DarkNet-19 based Decision Algorithm for the

Diagnosis of Ophthalmic Disorders

Zainoor Ahmad Choudhry
Department of Biomedical Engineering
Technology
University of Engineering and
Technology, Taxila
Taxila, Pakistan
zainoorah15@gmail.com
Hira Shahid
Department of Biomedical Engineering
Technology
University of Engineering and
Technology, Taxila
Taxila, Pakistan
ihiramalik170@gmail.com
Syed Zohaib Hassan Naqvi
Department of Electronics
Engineering, University of Engineering
and Technology Taxila
Taxila, Pakistan
zohaib.naqvi@uettaxila.edu.pk

Sumair Aziz Muhammad Umar Khan

Department of Electronics Engineering
University of Engineering and
Technology, Taxila
Taxila, Pakistan
sumair.aziz@uettaxila.edu.pk
Department of Electronics Engineering
University of Engineering and
Technology, Taxila
Taxila, Pakistan
sa.umarkhan@gmail.com

Abstract— Retinal diseases are identified by conducting
different medical examinations primarily of which are visual
examinations. One of the key issues in the visual diagnosis of
diseases is the human error due to poor decision making, for
that, an upcoming interdisciplinary technology named
computer-aided medical diagnostic system provides precise
detection and prediction of disease. In our proposed
methodology, images were treated with Contrast Limited
Adaptive Histogram Equalization, and deep features were then
extracted from the enhanced images. ADASYN was also
applied to acquire a balanced dataset. Support Vector Machine
classifier was used which yielded a mean accuracy of 93.8%.
Keywords—Artificial intelligence, retinal diseases, deep
features, CLAHE, CNN, ADASYN
I. INTRODUCTION
Over the past few years, researchers have turned their
attention to improving automatic disease recognition.
Automatic detection is a technology with a broad range of
applications, and as such has attracted considerable attention
from researchers in the last few years. A fully automated
artificial intelligence approach using deep learning
techniques for automated classification of medical images
has been utilized in this project. AI incorporates minimal
human being involvement to accomplish a task. We can say
that AI is the kind of human intelligence simulated in a
machine. When exposed to a dataset of interest, the system
first learns and then trains itself to classify disease thus
possessing cognitive abilities. The system becomes more
efficient and accurate upon improving. The widespread
presence of blindness and vision impairment among all
ethnic and racial groups is increasing rapidly with age,
specifically beyond the age of 75 [1]. The pervasiveness of
ocular disorders is posing a consequential economic
affliction to healthcare systems and patients. Vision
impairment is now considered a major worldwide health
concern accounting for a loss of normal vision and hence
sinking life quality. Eye diseases like diabetic retinopathy,
Cataract, glaucoma, and age-related macular degeneration
are common among people aged 40 years and older [2]. As
these diseases get worse over time, a vision of the human eye
gradually decays. Early diagnosis is obligatory to avoid
complete blindness.
In recent years, a considerable amount of work has been
done in the field of Artificial Intelligence-based
Ophthalmology. In [3], a deep transfer learning method was
used to classify OCT images of age-related macular
degeneration (AMD)and diabetic macular edema (DME).
The system yielded an accuracy of 98.6%. In [4], a system
was designed to classify fundus images of diabetic
retinopathy (DR) Glaucomatous optic neuropathy (GON)
using CNN.V. Bellemo et al. [5] used an ensemble AI model
consisting of a combination of two convolutional neural
networks to classify DR and DME and the accuracy obtained
was 97.3% and 94.2% DR and DME respectively. In [6],
age-related macular degeneration (AMD) was diagnosed
using deep convolutional neural networks yielding an
accuracy of approximately 89%.G. Lim et al. [7] designed a
system to recognize Ischemic stroke prediction using a 19-
layer VGGNet architecture and yielding an accuracy of
96.6%. In [8], an asymmetric keratoconus (AKC) detecting
system from OCT images with an accuracy of 100% was
designed. H. Takahashi et al. [9] proposed a system for
diagnosing DR from colored fundus images using
GoogLeNet deep learning neural network Fleiss’ kappa
(PABAK) and yielding an accuracy of 81% and 96%
respectively. U. Schmidt-Erfurth et al. [10] devised a system
for detecting age-related macular degeneration (AMD)
neovascularization (CNV) or the dry type with geographic
atrophy (GA) using OCT images and imaging, demographic,
and genetic input features. This system showed a
performance of 0.68 and 0.80 for CNV and GA. In [11], a
Diabetic Retinopathy detecting system using fundus images
was presented. This system deployed CNN and yielded a
specificity of 92% and the positive predictive value was
12%. E. Long et al.[12] presented a system for diagnosing
congenital cataracts using a deep convolutional neural
network and deep-learning algorithms to create CC-Cruiser.
The system showed an accuracy of 98.87%.In [13], A total of
75 137 publicly available fundus images from diabetic
patients were used to train and test an artificial intelligence
model to differentiate healthy fundi from those with DR.
learned features from the global average pooling layer are
extracted, yielding 1024 features. These features were used
to construct a visualization heatmap and to generate a final
image diagnosis through second-level classification models.
The proposed methodology requires a clear photograph of
eye from which the chromatic and spatial property of the

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sclera and iris is extracted. We used various classifiers of
which adaboost classifier which was found to give a
substantially high accuracy i.e., about 95% accuracy when
compared to others k-NN and naive-Bayes [14]. This
research will focus on applying novel machine learning
algorithms to automatic analysis of both digital fundus
photographs and OCT in Moorfields Eye Hospital NHS
Foundation Trust patients. All patients attending Moorfields
Eye Hospital NHS Foundation Trust sites between
01/01/2007 and 31/01/2017, and who had digital retinal
imaging (including fundus digital photographs and OCT) as
part of their routine clinical care, will be eligible for
inclusion in this study [15]. The experiment conducted
employing the top two pretrained convolutional neural
network (CNN) models on ImageNet. Furthermore, various
performance improvement techniques were employed, i.e.,
fine-tune, optimization, and contrast enhancement.
Maximum accuracy of 88.3% was obtained on the VGG16
model [16]. CNN, VGG16, and InceptionV3 neural network
structures are compared singly and together using a bagging
ensemble, to diagnose eye diseases. All experiments were
applied and the result was obtained. It has been shown that
using a bagging ensemble yields better predictive efficiency
than can be obtained using learning algorithms alone [17].
[18] devised an ophthalmic disease recognition system using
a Convolutional neural network (CNN) after the dataset has
been enhanced by Contrast-limited adaptive histogram
equalization (CLAHE), labeled and augmented. The
accuracy of this system was 80.5%. In [19], and ocular
disease detecting system using AUBNet and ResNet for
feature extraction is proposed. Feature fusion is performed by
either Summation, Concatenation, or Multiplication and the
highest accuracy of 93.4% is yielded using ResNet-101.In
the proposed method, the ODIR-5k dataset was used,
preprocessing included image enhancement using CLAHE.
Feature extraction was done using DarkNet-19 and the
features extracted were then fed into k-Nearest Neighbors
(KNN) classifier after doing class balancing by ADASYN
which yielded an accuracy of 86.1% and Area Under Curve
(AUC) equal to 98%.
II. METHODS AND MATERIALS
Figure 1 shows the overview of our system. The first
stage is the acquisition of the publicly available ODIR-5K
dataset and training the dataset of the images. Based on
distinctive features of images, different diseases are
identified. The foremost requirement for this system was to
design it in a way so that it classifies a maximum number of
eye-related diseases with the least complex methodology. We
were successful in achieving this objective. After extensive
experimentation, the best results were obtained by first
enhancing the original raw images so that the regions of
interest were more prominent and visible. This task was
performed by using one of the most effective image
enhancement tools, Contrast Limited Adaptive Histogram
Equalization (CLAHE). After the images were preprocessed
and enhanced by the above-mentioned technique, the next
step involved feature extraction. In our proposed system,
deep features were extracted using the Neural Network,
DarkNet-19. To balance out the classes, the Adaptive
Synthetic (ADASYN) algorithm was applied to the feature
file. This feature file was then fed into a machine learning
classifier, Cubic SVM classifier, and 10-fold cross-validation
was applied. This proposed system yielded the best accuracy
and Area Under Curve (AUC) values.
A. Data Acquisition
The dataset used in this project is called Ocular Disease
Intelligent Recognition (ODIR-5k). It is a publicly available
dataset of colored fundus images collected at different
hospitals in China. The dataset contains fundus images of
both eyes of 5000 patients with eight different labels as
Normal (N), diabetes (D), Glaucoma (G), Cataract (C), Age-
related Macular Degeneration (A), Hypertension (H),
Myopia (M) And Other Diseases/Abnormalities (O). The
images are taken using a fundus camera that is used to take
images of the retina of the eye. It has a built-in camera,
magnifier, and a light source and the images taken can be
viewed on any display device. In our proposed system, a total
of seven classes were used. The other diseases/abnormalities
(O) class was excluded as it included all sorts of images of
different diseases and images that had noise [20].
B. Preprocessing
After the acquisition of the publicly available data, the
next step was to perform preprocessing of the images to
make the most suitable for further experimentation and to
obtain the best results. Image enhancement was done to
amplify the regions of interest of the images which were to
act as the classifying factors for each class. Hence the
enhancement of images directly affected the results and
efficiency of the system. Contrast Limited Adaptive
Histogram Equalization (CLAHE) was applied to the raw
images and the output showed much-enhanced images. In
global histogram equalization, the grayscales of the whole
image are re-mapped to obtain a uniform histogram. This
process is performed with the assumption that the image has
a uniform quality. But in many cases, this assumption does
not hold. For such cases, Adaptive Histogram equalization is
used, which divides up the image into several regions and
histogram equalization is applied on each region based on its
neighboring grayscale values. CLAHE is also a type of
adaptive histogram equalization most suitable for fundus
retinal images. The image is divided into corner regions,
border regions, and inner regions and then a clip limit is set
so that the resultant histogram does not exceed a specific
height. The resultant pixel of each region is the linear result
of a combination of its four nearest regions [21]. Fundus
retinal images when treated with CLAHE, the features are
enhanced and the noise due to uneven illumination is reduced
[22]. In our system, the image was divided into 8 rows and 8
columns, and the clip limit was set at 0.005. The above-
selected parameters yielded the best results as shown in
Figure 2.
C. Feature Extraction
For feature extraction, a convolutional neural network
(CNN) called DarkNet-19 was used. A CNN consists of a
combination of convolution layers, pooling layers, fully
connected layers and softmax layers. When a CNN is used as
a feature extractor, as in our case, the convolution layers and
pooling layers are of utmost importance [23]. DarkNet-19 is
a pre-trained CNN consisting of a total of 64 layers. In our
proposed method, the ‘pool5’ layer, which is a pooling layer,
was used for feature extraction. It is the 45th layer of the
deep network and yielded a total of 512 deep features.
D. Adaptive Synthetic (ADASYN) algorithm
After feature extraction, the next task was to have a
perfectly balanced dataset. Originally, there was a large
difference between different classes with Diabetic
retinopathy having a total of 1551 samples and Hypertensive
retinopathy having the minimum number of classes i.e., 126.
Diabetic Retinopathy acted as the majority class and the rest
of the classes were minority classes. The minority class was
brought on a level with the majority class to avoid any biased
classification ass the classifier tends to become more
sensitive towards the majority class [24]. For this purpose,
ADASYN was used. This algorithm works by first
calculating the degree of imbalance and then calculating the
amount of synthetic data that needs to be generated for the
minority class. The synthetic data is generated until the
minority data comes at par with the majority data so that no
bias occurs during the classification stage [25].
classifying features using pre-trained CNN DarkNet-19.
These features were fed into a Machine learning classifier
and an accuracy of 93.8% and an error rate of 6.2% was
obtained using Cubic SVM classifier. The area under the
curve was also obtained which came out to be 100%. Other
classifiers were also experimented with but they yielded less
satisfactory results. These classifiers and their resulting
accuracies and error rates are shown in Figure 3. The best
results were obtained using the ‘pool5’ layer of Darknet19.
However, the ‘conv17’ layer was also experimented with and
an accuracy of 92.6% was obtained. Some experimentation
was also done by using the fusion of deep features and time
and frequency domain features and the maximum accuracy
obtained through this was 93.4% with 522 features. A
number of validation techniques were used during
experimentation. The method used for the validation of our
results was 10-fold cross-validation. In this technique, the
dataset is divided into 10 subsets, 9 of which are used for
training, and 1 is used for testing. The final results were
obtained using 512 deep features on 7 classes and using a 10-
fold cross-validation technique. The confusion matrix is
shown below to give a detailed view of true positive and true
negative classes in Figure 4.

E. Classification:
After feature extraction and application of ADASYN, the
feature dataset was fed to different classifiers and using 10-
fold cross validation in which the dataset is divided into 10
subsets, 9 of which are used for training and 1 is used for
testing. Different classifiers were used but the highest
accuracy was yielded by Cubic SVM. Support vector
machine (SVM) is widely used for biomedical imaging
classification and is considered as a most effective and
efficient method in machine learning [26] Kernel-based
SVM classifier works in way of segmenting data into
different groups that are equal to the number of classes in a
dataset by finding hyperplane that differentiates between
various data points and maximizing variance for multi-class
distinction [27]. Linear SVM and SVM with other kernels
were being experimented however, based on results
computed cubic SVM(C-SVM) outperformed others with an
accuracy of 93.8%, an error rate of 6.2%, and an area under
curve AUC value of 100% was achieved. This technique
showed the best results as compared to all the previous
researches.
III. RESULTS AND DISCUSSIONS
The suggested architecture of the AI-based ocular disease
recognition system first performs preprocessing and image
enhancement using the CLAHE technique and extract
 IV. CONCLUSION
The fundamental objective of this project was to design
an intelligent system capable of the identification of eye
disorders early so that treatment can be done and blindness
caused by it can be avoided due to delayed detection and
analysis. Our motive was to make a system that could
classify and diagnose a maximum number of ophthalmic
diseases. For this purpose, a publicly available dataset called
ODIR-5k was used that had data of six diseases i.e., Diabetic
Retinopathy, Glaucoma, Cataract, Age-related Macular
Degeneration, Hypertensive Retinopathy, Myopia, and
normal retinal fundus images. Preprocessing was done using
CLAHE and deep features were extracted using the DarkNet-
19 neural network. These features were then fed into the
SVM-C classifier which yielded an accuracy of 93.8% and
an AUC of 100%. Our proposed system provided efficient
results in detecting a total of seven classes as compared to
preciously presented works which had either a smaller
number of classes or lower results. This system cannot be
regarded as a fully advanced system as the technology is
ever-growing and changing. Like every system, our system
also has space and potential future improvement and
development. A raspberry pi-based hardware system can be
designed that receives the fundus retinal images and after
preprocessing and feature extraction, classifies the sample.
Now a day’s wireless technology is rapidly developing. A
further improvement in this system can be done by using a
Wi-Fi module through which the fundus images are directly
transferred from the fundus camera setup to the ophthalmic
disease classifying system. All these developments can help
us achieve an embedded system that can efficiently classify a
maximum number of ophthalmic diseases and reduce the
chance of permanent blindness in people due to late or
inaccurate diagnoses.
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