Journal Pre-proof

DRNet: Segmentation and Localization of Optic Disc and Fovea from

Diabetic Retinopathy Image

Md. Kamrul Hasan, Md. Ashraful Alam, Md. Toufick E Elahi,

Shidhartho Roy, Robert Martı́

PII: S0933-3657(20)31266-5
DOI: https://doi.org/10.1016/j.artmed.2020.102001
Reference: ARTMED 102001

To appear in: Artificial Intelligence In Medicine

Received Date: 16 August 2020

Revised Date: 22 November 2020
Accepted Date: 6 December 2020

Please cite this article as: Md. Kamrul Hasan, Md. Ashraful Alam, Md. Toufick E Elahi,
Shidhartho Roy, Robert Martı́, DRNet: Segmentation and Localization of Optic Disc and
Fovea from Diabetic Retinopathy Image, <![CDATA[Artificial Intelligence In Medicine]]>
(2020), doi: https://doi.org/

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 DRNet: Segmentation and Localization of Optic Disc and Fovea
from Diabetic Retinopathy Image
Md. Kamrul Hasana,1,∗, Md. Ashraful Alama , Md. Toufick E Elahia , Shidhartho Roya ,
Robert Martı́b
a
Department of Electrical and Electronic Engineering, Khulna University of Engineering & Technology,
Khulna-9203, Bangladesh
b
Computer Vision and Robotics Institute, University of Girona, Spain

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Abstract

Background and objective

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In modern ophthalmology, automated Computer-aided Screening Tools (CSTs) are cru-
cial non-intrusive diagnosis methods, where an accurate segmentation of Optic Disc (OD)
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and localization of OD and Fovea centers are substantial integral parts. However, designing
such an automated tool remains challenging due to small dataset sizes, inconsistency in
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spatial, texture, and shape information of the OD and Fovea, and the presence of different
artifacts.
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Methods

This article proposes an end-to-end encoder-decoder network, named DRNet, for the
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segmentation and localization of OD and Fovea centers. In our DRNet, we propose a skip
connection, named residual skip connection, for compensating the spatial information lost
due to pooling in the encoder. Unlike the earlier skip connection in the UNet, the proposed
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skip connection does not directly concatenate low-level feature maps from the encoder’s
beginning layers with the corresponding same scale decoder. We validate DRNet using
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different publicly available datasets, such as IDRiD, RIMONE, DRISHTI-GS, and DRIVE
for OD segmentation; IDRiD and HRF for OD center localization; and IDRiD for Fovea
center localization.

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Results

The proposed DRNet, for OD segmentation, achieves mean Intersection over Union
(mIoU) of 0.845, 0.901, 0.933, and 0.920 for IDRiD, RIMONE, DRISHTI-GS, and DRIVE,
respectively. Our OD segmentation result, in terms of mIoU, outperforms the state-of-the-
art results for IDRiD and DRIVE datasets, whereas it outperforms state-of-the-art results
concerning mean sensitivity for RIMONE and DRISHTI-GS datasets. The DRNet localizes
the OD center with mean Euclidean Distance (mED) of 20.23 and 13.34 pixels, respectively,
for IDRiD and HRF datasets; it outperforms the state-of-the-art by 4.62 pixels for IDRiD

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dataset. The DRNet also successfully localizes the Fovea center with mED of 41.87 pixels for
the IDRiD dataset, outperforming the state-of-the-art by 1.59 pixels for the same dataset.

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Conclusion

As the proposed DRNet exhibits excellent performance even with limited training data
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and without intermediate intervention, it can be employed to design a better-CST system to
screen retinal images. Our source codes, trained models, and ground-truth heatmaps for OD
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and Fovea center localization will be made publicly available upon publication at GitHub1 .
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Keywords: Diabetic retinopathy and glaucoma, Ophthalmology, Encoder-decoder

network, Skip connection, Segmentation and localization.
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1. Introduction

1.1. Problem presentation

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Diabetic Retinopathy (DR) is a severe complication of diabetes, which affects the vascu-
lature of the eye of roughly one-third of diabetes patients [9, 83]. In the United States (US)
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1
https://github.com/kamruleee51/DRNet_Segmentation_Localization_OD_Fovea
∗
I am corresponding author
Email addresses: m.k.hasan@eee.kuet.ac.bd (Md. Kamrul Hasan), alam1603001@stud.kuet.ac.bd
(Md. Ashraful Alam), toufick1469@gmail.com (Md. Toufick E Elahi), swapno15roy@gmail.com
(Shidhartho Roy), robert.marti@udg.edu (Robert Martı́)
1
Department of Electrical and Electronic Engineering, Khulna University of Engineering & Technology,
Khulna-9203, Bangladesh.
Preprint submitted to Artificial Intelligence in Medicine December 10, 2020
alone, the number of US adults, having positive diabetes, is estimated to increase from 22.3
million (9.1 %) (2014) to 39.7 million (3.9 %) (2030), and to 60.6 million (17.9 %) in 2060
[45]. Another statistical study on diabetes, in 2017, predicted that the existing 451.0 million
patients with positive diabetes worldwide would increase to 693.0 million by 2045 [15, 30].
However, DR, as a microvascular complication of Diabetes Mellitus (DM), appears to be the
leading cause of acquired vision impairment worldwide in middle-age subjects [39]. DR acc-
counts for 4.8 % of blindness cases (37.0 million) worldwide [68]. A conclusion of 35 studies,
on 22, 896 individuals with positive diabetes in the US, Australia, Europe, and Asia (between

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1980 and 2008), found that the average incidence of both DR (Type-1 DM and Type-2 DM)
was 34.6 %, with 7.0 % vision-threatening DR [93]. However, the severity of DR and the pos-

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sibility of eye vision loss can be reduced significantly, approximately by a 57.0 %, with early
diagnosis [26]. For that, diabetic patients are strongly invited once or twice a year for reti-
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nal screening [40]. The ophthalmologist or expert diagnoses DR via physical assessment of
the retinal fundus images looking for different lesions such as microaneurysms, hemorrhage,
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soft exudates, hard exudates etc. However, the number of ophthalmologists worldwide is
insufficient, currently estimated at around 1.0 per 29.0 million people approximately [67].
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This scenario is more severe in underdeveloped and developing countries, especially in ru-
ral areas, where most of the population is unaware of the importance of screening for an
early diagnosis. However, visual assessment of the retinal images via the naked eye may
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introduce discrepancies in the assessment, as eye lesions and healthy eye tissues may have
similar characteristics [35]. Visual assessment done by ophthalmologists are also tedious,
time-consuming, subjective, and error-prone tasks. Currently, CST systems are developed
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for alleviating all the above-motioned limitations, in addition to reducing the working load
of ophthalmologists by providing an automated diagnostic tool. In that sense, OD segmen-
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tation and localization of the Fovea and OD centers are integral parts of an automatic CST
system. The segmentation is an essential requirement in the CST systems as it extracts
the Region of Interest (ROI), which can be used to obtain detailed structural information
of various types of retinal lesions. Segmentation is also important to find signs of venous
bleeding, retinal neovascularization, retinal thickening, fluid accumulation, among others.
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OD and Fovea are the most important anatomical structures used by ophthalmologists for
the assessment of retinal fundus images. For instance, around the OD, glaucoma severely
damages the optic nerves, which can be primarily detected from the segmented and localized
OD ROI. However, the automation of the OD segmentation and the localization of OD and
Fovea centers is highly challenging for the following reasons:

1. OD and Fovea are not always well-visible, as they present low contrast compared to
the background (see Fig. 1). Sometimes they also confound with other visually similar
structures (see in Fig. 1).

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2. Fovea shows a large variability in terms of shape, structure, and boundary (see in
Fig. 1). It is usually small in size compared to the whole image size, and often imper-

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ceptible to the naked eye (see in Fig. 1).
3. The presence of different artifacts, such as dust particles, flash, diffused bright areas,
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lubrication on the camera lens, and reflection in the retinal fundus images.
4. Small numbers of manually annotated images are currently available, limiting the
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robustness of supervised learning systems.
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Optic disc Fovea

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Figure 1: Example of challenging retinal fundus images, in the Indian Diabetic Retinopathy Image dataset
[59], for automatic segmentation and localization of OD and Fovea. It can be observed that hard exudate
is more visible than the OD (first-row-first-column) as well as the OD is confounded with the background
(second-row-first-column). The Fovea is also imperceptible to the naked eye (second-row-second-column).

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1.2. Related work

In this subsection, we present previous related methods of the OD segmentation and

localization of OD and Fovea centers in retinal fundus images, as follows:

Methods for segmentation. Dashtbozorg et al. [17] automated an OD segmentation

method by employing a multiresolution Sliding Band Filter (SBF) [57]. They respectively
utilized low-resolution and high-resolution SBFs to locate a maximum response from the
filter and obtain a set of pixels for a coarse estimation of the OD boundary. Finally, they
smoothed the coarse output using a second-degree polynomial. Marin et al. [50] performed

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iterative morphological operations for producing a region-enhanced retinopathy image. The

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authors also employed 2-step automatic thresholding for obtaining the OD ROI by con-
straining that blood vessel confluence at the OD. Mittapalli and Kande [51] proposed an
OD segmentation model based on a region-based active contour model [43] by incorporat-
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ing localized image information from different channel features such as intensity, color, and
texture. However, the selection of robust initial contours is often tricky when the OD is sim-
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ilar to the background. A method based on mathematical morphology, the Circular Hough
Transform (CHT), and the grow-cut algorithm [86], was proposed by Abdullah et al. [3].
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Morphological operators were applied in order to enhance the OD region and remove the
retinal vasculature. Subsequently, CHT was used to approximate the center of the OD, and
a grow-cut algorithm was finally used to segment the OD. A low-pass finite impulse response
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filter was proposed by Bharkad [13] to suppress the dominance of blood vessels and enhance
the OD region. However, it requires selecting a proper value of the filter design parameters
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for obtaining a suitable frequency response with an optimized order of the filter. Finally,
the OD region segmentation was performed using grayscale morphological dilation and me-
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dian filtering. Sarathi et al. [73] proposed an adaptive threshold-based region growing for
the OD segmentation, where they removed the vascular structure by precise inpainting of
blood vessels in the disc region. Tan et al. [81] developed a Convolutional Neural Network
(CNN) to segment OD, Fovea, and blood vessels. The authors extracted three channels
from the neighborhood points and forwarded the response to a network of 7-layers for every

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point in a fundus image. Finally, the output layer consists of four neurons representing the
background, OD, Fovea, and blood vessels. A deep learning-based network for OD segmen-
tation, called MNet, was introduced by Fu et al. [21]. It includes a multiscale input layer,
U-shape CNN to learn the salient features, and a multi-label loss function. The authors
also proposed transforming the original image into a polar coordinate system to provide the
new representation of the original image and improve segmentation results. Porwal et al.
[58] used intensity profile analysis for the OD segmentation using a L0 Gradient Minimiza-
tion (L0 -GM)-based technique [90], where the authors had chosen the optimum threshold

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applying an OTSU’s method. A method based on OD homogenization was proposed by
Naqvi et al. [52]. OD’s contour was achieved by inpainting the major vascular structure

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after utilizing a local Laplacian filtering. Finally, the authors used the gradient-independent
active contour for the OD boundary extraction. Raj et al. [61] segmented the OD employing
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the structural features such as brightness and contrast around the OD. The Harris corner
detection algorithm was used to extract the key features, called landmark points, followed
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by a Voronoi image decomposition. In the end, the authors used Pratt’s circle fitting algo-
rithm for segmenting the OD based on those extracted landmark points. Zabihollahy and
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Ukwatta [95] proposed a CNN network for segmenting the OD, after localizing it using a
random forest classifier [97]. The saliency-based OD segmentation method, proposed by
Zou et al. [102], includes two stages: the OD localization and the saliency-based segmen-
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tation. The authors estimated a region’s saliency by exploiting boundary and connectivity
priors, and the OD segmentation was obtained by thresholding and ellipse fitting. Kumar
et al. [42] proposed a pipeline for OD segmentation, which consists of preprocessing, blood
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vessels detection, and finally segmenting the OD. They employed mathematical morphology
and watershed algorithms for preprocessing and segmentation, respectively. Particle Swarm
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Optimization (PSO) [85]-based ensemble, of deep neural networks, was proposed by Zhang
and Lim [98] for OD segmentation. The authors used an ensemble segmentation model to
avoid a single network’s bias, where final output masks were obtained from a voting mech-
anism. Abdullah et al. [2] proposed a fuzzy clustering method to extract the OD mask.
The authors chose the first channel of the input image for a preprocessing stage. Subse-
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quently, their framework uses an active contour model based on a fuzzy clustering method
to obtain the final result. Lu and Chen [48] used the GrabCut [71] method for generating
pseudo-ground-truths images which were used to train a modified UNet [70] model. Finally,
they utilized a smaller number of ground-truth images to fine-tune the model. A rough OD
boundary was extracted by Xie et al. [89] based on a UNet framework. Subsequently, the
authors proposed a SUNet and a Viterbi method to jointly obtain the segmentation masks.
Ramani and Shanthamalar [62] used different image preprocessing methods such as image
resizing, binary conversion and masking, erosion, mapping, and Gaussian filtering. Then,

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they proposed a region-based pixel density calculation method for OD localization and an
improved CHT with Hough peak value selection using super-pixels from the red channel to

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obtain the final OD segmentation.

Methods for localization. Gegundez-Arias et al. [24] localized the Fovea center in two
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steps. Firstly, they obtained a pixel within the Fovea region using prior anatomical location
information related to the OD and vascular tree. Secondly, that pixel was used to crop a sub-
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image containing the Fovea, and finally, the Fovea center was localized using thresholding
and feature extraction techniques. Wu et al. [88] presented a localization method based on
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two-directional models. A global directional model was used to model the main vessels by
using two parabolas that shared vertex and different parameters. Then, a local directional
model was applied to characterize the local vessel convergence in the OD. In the end, both
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models were integrated to localize the OD center. Kamble et al. [37] localized a center from
one-dimensional intensity profile analysis using time and frequency domain information.
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OD’s final central landmark was localized using signal peak and valley analysis in both
time and frequency domains. With the previous OD location’s help, the final Fovea central
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landmark was estimated by finding a valley point. Araújo et al. [8] proposed a UOLO
method for simultaneous localization and segmentation. They derived the UOLO model from
the well-known YOLO [65] and UNet networks. The authors then obtained the geometric
centers from the segmented masks as the final OD and Fovea positions. Babu et al. [10]
proposed a two-stage framework for the OD and Fovea localization. In the first stage,

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they used an object detection framework such as faster-RCNN (FRCNN) for obtaining the
object bounding box [66]. This was used to select the ROI and, in a second stage, the
authors applied a two-layer regression CNN with batch normalization to finally estimate
the OD and Fovea coordinates. Li et al. [44] detected the OD and Fovea centers using a
multi-stage region-based CNN. Firstly, they employed a standard FRCNN and SVM [69]
for the segmentation. Secondly, the authors proposed a relative position information-based
FRCNN for the detection. The localization of Fovea and OD centers was proposed by Al-
Bander et al. [5] employing a deep multiscale sequential CNN. The authors converted and

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rescaled all the images to grayscale and 256 × 256 pixels before feeding them to the network.
They then applied a contrast-limited adaptive histogram equalization technique to reduce

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uneven illumination and enhance the images’ brightness. Lin et al. [46] implemented a
localization framework, where they incorporated pre-processing and main vessel extraction
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steps based on morphological operations. Finally, a parabolic fitting algorithm was used
to convey the main vessels by a least-square method. Joshi et al. [36] localized the OD
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from the segmented binary mask. The authors added motion to the fundus image for
extracting the bright regions, which were then used for OD segmentation by thresholding.
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Finally, those binary masks were used to obtain the center of the disc. A low-rank semi-
supervised learning algorithm was presented by Zhou et al. [99] for automated disc and
Fovea localization. The authors used a low-rank representation for preserving the local
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and global structures of the original fundus image. A template-supervised network, called
TNet, was proposed by Song et al. [78] to extract task-specific salient features. Firstly,
the authors obtained the templates from pixel-level annotations by down-sampling binary
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masks of recognition targets according to specific tasks. Then, the encoding network was
trained under the supervision of the specific templates. Finally, the encoding network was
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merged with a posterior network for upsampling to obtain the segmented masks and a region
proposal network for the OD and Fovea localization. Maiya and Mathur [49] proposed a
Naive Single Stacked Hourglass (NSSH) network to learn the spatial orientation and pixel
intensity contrast between OD and Fovea. The NSSH incorporates three salient design
decisions, such as hourglass geometry, convolutional layer stacking, and replacing ResNet
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blocks [32]. El Kim et al. [20] utilized a pre-trained network to locate the OD in the fundus
images. The authors used transfer learning in the well-known AlexNet [41] with a linear
regression output for localization. A concentric circular sectional symmetry measure was
proposed by Guo et al. [28] for symmetry axis detection and extraction of ROI. A weighted
gradient accumulation map was also proposed for locating the intensity changes, which
mitigated the effect of noise and artifacts to refine the localization.
Table 1 presents numerous methods mentioned above for the segmentation of OD and
localization of OD and Fovea centers with their respective utilized datasets and correspond-

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ing results. Different methods for the segmentation of OD and the localization of OD and
Fovea centers have been reviewed in the previous paragraphs, which can roughly be split into

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image processing and deep learning-based approaches. However, a common characteristic
of both sets of methods is that they are highly dependent on parameter tuning, impacting
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the robustness and generability of the methods. Remarkably, robust parameter selection is
often complicated due to different challenging conditions in the fundus image (see in Fig. 1),
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as described earlier. Moreover, several localization methods, as presented in subsection 1.2,
firstly segment the OD and Fovea, then measure the geometric center from the binary mask
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as their center. However, these approaches are primarily dependent on the shape of the ob-
ject on a binary mask. In the next subsection, we present our approach to alleviating those
above-motioned limitations for segmentation and localization of OD and Fovea in retinal
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fundus images.

1.3. Our contribution

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This article proposes an automated CNN-based encoder-decoder network, called DRNet

(Diabetic Retinopathy Network), for both segmentation and localization of the OD and
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Fovea, which substantially alleviates the necessity of manual parameter tuning while being an
end-to-end system. The proposed DRNet has a U-shaped structure with newly proposed skip
connections, called residual skip connections, consisting of two shortcut paths. Those two
paths act as a regularizing path to each other (see details in subsection 3.2). The summing
output of those two shortcut paths from the encoder are then concatenated, channel-wise,

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Table 1: Several published literature for the segmentation of OD and localization of OD and Fovea with their
utilized datasets and performances, where we show different metrics such as Acc, mDSC, mED, mIoU, and
mSn respectively for accuracy, mean dice similarity coefficient, mean Euclidean distance, mean intersection
over union, and mean sensitivity.

Localization result
Different methods Year Different datasets OD segmentation result
OD Fovea
Morphological reconstruction, DRIVE mIoU: 0.807, mSn: 0.878 - -
Gaussian mixture model, and DIARETDB1 mIoU: 0.802, mSn: 0.882 - -
2015
finally, morphological DIARETDB0 mIoU: 0.776, mSn: 0.866 - -
post-processing [72] CHASE DB1 mIoU: 0.808, mSn: 0.896 - -
Measurement of global symmetry DRIVE - Acc: 0.975 -
axis, then finding the centroid of 2015 STARE - Acc: 0.975 -

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the blood vessel [56] HRF - Acc: 1.00 -
Adaptive threshold-based region MESSIDOR mIoU: 0.890 - -
2016
growing Sarathi et al. [73] DRIVE mIoU: 0.870 - -
Thresholding using grayscale DRIVE mIoU: 0.626, mSn: 0.871 mED: 9.12 -
morphological dilation and median 2017 DIARETDB0 mIoU: 0.611, mSn: 0.746 mED: 11.83 -

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filtering Bharkad [13] DIARETDB1 mIoU: 0.586, mSn: 0.751 mED: 13.00 -
Edge detection is followed by
2018 HRF - Acc: 0.933 -
circular hough transform [18]
UOLO algorithm for simultaneous DRIVE mIoU: 0.820, mDSC: 0.890 mED: 8.13 -
detection and segmentation [8]
A framework using an attention
based object relation module [10]
Faster-RCNN and SVM, then
2018

2018

2018
MESSIDOR

IDRiD

IDRiD
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mIoU: 0.880, mDSC: 0.930

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mED: 9.40

mED: 60.32

mED: 32.6
mED: 10.44

mED: 95.45

mED: 52.0
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RPI-based faster-RCNN [44]
U-shaped architecture using DRISHTI-GS mIoU: 0.904, mDSC: 0.949 - -
2018
fully-connected DenseNet [6] RIMONE mIoU: 0.829, mDSC: 0.904 - -
L0 -gradient minimization with IDRiD mIoU: 0.721, mDSC: 0.802 - -
2018
OTSU thresholding [58] MESSIDOR mIoU: 0.826, mDSC: 0.785 - -
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Harris corner detection and Pratt’s

2019 DRISHTI-GS + MESSIDOR mIoU: 0.695, Acc: 0.960 - -
circle fitting algorithm [61]
Threshold-based segmentation of
2019 DRISHTI-GS - mDSC: 0.925 -
OD to estimate it’s center [36]
Matched template-based DRISONS mIoU: 0.081, Acc: 0.996 - -
2019
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framework [102] MESSIDOR mIoU: 0.848, Acc: 0.998 - -

Level set-based adaptively RIMONE mIoU: 0.910, mDSC: 0.930 - -
regularized kernel-based 2019 DRISHTI-GS mIoU: 0.910, mDSC: 0.920 - -
intuitionistic fuzzy C-means [82] MESSIDOR mIoU: 0.910, mDSC: 0.940 - -
RIMONE mIoU: 0.896, mSn: 0.904 - -
GrabCut and UNet methods [48] 2020
DRISHTI-GS mIoU: 0.919, mSn: 0.929 - -
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UNet, sequence-UNet (SUNet), MESSIDOR mDSC: 0.979 - -

2020
and Viterbi algorithm [89] DRISHTI-GS mDSC: 0.976 - -
Template-supervised network,
2020 IDRiD - mED: 24.85 -
called TNet [78]
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Spatially orientated naive single

2020 IDRiD - mED: 14.21 mED: 35.45
stacked hourglass network [49]
Firefly and distance regularized
2020 RIMONE mSn: 0.979, Acc: 0.975 - -
level set algorithms [64]

GrabCut and UNet methods [55] 2020 RIMONE mIoU: 0.880, mSn: 0.910 - -

Semi-supervised and transfer

2020 RIMONE mIoU: 0.882, mDSC: 0.902 - -
learning using an autoencoder [12]

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with the same scale corresponding decoder. Unlike earlier skip connections as in UNet [70],
the proposed residual skip connection will not directly aggregate low-level features from the
earlier layers of the encoder with the same scale decoder since skipping features are passed
through several convolutional layers and merged with the non-zero regularizing skipping
path. Thus, the proposed DRNet has a better-compensating capability of losing spatial
information due to pooling in the encoder. For localization, we generate and propose a
2D heatmap (see details in subsection 3.1), having Gaussian-shaped intensity distribution,
whose peak is located at the given center of the OD and Fovea. Those 2D maps are then

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used to train the proposed DRNet as a regression network to predict the OD and Fovea
centers from the predicted heatmap’s peak intensity points. Thus, we propose a shape

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independent localization method, which can provide higher accuracy in localization than
earlier methods (subsection 1.2), which are likely to be adversely affected by noise, low
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contrast, and artifacts. To our best knowledge, our proposed DRNet outperforms state-of-
the-art results on five different datasets for the OD segmentation and localization of OD
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and Fovea centers.
The remaining sections are presented as follows: section 2 describes the utilized datasets
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to carry the experimentation. The proposed methodologies, along with the designing of the
proposed DRNet, are presented in section 3. Section 4 describes the obtained results, for
both segmentation and localization, along with a proper interpretation and state-of-the-art
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comparisons. Finally, section 5 concludes the article with future works.

2. Datasets
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We evaluate our proposed DRNet for two different tasks: the segmentation of OD and
centers’ localization of OD and Fovea. Table 1 shows the different datasets and corresponding
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methods used in the recent literature for the segmentation and localization. In this article,
we utilize five different datasets, from Table 1, in order to compare our method with current
state-of-the-art. We use the Indian Diabetic Retinopathy Image Dataset (IDRiD) [59],
the Retinal Image Database for Optic Nerve Evaluation (RIMONE) [22], the DRISHTI-
GS [77, 76], and the Digital Retinal Images for Vessel Extraction (DRIVE) [79] for OD
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segmentation. IDRiD and High-Resolution Fundus (HRF) [14] datasets are used for OD
center localization, whereas the IDRiD dataset is adopted for Fovea center localization.
Table 2 shows a summary of the data distribution of all the datasets. However, the validation
set is not provided for all the datasets, which is essential for supervised learning systems.
We have applied a cross-validation technique for the training, validation, and testing sets
selection. Fig. 1 shows several challenging instances of retinal fundus images in the datasets.
In the following paragraphs, we briefly describe all the used datasets.

Table 2: Distribution and details of the five different datasets used for evaluating the proposed DRNet for

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OD segmentation and OD and Fovea center localization.

Center localization Segmentation

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Different datasets Resolution FoV Bit depth
OD Fovea OD mask
IDRiD [59] 4288 × 2848 50◦ 24-bits 516 516 81
RIMONE [22]
DRISHTI-GS [77, 76]
1072 × 1424
2896 × 1944
-
30◦
24-bits
24-bits
-p -
-
-
-
169
101
◦
DRIVE [79] 786 × 584 30 8-bits - - 40
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HRF [14] 3504 × 2336 45◦ 24-bits 45 - -
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IDRiD. The images were acquired in India using a digital fundus camera (Kowa VX-10a)
and manually annotated by a master’s student using special software developed by ADCIS
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[4], where two retinal specialists reviewed annotations.

RIMONE. This dataset was captured and proposed in Spain using Nidek AFC-210 with a
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body of a Canon EOS 5D Mark II of 21.1 megapixels, where the OD and cup were manually
segmented by five experts, which were then combined to form the ground-truth segmentation
masks.
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DRISHTI-GS. This dataset is generated by the medical image processing group, IIIT,
India. The ground-truth segmentation masks containing the optic disc were annotated by
combining the markings of four practitioners.

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DRIVE. The images were acquired in The Netherlands using a Canon CR5 non-mydriatic
3CCD camera. The volunteers, who manually annotated the images, were instructed and
trained by an experienced ophthalmologist.

HRF. Those images were extracted in Germany using a Canon CR-1 fundus camera, where
the gold standard ground-truth data was generated by a group of experts working in retinal
image analysis and clinicians from the cooperated ophthalmology clinics.

3. Methodology

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In this section, we describe the proposed methodology for segmentation and localization.

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In subsection 3.1, we present the preprocessing of all the images in different datasets, as
described in earlier section 2, before feeding them to the proposed network. Subsection 3.2

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represents the design of the proposed network. Finally, in subsection 3.3, we describe the
training protocol for the segmentation and regression by employing the proposed DRNet.
The proposed workflow, as shown in Fig. 2, serves two different tasks: (1) OD segmentation
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and (2) regression to generate heatmaps for OD and Fovea center localization. We describe
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Train
Preprocessing
DRNet Task-1
Training phase OD Segmentation
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DRNet

Task-2
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Query Image OD and Fovea Localization

Figure 2: A block presentation of the proposed workflow employing the proposed DRNet, where the pre-
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processing is the crucial integral part of the workflow in the training phase.

each part of the proposed workflow shown in Fig. 2, in the following subsections.

13
3.1. Preprocessing

Preprocessing is a crucial integral step to train the proposed network. Generally, large
amounts of data are used to train a CNN to overcome overfitting. However, many medical
imaging domains, such as the one addressed in this paper, have access to small-sized datasets
as manually annotated training images are challenging to generate [29]. Data augmentation
is a commonly used preprocessing step for training a CNN network, enhancing the size and
quality of training datasets to improve the generalization of the CNN network [75]. In this
article, we use several geometry-based augmentations: rotation (40◦ around the center of the

of
image), height-width shift (10 %) and zooming (10 %). To reduce the computational burden,
we resize all the images to 256 × 170 pixels using nearest-neighbor interpolation by keeping

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the same aspect ratio, approximately 1.5, as in the original fundus images. Additionally, we
have standardized the images to zero mean and unit variance, and rescaled to [0 1].
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We train the proposed DRNet with the 2D heatmaps, centered on the ground-truth
coordinates, to localize OD and Fovea center coordinates [53, 84, 92]. Such training of
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DRNet resembles output heatmaps of the test images, where the predicted OD and Fovea
center coordinates are obtained by computing the argmax of pixel values from the predicted
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heatmap. However, the utilized datasets provide only the coordinate of the OD and Fovea
centers rather than 2D center heatmaps. For example, for the image, as shown in Fig. 3,
the coordinate of the OD center is given as (2858, 1805). Therefore, we create 2D heatmaps
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(0,0)

2858
(2858,1805)
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(0,0)
(2858,1805)
1805

Figure 3: Generation of 2D heatmaps for regression to localize the OD and Fovea centers, where the heatmap
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has a peak intensity at the OD and Fovea centers.

by rendering a spherical 2D Gaussian, centered on the given ground-truth coordinates to

train our DRNet. The generated heatmaps, as shown in Fig. 3, have bell-shaped intensity
distribution whose center, having maximum intensity, is located at the given coordinate.
14
The central maximum intensity of the generated heatmaps reduces following the Gaussian
bell-shaped distribution, and it continues up to ±3σ, where σ is the standard deviation of
the Gaussian distribution.

3.2. Proposed DRNet

Medical image segmentation has achieved tremendous success markedly since 2015 after
the introduction of UNet [70]. Nowadays, for medical images, CNN-based segmentation net-
works have been widely applied, outperforming traditional image processing methods relying

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on hand-crafted features [80]. The latter often requires a significant amount of parameter
and feature tuning, while the former is considered an end-to-end approach. However, the

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CNN-based segmentation network comprises two necessary components: the encoder and
the decoder [70]. An encoder, also called the feature learner module, consists of convolu-

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tional and pooling layers. The convolutional layers are used to generate the feature maps,
while the pooling layers gradually reduce the dimension of those feature maps to capture
higher semantic features with higher spatial invariance [31]. Such a reduction in resolution
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due to pooling also expands the Field of View (FoV) of the generated feature maps and
reduces the computational cost [47]. The encoder part in our proposed DRNet, as presented
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in Fig. 4, has five convolutional layers with the kernels of 3 × 3 and four pooling layers with
the stride of 2 × 2. The final feature map has the resolution of M/24 × N/24 for an input
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resolution of M × N .
A decoder projects the lower resolution learned features resulting from the encoder onto
a higher resolution for gradually recovering the spatial information and finally obtaining the
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semantically segmented mask of the input image resolution [47, 70, 31]. All current segmen-
tation networks contain almost similar encoders, but they differ significantly in the decoder
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mechanism to regain the lost spatial information. However, after the encoder, the reduced
feature maps often suffer from spatial resolution loss, which introduces coarseness, less edge
information, checkerboard artifacts, and over- and under-segmentation in the final predicted
masks [47, 70, 54]. Currently, several methods have already been proposed to alleviate the
limitations of regaining lost spatial information. Ronneberger et al. [70] introduced a skip

15
 +

8 24 16 64 2 Sigmoid
Input Output

8 16 32 8
+

16 40 16
16

16 32 16
+

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32 64 32
24

64 32

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+
32 64 32
32

32

32
32
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+
Conv. with ReLU Batch Norm Pooling Upsampling Concatenation Final Feature Map Addition
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Figure 4: Structure of the proposed DRNet, for both segmentation and regression, employing the proposed
residual skip connection.
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connection in their popular UNet, which allowed the decoder to regain lost spatial informa-
tion by the channel-wise concatenation at each stage of the encoder and decoder with the
same scale. However, as in UNet, skip connections unessentially aggregate the same scale
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feature maps of the encoder and decoder. Such aggregation is regarded as a limitation of
the UNet, as it forces an unnecessary fusion strategy, imposing aggregation only at the same
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scale feature maps of the encoder and decoder [100]. Long et al. [47] fused features from
different pooling layers of the encoder in their Fully Convolutional Network (FCN). Finally,
those fused maps were then upsampled using different up-scaling factors. A deconvolution
overlap occurs when the kernel size is not divisible by the up-scaling factor. The number
of low-resolution features across the high-resolution feature map is not constant due to the

16
deconvolution overlap, which introduces checkerboard artifacts in the final segmented masks
[54, 31]. Al-Masni et al. [7] proposed a Full resolution Convolution Network (FrCN) without
any pooling layers, which preserves the spatial information in the output segmented masks.
However, the pooling layers are highly desirable to learn the most salient features from dif-
ferent resolutions, as described earlier. In SegNet, Badrinarayanan et al. [11] preserved the
indices at each pooling layer in the encoder, which was utilized to upsample the correspond-
ing feature map in the decoder. However, the neighboring information was not considered
during the upsampling.

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In the DRNet, we propose a residual skip connection, as depicted in Fig. 5, instead of the
earlier skip connection in the well-known UNet. The proposed residual skip connection, in

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Xin
-p F
+
Xout
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Figure 5: A presentation of the proposed residual skip connection to generate a skipped output of Xout for
the input of Xin .
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our DRNet, has two shortcut paths: the convolutional path and the regularizing path. The
convolutional shortcut path can not degrade the features’ quality as a non-zero regularizing
path will skip over them. On the other hand, the direct skipping of the non-zero regularizing
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path can not also hamper the performance as it has been added with the learned features in
the convolutional shortcut path. For nth convolutional layer of the DRNet, the feature map
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n n
Xin is used to produce an output feature map Xout by applying the proposed residual skip
n n n
connection (see Fig. 5) as Xout = F (Xin ) + Xin , where F is the stack of convolutions in the
n
convolutional shortcut path. The output of a residual skip connection Xout ∈ RB×H×W ×E is
then concatenated with the same scaled nth decoder output Yout
n
∈ RB×H×W ×D , to regain the
lost spatial information. Mathematically, XCn = [Xout
n n
++ Yout ], where XCn ∈ RB×H×W ×(E+D)

17
and + , B, H, W , E, and D respectively denote the channel concatenation, batch size,
n n
height, width, depth of Xout , and depth of Yout . Such a proposed residual skip connection,
as in our DRNet, will not directly aggregate low-level features in the encoder with the
corresponding same scale decoder since features are passed through several convolutional
layers merged with the non-zero regularizing skipping path.
Additionally, all the convolutions, in both encoder and decoder, are followed by the
batch normalization layers [34] for standardizing the inputs to the layers each mini-batch to
tackle the internal covariate shift. The number of convolutional layers and the corresponding

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feature depth in DRNet are kept small to learn fewer parameters, without sacrificing the
quality results, considering also the small size of the datasets used (see section 2). Such

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a network design also makes the DRNet lightweight and more suitable for real-time CST
systems. Moreover, the final output 2D feature map from the sigmoid activation function
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allows the DRNet as a segmentation or regression network. For segmentation, the output
maps are thresholded to get binary masks of the OD. For localization, 2D argmax on the
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resembled output heatmaps provides the OD and Fovea centers’ spatial coordinates.

3.3. Training protocol

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The Xavier uniform distribution, also known as Glorot uniform distribution [25], is used
to initialize the kernels in all the convolutional layers in both encoder and decoder. Such a
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distribution draws the samples from a truncated normal distribution centered on 0.0 with
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a standard deviation of (2/(Fin + Fout )). Fin and Fout denotes the number of input and
output units in the weight tensor, respectively. As the OD ROIs are much smaller than the
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background, a typical metric that equally weighs background and foreground pixels would be
biased towards background pixels. Hence, we use IoU as a metric (Mseg ), to be maximized
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during the training, for the OD segmentation in the proposed DRNet.

N
X
yi × ŷi
i=1
Mseg (y, ŷ) = N N N
(1)
X X X
yi + ŷi − yi × ŷi
i=1 i=1 i=1

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where y, ŷ, and N are the true label, predicted label, and the total number of pixels,
respectively. The product of y and ŷ, in Eq. 1, is the measure of similarity (intersection)
between true and predicted mask. On the other hand, binary cross-entropy and mean
squared errors are applied as the loss functions for segmentation and regression by the
proposed framework, respectively. For both the tasks, the loss functions are optimized
using the Adam optimizer [38] with initial Learning Rate (LR) and exponential decay rates
(β 1 , β 2 ) as LR = 0.001, β 1 = 0.9, and β 2 = 0.999, respectively, without AMSGrad variant.
The LR is reduced after 5 epochs by 10.0 % if validation loss stops improving. We set the

of
initial epochs as 200 and stop the training using a callback function when the validation loss
has stopped improving.

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4. Results and Discussion
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In this section, we are presenting the results of different experiments. In subsection 4.1,
we firstly present the ablation studies on our proposed DRNet, specifically to evaluate the
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benefits of the proposed skip connection in DRNet, using four different datasets (see sub-
section 4.1.1). We also show OD segmentation results on those datasets and compare them
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to state-of-the-art methods on the same datasets (see in subsection 4.1.2). The localization
results using different datasets for OD and Fovea centers are presented in the subsection
4.2 along with the state-of-the-art comparisons. Finally, in subsection 4.3, we show several
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failing cases of DRNet with possible remedies.

4.1. Segmentation
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This subsection shows qualitative and quantitative results for OD segmentation on

IDRiD, RIMONE, DRISHTI-GS, and DRIVE datasets. We use mean sensitivity (mSn),
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mean accuracy (mAcc), mean Intersection over Union (mIoU) as the metrics to evaluate
the segmented OD masks. The mSn and mAcc are the metrics used to evaluate the false-
negative region and the percentage of correctly classified pixels, whereas the mIoU quantifies
the overlap between the true and predicted OD masks.

19
4.1.1. DRNet segmentation results
Fig. 6 shows comprehensive OD segmentation performances using our proposed DRNet
and the equivalent traditional encoder-decoder network without our proposed skip connec-
tion on four different datasets. The experimental results demonstrate higher performance, in

1.00
0.95
0.90
IoU

0.85

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0.80 With Proposed SC
Without Proposed SC

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IDRiD RIMONE DRISHTI-GS DRIVE

Figure 6: Box-whisker visualization of OD segmentation results in terms of IoU using an encoder-decoder

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network with and without the proposed Skip Connection (SC) in DRNet using four different public datasets.
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terms of mIoUs, for all the datasets when we use our proposed skip connection instead of the
traditional skip connection as in the UNet (improvement of 0.9 %, 1.6 %, 2.3 %, and 6.2 % for
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IDRiD, RIMONE, DRISHTI-GS, and DRIVE datasets, respectively). Fig 7 demonstrates

several examples of the OD segmented masks with and without proposed skip connection on
two different datasets, such as RIMONE and DRISHTI-GS. Those results, as in Fig 7, ex-
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hibit that the OD masks with proposed skip connection have smoother boundaries, whereas
the other masks suffer from the zigzag or coarse boundaries. The zigzag boundaries are due
to the checkerboard or blocky artifacts during the upsampling with less spatial information.
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Such improved results experimentally reveal that the direct concatenation of low-level fea-
tures to the corresponding decoder has an adverse effect in semantic segmentation to regain
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the lost spatial information due to pooling in the encoder. Hence, the addition of the convo-
lutional path with a regularizing path in our proposed skip connection successfully improves
the OD segmentation results, which exhibits better regaining capability of our proposed
skip connection for the semantic segmentation. In the next paragraph, we further explore
qualitative and quantitative OD segmentation results employing our proposed DRNet on
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 Query image with PSC without PSC Query image with PSC

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p roposeds kipc onnection.pdf
RIMONE dataset DRISHTI-GS dataset

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Figure 7: Qualitative results on two different datasets, such as RIMONE and DRISHTI-GS, with and
without Proposed Skip Connection (PSC).

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different datasets as the skip connection in our DRNet has a better performance comparing
the earlier skip connection in the UNet.
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Table 3 presents the mean and median values of different metrics for OD segmentation on
four different datasets. On average, 89.9 %, 95.9 %, 96.0 %, and 96.2 % pixels are correctly
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Table 3: OD segmentation results employing the proposed DRNet on four different publicly available
datasets.
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Metrics
Different datasets mSn mAcc mIoU
Mean Median Mean Median Mean Median
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IDRiD 0.899 0.960 0.997 0.998 0.845 0.913

RIMONE 0.959 0.977 0.962 0.974 0.901 0.935
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DRISHTI-GS 0.960 0.968 0.998 0.998 0.933 0.947

DRIVE 0.962 0.980 0.999 0.999 0.920 0.934

labeled as OD, with respective type-II errors as 10.1 %, 4.1 %, 4.0 %, and 3.8 %, for IDRiD,
RIMONE, DRISHTI-GS, and DRIVE datasets, respectively. It is also noteworthy from
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the mIoU of the segmented OD masks by the proposed DRNet that approximately 84.5 %,
90.1 %, 93.3 %, and 92.0 % predicted disc pixels have coincided with true disc pixels for
IDRiD, RIMONE, DRISHTI-GS, and DRIVE datasets, respectively. The median values of
different metrics, as in Table 3, also exhibit the average performances of the OD segmentation
for more than 50 % test samples.
The qualitative results of several fundus images of four separate datasets, for the OD
segmentation employing the proposed DRNet, are presented in Fig. 8. The overlay results,
as in Fig. 8, qualitatively depict that the DRNet generates the OD mask with very high

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true-positive pixels compared to false-positive and false-negative pixels, which also shows
the precision of the segmented OD boundary (green color) comparing the true OD boundary

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(blue color) for all the datasets. The segmented OD results qualitatively show that the OD
boundaries do not show checkerboard or blocky results, as they show those effects in Fig. 7
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(third- and sixth-columns), due to the proposed skip connection’s capability of compensating
the lost spatial information in the encoder. Although there are different types of lesions in
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some images, the DRNet can accurately extract the OD boundaries, with very negligible
false-positive and false-negative regions, for all the datasets.
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4.1.2. State-of-the-art comparison

Table 4 shows the OD segmentation results of different methods on the same datasets:
IDRiD, RIMONE, DRISHTI-GS, and DRIVE. DRNet produces the best OD segmentation
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masks for seven out of the twelve cases while performing as a second-best on the three cases
on four different datasets. The proposed DRNet produces the best OD segmentation results
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for the mIoU by outperforming the recent state-of-the-art FCN [23] and DCF+CHT [19]
with the margins of 7.7 % and 4.7 % on the IDRiD and DRIVE datasets, respectively. A
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method, DCF+CHT proposed by Dharmawan et al. [19], is solely reliant on the OD size
estimation and its center localization, which requires a significant amount of parameter
tuning. The robust estimation of those two requirements is often highly challenging when
the images of OD are noisy (see in Fig. 1 and subsection 1.1). On the other hand, the
FCN network implemented by Furtado [23] but originally proposed by Long et al. [47],

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 (a) OD segmentation results of IDRiD dataset

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(b) OD segmentation results of RIMONE dataset
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(c) OD segmentation results of DRISHTI-GS dataset

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(d) OD segmentation results of DRIVE dataset

Figure 8: Qualitative OD segmentation results using the proposed DRNet on different publicly available
datasets, where the green and blue circles respectively denote the predicted and true OD boundaries. The
IoU is also provided for quantitative evaluation.

23
Table 4: OD segmentation results for the proposed DRNet and other state-of-the-art methods on the IDRiD,
RIMONE, DRISHTI-GS, and DRIVE datasets. Bold-font and underline respectively denote the best and
second-best metrics. The acronyms of the methods are given in the table footnote.

IDRiD dataset RIMONE dataset DRISHTI-GS dataset DRIVE dataset

Different methods Year
mSn mAcc mIoU mSn mAcc mIoU mSn mAcc mIoU mSn mAcc mIoU
Modified UNet [74] 2017 - - - - - 0.890 - - - - - -
CHT+AT∗ [96] 2017 - - - 0.911 0.975 0.748 - - - 0.831 0.998 0.756
BAO∗ [1] 2018 - - - - - - - - - 0.871 0.992 0.810
PCA+OT∗ [16] 2018 - - - - - - - - - 0.723 0.956 -
L0 -GM [58] 2018 - - 0.712 - - - - - - -
Deep FCNN [6] 2018 - - - 0.874 0.992 0.829 0.927 0.997 0.904 - - -
CENet [27] 2019 - - - - - 0.913 - - - - - -
UNet [87] 2019 - - - - - - - - - 0.794 - 0.783

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DMS∗ [91] 2019 0.952 - - - - - - - - - - -
LARKIFCM∗ [82] 2019 - - - 0.868 0.934 0.880 0.848 0.926 0.870 - - -
GSOA∗ [60] 2020 - - - - 0.986 - - - - - 1.00 -
GrabCut+UNet [48] 2020 - - - 0.904 0.993 0.896 0.929 0.997 0.919 - - -

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DeepLab [23] 2020 - - 0.680 - - - - - - - -
FCN [23] 2020 - - 0.768 - - - - - - - -
UNet [23] 2020 - - 0.173 - - - - - - -
ResNet+UNet [94] 2020 - - - - - 0.925 - - 0.949 - - -
DCF+CHT∗ [19]
SSTL∗ [12]
Proposed DRNet
∗
2020
2020
2020
-
-
0.899
-
-
0.997
-
-
0.845
-
0.873
0.959
-
0.995
0.962
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0.882
0.901
- -
0.954
0.960
-
0.996
0.998
-
0.931
0.933
0.914
-
0.962
-
-
0.999
CHT+AT: Circular Hough Transform + Adaptive Thresholding; BAO: Bat Algorithm Optimization; PCA+OT: Principal Component
0.873
-
0.920
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Analysis + OTSU Thresholding; DMS: Deep Membrane System; LARKIFCM: Level Set-based Adaptively Regularized Kernel-based
Intuitionistic Fuzzy C means; GSOA: Glowworm Swarm Optimization Algorithm; DCF+CHT: Dolph-Chebyshev Filter + Circular Hough
Transform; SSTL: Semi-supervised and Transfer Learning.
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has several limitations in the semantic segmentation, such as checkerboard artifacts and
deconvolution overlapping, as it was shown in DSNet [31] and FrCN [7] for skin lesion
segmentation. Moreover, our DRNet, with 1.0 million parameters, is more lightweight than
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FCN Furtado [23], as DRNet has 184-times less parameters. Furthermore, the mIoU of the
OD segmentation using the traditional UNet [23], initially proposed by Ronneberger et al.
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[70], has been outperformed by our proposed DRNet by a margin of 67.2 % for IDRiD dataset.
Results indicate that the proposed residual skip connection better estimates the lost spatial
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information due to pooling in the encoder layers. Although the ResNet+UNet of Yu et al. [94]
for DRISHTI-GS outperforms our network by a margin of 1.6 % for mIoU, DRNet achieves
second-best results. In terms of mSn and mAcc, DRNet outperforms all other methods being
SSTL [12] and Deep FCNN [6], the second-best performing methods, respectively. Again, for
the RIMONE dataset, DRNet beats the second-best OD segmentation method (CHT+AT

24
[96]) by a margin of 4.8 % in terms of mSn. ResNet+UNet of Yu et al. [94] is a two-stages
method for OD segmentation, which is computationally expensive, and the failure of the
first-stage hampers the performance of the second stage. However, our DRNet is an end-
to-end single-stage method without intermediate intervention, with approximately 33-times
less number of parameters than the ResNet+UNet. CHT+AT, of Zahoor and Fraz [96],
requires a large number of parameter selections, which is often less robust and error-prone
due to variability of the retinal images (see in Fig. 1 and subsection 1.1). In conclusion,
the above all discussions experimentally validate our proposed DRNet, with proposed skip

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connection for the OD segmentation.

4.2. Localization

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In this subsection, we show qualitative and quantitative results for OD and Fovea center
localization. In subsection 4.2.1, the Euclidean distance (ED) (in pixels) between true (blue
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color) and predicted (green color) markers is used as a quantitative metric. Subsequently,
we compare the results of the proposed DRNet with the state-of-the-art results on the same
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datasets, in subsection 4.2.2.
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4.2.1. DRNet localization results

The respective mean and median error values of the ED for the OD center localization
using the proposed DRNet are 20.23 and 16.45 pixels for the IDRiD dataset, while for the
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HRF dataset, the values are 13.34 and 13.60 pixels, respectively. Regarding Fovea center
localization, the values are 41.87 and 22.36 pixels for the IDRiD dataset, respectively. Those
median localization results show that 50.0 % of the predicted OD centers have been located
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within 16.45 and 13.60 pixels from the true locations in the IDRiD and HRF datasets,
respectively, and a larger value of 22.36 pixels for the Fovea center localization in the IDRiD
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dataset. Those results are generally regarded as satisfactory for center localization, especially
considering the high spatial resolution of the original fundus images of up to 4288 × 2848
and 3504 × 2336 pixels. Qualitative localization results are shown in Fig. 9, for both OD
and Fovea localization. For OD localization (see in Fig. 9 (left) and Fig. 9 (middle)) ED
errors are 16.55 and 13.60 pixels. However, visually they are located inside the OD and
25
slightly deviated from the true locations. Similarly, the detected Fovea center is also slightly
deviated (22.02 pixels) from the true location (see Fig. 9 (right)) but also visually acceptable.

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Figure 9: Three examples of qualitative results where true and predicted markers are denoted in blue and
green, respectively. The Left and middle images show OD center estimation in the IDRiD and HRF datasets,
respectively, and the right image depicts the Fovea center localization in the IDRiD dataset.

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Additional qualitative results for the OD and Fovea center localization are presented in
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Fig. 10 showing results for different EDs and datasets. Fig. 10 shows qualitative localization
results under different conditions. The OD results in Fig. 10 (a) (first row-third column)
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show that the HE is more visible than the OD, but still, DRNet can detect the location of
OD center with ED of 16.4 pixels (less than the median value). The last column of Fig. 10
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(a) shows a difficult case, and although a large ED is obtained, the OD is predicted inside the
real OD region. Other complex examples are also shown in Fig. 10 (b) for the HRF dataset,
with similar results of satisfactory OD localization. The DRNet also successfully locates the
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Fovea center in the complex retinal images of Fig. 10 (c), where results are satisfactory if
Fovea is well visible. As an extreme illustrative case, the last column and last row of Fig. 10
(c) shows a case where the Fovea is barely visible, but DRNet can determine the Fovea
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center reasonably accurate (error of 81.32 pixels).

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4.2.2. State-of-the-art comparison

Table 5 shows the results for OD and Fovea center localization from our proposed method
and other methods for comparison on the same datasets. We use two datasets (IDRiD
and HRF) for OD center localization, whereas a single dataset (IDRiD) for Fovea center
localization. All the published works using the HRF dataset for OD localization [56, 18, 63]

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 (a) OD center localization results of IDRiD dataset

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(b) OD center localization results of HRF dataset
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(c) Fovea center localization results of IDRiD dataset

Figure 10: DRNet Qualitative results for center localization (a) OD of IDRiD dataset, (b) OD of HRF
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dataset, and (c) Fovea center localization of IDRiD dataset. The ROIs are zoomed to better-visualize the
true (blue color) and predicted (green color) markers. ED metric is also shown overlaid.

reported accuracy as a metric to evaluate the OD center localization performance. Hence,

they are not included in Table 5, but we compare and discuss them in the current subsection.

27
Table 5: The qualitative metric (ED in pixels) from different OD and Fovea localization methods, including
the proposed DRNet. Bold-font and underline respectively denote the best and second-best metrics.

IDRiD dataset HRF dataset

Different methods
OD center Fovea center OD center
Challenge Winner [101] 25.61 45.89 -
ResNet-18 [10] 80.48 115.22 -
ResNet-50 [10] 60.32 95.45 -
RN Regressor [10] 26.12 43.46 -
Region Proposal Network [44] 32.60 52.0 -

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UNet [78] 32.61 - -
TNet [78] 24.85 - -

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Proposed DRNet (2020) 20.23 41.87 13.34

ResNet and UNet were originally proposed by He et al. [33] and Ronneberger et al. [70]
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respectively, but implemented by Babu et al. [10], for OD and Fovea center localization, and
Song et al. [78] for OD center localization. The proposed DRNet outperforms all methods,
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being better than the second-best [78] and [10] by the 18.59 % and 3.66 %, for OD and
Fovea center localization, respectively, for the IDRiD dataset. DRNet also outperforms the
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IDRiD challenge winner [101] by the margins of 21.0 %, and 8.76 % respectively for the OD
and Fovea centers. One should also note that the proposed DRNet, with the proposed skip
connection, again outperforms the traditional UNet, which again experimentally shows the
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better capability of our proposed skip connection for regaining the lost spatial information.
For OD center localization on the HRF dataset Panda et al. [56], Devasia et al. [18], and
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Rathod et al. [63] achieved accuracies of 100 %, 93.3 %, 95.0 %, respectively. In all those
works, the accuracy criteria used defines localization as correct if the detected OD center
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lies inside the OD region, without considering its distance from the true location. In that
sense, to our knowledge, this is the first work to provide OD center localization error in
pixels for the HRF dataset. Using the same accuracy criteria, our DRNet achieved 100 %
accuracy with mED of 13.60 pixels, which shows the accuracy and robustness of the DRNet
for OD center localization on the HRF dataset.

28
4.3. Limitation of DRNet
Although the overall satisfactory results obtained by the DRNet (additional results are
shown in the Appendix, Fig. A.12), Fig. 11 shows several cases where the proposed DRNet
fails to generate precise results for the segmentation of OD and localization of OD and Fovea
centers.

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Figure 11: Several examples of failing cases for the segmentation of OD (first row) and localization of OD
and Fovea by the DRNet (second and third rows), where the true and predicted markers are denoted by the
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blue and green colors, respectively.

A possible explanation for those errors could be related to the relatively small size of the
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training dataset (see in section 2), which could impact on generalization capabilities of the
network. The additional fact is that the network structure (depth, number of convolutions
and subsampling layers, and other hyperparameters) has not been explicitly tuned for the
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datasets used could also explain the small number of failed cases. However, in the future,
we will collect additional images to enhance the diversity in the training samples and search
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for suitable parameters using greedy or heuristic algorithms.

5. Conclusion

Automation in the segmentation of OD and localization of OD and Fovea centers is

crucial in CST systems, although it is very challenging due to diverse artifacts and image
29
variability. This article has automated the segmentation of OD and localization of OD
and Fovea centers by proposing an end-to-end network called DRNet. As in the proposed
DRNet, the proposed residual skip connection has shown to improve the segmentation and
localization performances comparing to traditional skip connections, as in UNet, while being
a very lightweight structure (1.0 million parameters). The proposed regression approach
using 2D heatmaps has shown to outperform existing approaches for the OD and Fovea
center localization, without the assumption of any prior OD and Fovea shape information,
even in complex cases. In the future, we will further explore and investigate the effects of

of
the number of parameters, layers, and depth of the DRNet for achieving the highest possible
performances. Since the proposed skip connection has a better-compensating capability of

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lost spatial information due to pooling in the encoder, other domains of medical images for
segmentation and localization will be used, where precise spatial information is crucial. The
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proposed DRNet will be applied to other domains for medical imaging to verify its versatility
and generability.
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Acknowledgements
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None. No funding to declare.

Declaration of Competing Interest

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The authors have no conflict of interest to disclose.

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Appendix A. Additional Segmentation and Localization Results

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Figure A.12: Additional results for OD segmentation (top), OD center localization (middle), and Fovea
center localization (bottom), where blue and green colors respectively denote ground-truth and prediction.

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 Major Highlights
1. Precise segmentation and localization of optic disc and Fovea using proposed

DRNet

2. Redesigning of skip connection, in DRNet, called residual skip connection

3. A considerable lightweight structure (fewer parameters (1.0M), shorter

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training, and testing times)

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4. Localization of optic disc and Fovea centers by proposing 2D bell-shaped

heatmaps of central landmarks

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5. A generic DRNet by image augmentation although small datasets are being
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Preprocessing
DRNet Task-1
Training phase OD Segmentation

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Task-2
Query Image OD and Fovea Localization