a color fundus
y, the scale of the
pixels by obtaining
e data to improve
the fundus images,
he fundus images.
fundus images, we
sing hue saturation
alues of the HSV
d brightness value
n filtering. Lastly,
othened brightness
btained brightness
wing equation:
1]
2

Where V(i, j) is the smoo
HSV space.
Next, the red value R(i, j)
value B(i, j) were changed b
equally corrected from the ce
fundus image (as shown in Fig.
corrected by Bc(i, j) were then p
The gamma value was experim
Fig. 3 (c)). Finally, the histogra
image were extended (as show
color images were then conve
selecting only the green comp
which will have better contra
fundus images were standardize

(a)

(c)
Fig. 3. Color contrast enhancement.
Brightness of fundus image was c
brightness values of HSV space. (c
adjusted in the dynamic range. (d) G
green component.
D. Detection of optic disc and
The grayscale image obtain
to detect optic disc and exuda
exudates were then extracted
where the threshold values corr
disc were obtained. This is been
Before the exudates candid
understand the distribution of
lesions viz. hemorrhages, exuda
vessels and optic disc which oc
study analysis, intensity profile
hemorrhages being the darkest
vessels which is not as dark
exudates which appear more in
color and finally the brightest
intensity distribution of a fundu
corresponding to each one of th
hemorrhages and last peak bein
4 (a,d). This study knowledge
while looking for the intensity r
othened brightness value of the
), green value G(i, j), and blue
by Bc(i, j). The brightness was
enter to the skirt region of the
3 (b)). The color fundus images
processed by gamma correction.
mentally set to 0.5 (as shown in
ams of each red, green and blue
wn in Fig. 3 (c)). The corrected
erted into grayscale images by
ponent (as shown in Fig. 3 (d))
ast of the vascular details. The
ed by using these processes.

(b)

(d)
(a) Original color fundus image. (b)
hanged by the nonlinear curve with
c) Image after gamma correction and
Grayscale image obtained by selecting
exudates candidates
ned in the previous step was used
ates. Accordingly optic disc and
d using the histogram analysis
responding to exudates and optic
n described as follows.
dates are extracted, one should
intensity values of the different
ates and other objects viz. blood
ccur in a fundus image. From our
e of a fundus image starts with
lesions, second being the blood
k as hemorrhages, next is the
number having yellowish bright
being the optic disc. So, in the
us image one can find four peaks
he four objects with first peak for
ng for optic disc as shown in Fig.
is being utilized in our system
range of exudates and optic disc.
278

(a)
(b)
(c)
Fig. 4. Exudates detection approach. (a) Histogra
(c) Portions of optic disc d
(e) Optic disc candidate extraction from




(
(
(
am from green channel. (b) Exudate candidates along w
etected from green channel. (d) Histog
red channel. (f) Localization of optic disc

(d)

(e)

(f)
with optic disc candidate detection.
gram from red channel.
using binary filling operation.
279

(a)

(b)
Fig. 5. Elimination of false positives by combining the exudates detection from green channel and optic disc extraction from red channel. (a) Binary image
showing the finally detected exudates after eliminating false positives. (b) Detected Exudates outlined in the fundus image.
The exudates candidates were extracted with the help of the
threshold value chosen from the peaks in the histogram
obtained from the green component (as shown in Fig. 4 (a)). As
discussed earlier, we choose the third peak to extract exudates
candidates. With the chosen value, simple binary thresholding
is applied to the green component and the possible exudates
candidates were detected. Detected exudates are outlined as
shown is Fig. 4 (b).
Similarly, optic disc localization was performed by
thresholding the green component of the RGB color image.
Here, we choose the fourth peak to extract optic disc and the
threshold value corresponding to the fourth peak was obtained
from the histogram of the green component as shown in Fig. 4
(a). Due to the blood vessels present inside the optic disc
region, optic disc is not extracted in full but in small portions as
shown in Fig. 4 (c). The method to overcome this is explained
in the next stage.
E. Elimination of false positives using multi-channel
histogram analysis
While extracting exudates using automatically obtained
threshold value from histogram of the green component, few
candidates in the optic disc region will also be detected as
shown in Fig. 4 (b). In order to remove those falsely detected
exudates candidates, we use multi-channel histogram analysis
method.
Firstly, we obtain a threshold value from the peaks
corresponding to optic disc which is found from the histogram
of the red component as shown in Fig. 4 (d). Using this
threshold value, optic disc candidate is fully extracted as shown
in Fig. 4 (e). This is done by thresholding the red component to
the selected threshold value. The shape of the extracted optic
disc region is then approximated to a circle followed by a
binary filling operation. Here, approximation was done by
considering the average size of the optic disc obtained from our
image dataset. The fully extracted and outlined optic disc is as
shown in Fig. 4 (f). The idea of using the red component is
because optic disc being the brightest and dense object in the
fundus images. Also, from the section II.D we saw that
thresholding applied to the green component resulted in multi-
object optic disc detection as shown in Fig. 4 (c) instead of
single-object identification from the red component as shown
in Fig. 4 (f). This is due to the blood vessels present in the optic
disc. In nature, blood vessels are dark which cant be found
from green component. But with the red component, optic disc
can be found fully as the intensities of optic disc and blood
vessels will be more saturated. While extracting we made sure
that only optic disc candidates will be detected. This is done
with the help of binary opening operation.
Secondly, we make use of the exudates detected by
thresholding the green component as obtained in section II.D.
Finally, using the optic disc and exudates (including
candidates in optic disc) pixel informations obtained from red
and green component respectively, candidates in the optic disc
which presented as false exudates are removed. This is done by
binary filtering operation considering the fully extracted optic
disc as a mask. Fig. 5 (a) shows the finally detected exudates
from the fundus image and Fig. 5 (b) shows the outlining of
finally detected exudates.
III. RESULTS
The contrast of exudates in the images was enhanced. The
color of the processed image was standardized by the
histogram normalization method. However, if the fundus image
has some laser marks, the marks are changed brighter and more
obscure than the original color pixel.
A dataset of 158 fundus images having three different
resolutions was used for the experiment. The images were
obtained from two different sources and have sufficient
variations in color, illumination and quality. These included 69
images acquired in a diagnostic examination at the Regional
Institute of Ophthalmology (RIO), Thiruvananthapuram, India
and 89 images taken from the Diaretdb1 database [8].
The images in the dataset were classified by an
ophthalmologist as abnormal or normal image based on the
280
presence or absence of exudates respectively. Of the 69 images
obtained from RIO, 22 were normal and 47 were abnormal.
The Diaretdb1 database contained 37 normal and 52 abnormal
images.
Here, to evaluate our method of detecting exudates, we
examined 158 fundus images. Exudates were detected in 74 out
of 84 images with actual exudates and only 4 false positives
were detected in the 74 images without exudates. By using our
scheme, we succeeded in obtaining satisfactory results with a
sensitivity of 88.45% (74/84) and specificity of 95.5% (70/74).
Our method could remove as many FPs. However, our method
could not detect approximately 10% of exudates. The main
reason was that exudates that were not well focused became
undetected.
Table I summarises the results of our method for three data
sets captured under three different resolutions. Table I also
gives sensitivity (SN) and Specificity (SP) individually for the
three data sets. Elimination of incorrectly detected exudates
was done based on the method of finding the thresholds from
the histograms of red and green channels.
In Table II, the sensitivity and specificity results of our
exudates detection algorithm are presented along with other
published results from in the literature. Here, the comparison
has been made with the results claimed by the respective
authors and the image datasets used for their studies which are
different from ours and from one another. Even though the
result (Specificity) claimed by Sopharak et al [4] are higher
than our proposed method; their method was validated for only
10 images.


TABLE I. ACCURACY DETAILS OF OUR SYSTEM

Data set
Type of
Image
Diagnosed
Images
Correctly
Identified
Images

Accuracy
(%)
1
(1500 X 1152)
DR
Normal
37
52
32
49
SN = 86.48
SP = 94.23
2
(2144 X 1424)
DR
Normal
27
13
24
12
SN = 88.88
SP = 92.3
3
(4288 X 2848)
DR
Normal
20
9
18
9
SN = 90
SP = 100


TABLE II. COMPARISON OF RESULTS FOR EXUDATES DETECTION
Author No. of
Images
No. of Images
with exudates
SN
(%)
SP
(%)
Hatanaka et al. [2] 109 16 77 83
Niemeijer et al. [3] 300 105 95 86
Sopharak et al. [4] 10 DNP* 86.86 99.55
Our Method(Single
channel)
158 84 88.45 91
Our Method(Mutli
channel)
158 84 88.45 95.5
DNP* - data not provided in the paper
IV. CONCLUSION
In this study, a new method for automatic detection of
exudates in the digitized fundus images using multi-channel
histogram analysis is presented. This method can be applied to
the computer-aided diagnosis (CAD) system for diagnosing
eye diseases. The accuracy of the method was evaluated
against the ground-truth annotated by the expert
ophthalmologists. It was demonstrated that the algorithm can
detect abnormalities related to the DR with high accuracy and
reliability. The result of this work on exudates detection in the
fundus images demonstrated that the efficiency and accuracy of
the diagnosis of the DR can be considerably improved using
computer aided detection methods. In the future, the integrated
fundus image analysis scheme will be further improved and
more clinical cases will be reported for evaluating its accuracy.
The techniques employed in our study will help in improving
diagnostic accuracy as well as in improving the workflow
efficiency of the DR screening. Our next focus will be to
develop a full fledged automated system to detect other
symptoms of mild DR viz. microaneurysms, hemorrhages and
cotton-wool spots which will help in assisting
ophthalmologists.
ACKNOWLEDGEMENT
The Department of ophthalmology, Regional Institute of
Ophthalmology (RIO), Thiruvananthapuram provided us with
the required set of fundus images. The ophthalmologists and
domain experts from RIO were consulted for gaining domain
knowledge and for the verification and establishment of ground
truth for the experiment.
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