3rd International Conference on Advances in Electrical, Electronics, Information, Communication and Bio-Informatics (AEEICB17)
GAMES-Glaucoma Analysis and
Management using an Expert System
Jayashree Agarkhed1
Professor1
Computer Science and Engineering
Poojya Doddappa Appa College of Engineering
Kalaburagi, Karnataka-585 102, India.
jayashreeptl@yahoo.com
Abstract— As of late, Computer-rooted methods are
progressively used to revamp the quality of medical domain
services. There are a various PC pull techniques that are utilized
for the finding of eye maladies, for example, glaucoma, diabetic
retinopathy, and cataract and so on. However, these system are
independent programming with basic usefulness. An expert
system (ES) for the diagnosis of glaucoma disease is proposed
which uses databases of medical knowledge to offer advice or
make decisions. The GAMES is composed of knowledge base,
user interface and inference engine. The proposed medicinal
GAMES is utilized to analyze the glaucoma illness among the
patients. The diagnosis is done taking into account the symptoms
which can be felt or seen. The proposed GAMES will be
genuinely useful to the patients to secure the mandatory advice
about the glaucoma malady and can also ease the work of expert
or doctor in putting together the proper or suitable diagnosis of
patient.
Keywords—Glaucoma, knowledge base, inference engine,
Medical knowledge, Expert System.
I. INTRODUCTION
Glaucoma is a severe eye disease where the optic nerve
head is gradually damaged. Propelled glaucoma brings about
total visual deficiency. Around the world, Glaucoma is the
second driving base of visual deficiency, influencing 61
million humans by 2010, and accountable for estimated to 5.2
million instances of blindness [1].
In the late years, there is an expanding curiosity, for
the discovery of eye sicknesses, utilizing a robotized PC
frameworks. Be that as it may, these frameworks are normally
independent programming with fundamental capacities just,
restricting their use in an expansive scale. The consultation of
expert medical is exceptionally costly, scanty, yet judgmental
component of almost all health-care systems. Discussions
through PC frameworks utilizing the ability and information
of human specialists has dependably been recognized as an
urgent component for upgrading the way to deal with top
notch wellbeing administration. [2].
Reliability on the human specialist can be diminished
if his/her expertness can be relinquished into the computer-
978-1-5090-5434-3©2017 IEEE
Nabila Anam2
PG Scholar2
Computer Science and Engineering
Poojya Doddappa Appa College of Engineering
Kalaburagi, Karnataka-585 102, India
nabilaanam.work@gmail.com
based system. An ES is defined as system that brings in action
the expert knowledge, preserved in a computer to find a
solution problems that ordinarily require human expertness
[3]. ES hunts and uses related data from the accessible
learning base with a specific end goal to make advice [4]. ES
presents a more flexible and powerful method for acquiring
solutions to a diverse type of complications that ordinarily
cannot be dealt with by other means of, more traditional and
conservative methods. With the utilization of ES and its
associated applications, it is expanding quickly in a great deal
segments of our mechanical and social life.
An ES, sometimes called a Knowledge Base System
(KBS) is a computer application composed of discipline
particular knowledge of a numerous human experts. Expert’s
or the specialist’s task is automated through the use ES, which
rather required specialized skillfulness and also competence
training. For a number of applications, feature extricating is
done using the Rule-based method. It is to a great degree
supportive of building up the ES having the capacity and
processing abilities of PCs, so it can help specialist or
therapeutic professional with their analysis. By notifying the
doctor or medical practitioner about the unrealized
information requirements of a diagnosis, ES is the fate of an
extraordinary help to the specialist or therapeutic expert, by
making consistent the treatment and diagnostic process and
acts as a tutoring element with a detailed or brief information
concerned to causes, symptoms , analysis and treatment of
related malady. These sort of ES present better outcome for
difficulties which cannot be formalized especially adroit [5].
The rest of this article is organized as follows. Section
2 deals with the related work. Section 3 presents the system
design and architecture. Section 4 deals with the results and
discussion. Section 5 ends with the conclusion.
II. RELATED WORK
Broad Literature study has been done on programmed
examination and analysis of a few maladies and issues tended
to with the assistance of ES. The near investigation of
different existing reviews on fuzzy logic, rule based and
 3rd International Conference on Advances in Electrical, Electronics, Information, Communication and Bio-Informatics (AEEICB17)
artificial neural network based medical ES is given in table 2.
Deep research is carried out on the symptoms and causes of
the glaucoma malady.
At first open-point glaucoma does not demonstrate any
indications by any means. It causes no torment and
furthermore vision remains of course. Glaucoma can develop
in one or both eyes. Different side effects of Glaucoma
incorporate eye torment, vision misfortune, migraines, seeing
coronas around light. Everybody above 40 and having diabetes
can suffer from glaucoma. Another peril component of
glaucoma is having anomalous optic nerve anatomy or
elevated IOP (intraocular pressure).
Various generous reviews have demonstrated that eye
weight is an essential risk consider for harming of optic nerve.
Anterior chamber is a space in the front part of the eye. A
transparent liquid continues streaming all through the chamber
ceaselessly, in anterior chamber. This liquid clears through
chamber at an open point where the iris and cornea unite as
appeared in figure 1. Later on achieving the point the
transparent liquid keeps running along the light meshwork,
just similar to a drain, and after that ways out of the eye.
Fig 1: Pathway of the fluid in anterior chamber[6].
The transparent fluid travels too gradually through
the spongy meshwork deplete in the event of open-point
glaucoma, in spite of the way that waste edge is "open" [6],
which thusly causes the eye pressure increment to a degree
which may potentially harm the optic nerve. Vision
misfortune and open-glaucoma may happen because of the
harm created to optic nerve by an ascent in pressure. The most
acute risk components of glaucoma sickness incorporate Age
more than 40, hoisted/expanded eye pressure, and family
history of glaucoma, migraines, partial blindness, a thin
cornea, past wounds to the eyes, utilization of steroid. Since
the vision misfortune in glaucoma is lasting, it is imperative to
identify glaucoma at an early stage and back off the movement
utilizing proper treatment.
The author in [7] introduced a fuzzy ES for a location
of back torment ailment in light of exploratory intercession
manifestations utilizing some fuzzy standards. The parameters
like age, BMI (body mass record), exploratory examination
indications and gender of individual must be entered in by the
978-1-5090-5434-3©2017 IEEE
client for this fuzzy ES. The fuzzy master framework, in view
of these parameters, makes an attractive judgment of back
agony malady and after that gives a restorative medicine to the
patient.
A Rule-Based ES was introduced by author in [8] for
Neurological Disorders. More than 10 diverse kind of clutters
are dealt with by this framework. Patients can secure
suggestions for the strange issue assaults on their sensory
system. The information/master base incorporates information,
gathered from volumes and diverse professionals about the
neurology and its related issue.
In [9], the author constructed an ES to help soundness
of representatives working in jammed outpatient centers in
Egypt to make a speedy and ideal judgment. In this
framework, the therapeutic learning of around at least 300
noteworthy and minor regular maladies is encoded as
generation guidelines. These standards are requested in
accumulations as indicated by slightest seeming analytic and
side effects theories are concocted for the sicknesses most
anticipated that would reason these side effects. Once a
malady is recognized, suggestion is given for cure. The
framework will be evaluated in 10 outpatient facilities.
The author in [10] portrayed a computerized delivery
system for clinical guidelines (DSCG) that backings clinicians
in diagnosing and treating patient's anguish from trunk
torment. Determination of methodologies is done in a versatile
way from the learning based server which comprises of a huge
library of therapeutically characterized graphical proposals.
This framework acquires patient's data, for example, disease
and screening outcomes and matches the data with qualified
perspective. It proposes an appropriate treatment strategies and
furthermore examination in view of the most sensible
determination. Utilizing a savvy specialist, the experts or
therapeutic experts may either enact a determination to
analyze the recovering's condition amid the pharmaceutical or
utilize the recommendations as guidance.
The author developed an ES that urges sufferer with
malady conditions for reasonable investigation of a portion of
the eye sicknesses in [11]. The eye has dependably endured as
a passage to the internal workings of the body. A hefty portion
of the ailment states, typically starts indications from the eye.
CLIPS language is utilized as a gadget for creating ES. An
underlying examination of the ES was swoon and a good
response was perceived by the clients.
Medical ES are being utilized for malady conclusion
where the patient's side effects and different points of interest
are data sources and the framework analyze the ailment,
suggest treatment or medications which might be endorsed.
Utilizing an ES for glaucoma determination will adequately
teach healing center staff, clinicians and the community and
stretch out patient care and ability to remote regions and
furthermore enhance quiet care with portability arrangements.
Since glaucoma is an endless sickness, in which a dominant
part of cases requires a lifetime follow up. This puts a huge
strain on the ophthalmology centers. With the assistance of ES
this can be decreased.
 3rd International Conference on Advances in Electrical, Electronics, Information, Communication and Bio-Informatics (AEEICB17)

III. SYSTEM DESIGN AND METHODOLOGY If (CDR > 0.3 && < 0.5), Goto step 6.
An ES, otherwise called an information based framework, is a If (CDR > 0.5 && < 0.7), Goto step 7
PC program containing diagnostic aptitudes and master
learning of some human expert in a specific issue zone. The If (CDR > 0.7) goto step 8
objective of design of GAMES is, to store knowledge of an Step 6: Glaucoma not detected, have checkup every 2 months,
individual expert corresponding to Glaucoma disease and then Goto step 9.
code this in a computer in such that, knowledge of the
specialist/expert is available to a less proficient user. GAMES, Step 7: Optic nerve damaged, glaucoma detected, prescribe
a wise program that copies the conduct of a human master that Treatment procedure. Goto step 9.
has experience and information in glaucoma illness. Glaucomafnd  Prescribe (treatment)
Step 8: Optic nerve severely damaged, Glaucoma detected,
Prescribe treatment procedure.
Glaucomafnd  Prescribe (treatment)
Step 9: END.

The figure 3 shows the design of GAMES. Following are the

key components of expert system:

Core components of expert system

1
1 2a. Healthy Eye 2b. Glaucoma Infected Eye
(Normal Cup Size) (Enlarged Cup Size) 2 KNOWLEDGE
2 BASE
Fig 2: Effect of Glaucoma on CDR. USER
Optic disc (blue) and Optic cup (black) INFERENCE

BASIC MAJOR
INTER ENGINE

Amid glaucoma progression, the demise of ganglion -FACE ANALY ANALY

nerve cells regularly prompts to changes in the presence of the -SIS -SIS
optic nerve head, otherwise called optic disc. Specifically,
there is an extending and extension of the removal in the optic
circle, known as optic cup, as glaucoma advances, prompting
to an expansion in the cup to disc proportion (CDR) as
outlined in Fig. 2. Fundus picture of the Healthy eye is as Query
appeared in fig 2a. Looking at 2a1 and 2b1, the optic cup Advice
measure in 2b1 is expanded because of the harm of optic
nerve brought about by glaucoma ailment. CDR (the
measurement of the container separated by the distance across KNOWLEDE
of the entire nerve head or circle) is a noteworthy /DATA
consideration of clinicians in surveying glaucoma from direct USER FROM
perception. The calculation utilized for glaucoma conclusion EXPERT
performed on fundus picture is as delineated underneath. DOCTOR
---------------------------------------------------------------------------
Algorithm: GAMES Glaucoma Diagnosis. Fig 3: Design of GAMES.

Step 1: Upload Fundus Image.

Upload (Fimg) 1) KNOWLEDGE BASE
The core component of expert system is
Step 2: Perform segmentation on Fimg to obtain Optic Disc. Knowledge base. The rules and facts are represented
Seg (Fimg)  OD in information base. All the symptoms and causes of
Step 3: Perform segmentation on Fimg to obtain Optic Cup. the glaucoma malady is stored in the knowledge base
Seg (Fimg)  OC with appropriate treatment for the disease. All the
learning put away in it is right and genuine. Basic
Step 4: Calculate the optic cup to optic disk ratio. analysis and major analysis facts are stored in
Calculate (CDR)  OD/OC GAMES knowledge base.
Step 5: CDR Analysis. 2) USER-INTERFACE

978-1-5090-5434-3©2017 IEEE
 3rd International Conference on Advances in Electrical, Electronics, Information, Communication and Bio-Informatics (AEEICB17)
The user interface (UI) is used to offer a
channel of communication between non-user expert
and the computer. UI is the main channel and acts as
an interface between the user and Expert system.
GAMES user interface is simple to use for common
people.
3) INFERENCE ENGINE
The derivation motor nothing but inference
engine puts in application the principles to stored
facts to attract the deduction to new actualities.
Clarification and troubleshooting facility can be
incorporated into the Inference motors. The
deduction motor can likewise be looked as a
computerized thinking framework that gauges the
current situation with the information base, puts in
application the appropriate standards, and afterward
pronounces new learning into learning base. A
portion of the production rules that are utilized as a
part of the GAMES are as demonstrated as follows.
Rule 1:
If (eye_pain = ‘yes’ AND headache = ‘yes’ AND
blurred_vision = ‘yes’)
{Advice ‘Risk of Glaucoma’, stop}
Rule 2:
If (age>40 AND diabetes = ‘yes’)
{Advice ‘eye checkup every 2 months’, stop}
Rule 3:
If (age> 40 AND diabetes = ‘yes’ AND
fam_hist_glaucoma = ‘yes’)
{Advice ‘eye checkup every 2 months’, stop}
4) EXPERT KNOWLEDGE
Knowledge from the expert or specialist is
collected and stored in the knowledge base. This is
the crucial step in developing the ES, as the
knowledge collected from the expert doctor is used
for diagnosing of the glaucoma disease.
5) USER
User can be patient or an ophthalmologist
who uses the GAMES expert system for consultation
or diagnosis of glaucoma disease.
ES are computer programs which store the true and inferential
learning of human specialist in limited space. An itemized
dialog on medical ES and profound research on causes,
manifestations, and treatment for glaucoma are exhibited in
the following section.
978-1-5090-5434-3©2017 IEEE
IV. RESULTS AND DISCUSSION
The specialists or medical expert find it extremely hard to
comprehend all the known data which may be helpful for
making ideal therapeutic judgments because of the colossal
volume of existing medicinal learning and the quick increment
in information have brought about such circumstance,
shockingly even tough having done specialization. It is not
sudden, that factual work has exposed that specialist doesn't
reliably make ideal conclusions. As of now, it has been
acknowledged by all respects that PC supported medicinal
conclusion assembling framework, from analysis to patient
administration, may give an answer for a great part of the
trouble. Such ES are typically created planned to offer help
and not really supplant authority, giving a completing touch to
their characteristic capacities of making judgments using PC's
memory, handling abilities, and dependability [12]. The
utilization of medical ES is perfect answer for above.
A. Causes of Glaucoma.
An essential hazard components of
glaucoma illness include: Age more than 40,
raised/expanded eye pressure, and family history of
glaucoma, migraines, myopia, a thin cornea, poor
blood stream, past wounds to the eyes, utilization of
steroid, and history of extreme weakness or stun.
Less normal causes incorporate a limit or compound
harm to your eye, serious eye contamination, blocked
veins inside the eye, and incendiary conditions.
B. Symptoms of Glaucoma.
The most widely recognized manifestations
of glaucoma incorporate serious eye torment, Nausea,
spewing, redness in your eye, sudden vision
aggravations, seeing shaded rings or radiances
around lights, sudden obscured vision.
C. Treatment for Glaucoma.
The ophthalmologist will consider above
points of interest before choosing the treatment for
glaucoma or patient is ought to be seen all the time as
glaucoma suspect on the off chance that having
opportunities to inspire glaucoma to recognize the
underlying indications of harm to the optic nerve.
The treatment for glaucoma for the most part relies
on upon appearance and significance of each case.
Despite the fact that glaucoma can't be
cured, however it can be controlled utilizing eye
drops, laser methods, or pills and surgical operations
are utilized to keep or moderate going damage from
happening. The medicines that are utilized for
glaucoma are recorded in table 1. Steady eye check-
ups are exceptionally vital for all sort of glaucoma, to
analyze progression and to capture vision misfortune.
Since glaucoma can intensify without patient
monitoring it, patient’s treatment probably should be
changed after some time to accomplish a lower
"target eye pressure."
 3rd International Conference on Advances in Electrical, Electronics, Information, Communication and Bio-Informatics (AEEICB17)

finding and gauges the commitments made by specialists. A

TABLE 1: Treatment for Glaucoma couple of analysts have assessed their medicinal ES in various
clinics from the specialists and have recovered parameters like
Type Description
exactness and precision. These parameters of ES rely on upon
Eye Drops These either decrease the development of information base. The anxiety ought to be on learning
liquid in the eye or increment its procurement, where it is a phase in which information is
outpouring. gathered. Subsequently, the execution of framework relies on
Laser surgery This strategy can marginally expand the upon these variables.
stream of the liquid from the eye for
individuals with open-edge glaucoma. V. CONCLUSION
Trabeculoplasty Opens the outflow region. India is the second most populated nation and has more than 1
Iridotomy billion individuals. The effect of visual inability and visual
Makes a minor gap in the iris to let liquid deficiency from glaucoma is no doubt exorbitant. Glaucoma is
stream all the more openly. a long-standing eye ailment in which optic nerve head is step
Treats territories of the center layer of by step harmed. Propelled glaucoma prompts to an irreversible
Cyclophotocoagulation your eye to decrease liquid creation. visual deficiency. As lost abilities of the optic nerve can't be
Trabeculectomy The specialist makes another channel to recouped, early recognition and resulting treatment are basic
deplete the liquid and simplicity eye for influenced patients to protect their vision.
pressure. Current systems to analyze glaucoma is neither
particular nor sufficiently touchy to be a productive screening
apparatus. The proposed GAMES framework is a definitive
D. Types of Glaucoma. answer for the above issue. Making the knowledge and
There are a few glaucoma subtypes as shown in expertise of human specialists all the more generally
figure 4 underneath, albeit all are viewed as optic accessible through PC counsel framework i.e., GAMES goes
neuropathies. Glaucoma might be essential or auxiliary to about as a critical device for enhancing the entrance to
different conditions. Primary open-angle glaucoma (POAG) is fantastic social insurance. Utilizing GAMES will stretch
the most widely recognized sort of glaucoma, representing outpatient care and mastery to remote territories.
more than 70% of cases.
References
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distinct ESs in a particular zone, for example, medicinal

978-1-5090-5434-3©2017 IEEE
 3rd International Conference on Advances in Electrical, Electronics, Information, Communication and Bio-Informatics (AEEICB17)

[11] Samy S. Abu Naser, Abu Zaiter A. Ola, “An Expert System for
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TABLE 2: Categorization of medical expert systems.

Title Method Disease Advantages Disadvantages Accuracy

Diagnosed
The Diagnosis of Some Lung Rule based Lung This expert system contains Only symptoms entered in The system has
Diseases in a PROLOG Expert Expert Diseases. knowledge of 32 lung diseases. knowledge base are available. It 70% accuracy.
System[13] System. does not think & learn by itself.

Design and Implementation of Fuzzy Back This system is tested using The input, Body Mass Index 90% accuracy is
Fuzzy expert System of Back expert Pain. clinical data that corresponds to (BMI) to system is an extra achieved.
Pain Diagnosis[7] System 20 patients with different back burden.
pain diseases.
Artificial Neural Networks in Artificial Acute Reduction of diagnosis time. Considered only as a tool to 99% accuracy is
Medical Diagnosis[14] intelligence Nephritis The ability to process large facilitate the final decision of a achieved in
methods Disease. amount of data. clinician, who is ultimately diagnosis of Acute
responsible for critical evaluation Nephritis Disease.
of the ANN output.
The Diagnosis of Some Kidney Rule based Kidney Helps the doctor in making the Considered only limited number No experimental
Diseases in a PROLOG Expert Expert Disease. appropriate diagnosis of the of kidney diseases. results are found.
System [15] System. patient.

A Self Learning Knowledge Rule based Diabetes This system provides advice to Knowledge base should be kept Performance of
Based System for Diagnosis and expert Disease. physicians and patients to updating with new symptoms. the system is
Treatment of Diabetes [16]. system facilitate the diagnosis and 84.2% accurate.
treatment of diabetes.
GAMES- Glaucoma Analysis Rule based Glaucoma Using GAMES will extend Used to diagnose only glaucoma Experiments yet to
and management using Expert expert Disease patient care and expertise to disease. be performed.
System. system remote areas.

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