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Classification of stages of Diabetic Retinopathy using Deep Learning

Preprint · December 2020

DOI: 10.13140/RG.2.2.10503.62883

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Bournemouth University
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 Classification of stages of Diabetic Retinopathy
using Deep Learning
Nimmisha Shajihan
Department of computing and
informatics
Bournemouth University
United Kingdom
s5320644@vournemouth.ac.uk
Abstract—Nowadays most of the aged people are struggling
with a chronic disease which is Diabetes mellitus .This
dangerous disease can affect the heart functioning and can
affect the eye functioning as well. Diabetes is one of the reasons
for the damage of retina and results in diabetic retinopathy.
This infects the eye very badly and even causes blindness.
Early detection of diabetic retinopathy can save people from
even blindness by using laser technology. But early detection is
a challenging one for the ophthalmologists with the traditional
methods. This paper review about the Diabetic Retinopathy
and the method of Deep Learning approach used to detect this
condition of eye accurately with less expense and time.
Convolutional neural networks are used to classify the stages of
Diabetic Retinopathy. Moreover, the classification of DR
according to the severity of the condition of DR is also
discussed. This all process can be done with the help of Fundus
photography
Keywords— Deep Learning, Convolutional Neural Networks,
Diabetic Retinopathy, Fundus photography
Introduction
Artificial Intelligence (AI) becomes the most common
word in this rapidly developing world as the technology is
improving day by day. AI is the technology used to perform
tasks of human beings by the help of machines which are
developed with algorithms and programming. As AI is
performing tasks which need human intelligence therefore
the term itself contains the word „intelligence‟. The
suggestion of Artificial intelligence is not so recent. There
are so many fields which need human hands replaces AI
since 1960s.AI is more powerful and attractive recently
because of the availability of strong and economical
computing hardware and software. Moreover, the researchers
are developing improved algorithms to perform chores which
need human intelligence. AI is emerging faster into many
fields and results even more perfection than the one with
human hands. The most recent field in which AI researchers
concentrating more is healthcare and medicine like image
based diagnosing, online consultation and even in
administration[1].
Health care can use AI for number of needs which could
benefit in positive ways. Some of the multinational
companies like IBM also contribute more on AI for the
improvement of clinical sector . They developed a
technology named Watson for diagnosing cancer patients by
collecting data from patients, analyse from this information
and giving opinions with the help of data received from the
concerned doctors. Most of the developing and developed
countries are now adapting AI for efficient healthcare
system. Thus AI can do the most complex work in a quick,
efficient and cost effective manner even better than
humans[2].AI works together with machine learning, deep
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learning and Natural language processing (NLP) can find
possible solutions in an efficient way. Additionally, robotics
also added with AI which helps the doctors in a numerous
way including surgery .Even though robots cannot replace
human doctors, however, they can assist them in many ways.
AI with deep learning successfully sets a milestone in
different fields like dermatology, pathology, radiology,
ophthalmology etc [3].
AI plays a significant role in the field of ophthalmology
as it depend mostly on image based diagnosis [4]. Eye
diseases are generally combined with age related diseases
like diabetics. Early detection of this type of illness can
prevent even the loss of eyesight. Deep Learning (DL) which
is mentioned earlier can be used to detect several eye
problems with the help of Fundus photography. Diabetic
retinopathy is a common disease which affects millions of
people as most of the aged people and even the adults are
suffering with diabetic mellitus. Conventional method of
treating diabetic retinopathy is time consuming, expensive
and low efficient as it doesn‟t have an accurate data for
classification of severity of disease[5]. Diabetic retinopathy
results in swelling of blood vessels in retina and leads to
leakage of blood. Thus early detection of this chronic illness
is vital [6]. Convolutional neural network (CNN) is a highly
effective deep learning based method and it is cost effective
image based analysis to detect eye diseases. Deep learning
based algorithm can classify the DR according to the severity
of the condition.
I. BRIEF OUTLINE OF DIABETIC RETINOPATHY
Millions of people around the world are affected with
diabetes mellitus which results in serious health problems.
One of the most common diseases affected due to diabetes is
Diabetic retinopathy (DR). Retina of the eye damages by the
swelling of blood vessels which leads to leakage of fluid and
blood [7]. Some lesions like exudates, haemorrhages,
microaneuryms etc. occurs in the retinal area. This gradually
results in the loss of vision if the stage becomes worse. The
severity of this disease is classified into several levels. These
are:-
a) Non proliferative Diabetic Retinopathy (NPDR): -
No symptoms are present in the retinal area which may or
may not lead to mild NPDR.
b) Mild non proliferative Diabetic retinopathy: - At
least one microaneuryms exists in or around retina. All other
lesions may or may not present .This simple phase of DR is
affected by half of the diabetic people around the world.
 c) Moderate non proliferative Diabetic retinopathy: -
In this stage numerous retinal haemorrhages and
microaneurysms are found which may leads to next stage in
3-5 years if not treated.
d) Severe non proliferative Diabetic retinopathy: -
High number of lesions can be seen in this stage and also
cotton wool spots can be seen in almost every part of retina.
e) Proliferative Diabetic retinopathy (PDR): - This is
the last stag of DR which damages the retina and some extra
blood vessels also grow in and around retina. The blood
vessels may leak blood and fluids which results in swelling
of retina and develops unwanted blood vessels in and around
retinal
area
Fig 1: Stages of Diabetic Retinopathy
There is a high chance that people with long term
diabetes can cause any of the above symptoms. Longer the
duration of this disease, higher the chance to affect DR. Fig 1
shows the different stages of DR.
II. TREATMENT
The traditional method of diagnosis is done by
ophthalmologists. They put a drops into the eye for widen
the pupil so that the retina can be easily seen through a
special lens. They came to know about any blood vessels
leakage or any extra blood vessels etc. The also do eye
angiography for any further observation. A flourescent like
fluid is injected into the blood veins of upper arm and took
photo of the retinal area. Thus the ophthalmologist can
clearly see what parts of the eye gets infected and decide the
further treatments. This usually takes more time, observation
and money[6].
This can be resolved by the approach of Artificial
Intelligence with the help of machine learning and deep
learning[8]. This method is more efficient and cost effective.
It will take only less time as well. Machine learning is the
branch of AI which allows system to learn and improve from
experience without human hands. However, deep learning is
the upgraded version of machine learning which acts like
human brain to make decisions. Deep learning uses artificial
neural networks to deeply evaluate the processes and make
decisions more accurately and efficiently. In deep learning,
there are a number of neural networks which extracts the
useful data from the given input by several processes and
pass to the classifier. This method took comparatively more
time than machine learning and use complex algorithms, but
results more efficiently and accurately. Deep learning only
focuses on the useful information from the input data by
eliminating the unwanted information. This is done by the
Convolution neural networks[9].
This same process is done in classifying the levels of
Diabetic retinopathy according to the severity of the disease.
The retinal images captured with the help of fundus cameras
are given as input. These images are passed to several
processes including filtering. The final results are the
classification of different stages of DR[10].
Fundus Photography: It is the procedure of capturing two
dimensional images of retina and other parts of eye using
retinal cameras. These photographs are examined using CNN
to detect diabetic retinopathy which results in blindness.
Earlier, for taking photographs of eye parts a liquid is used to
widen the pupil which as time consuming and painful
.Fundus photography completes within two to three minutes
and it uses a beam of reflected light to take the photographs
Fig 2. Blockchain of DR detection
A. The detection method and process
Fig 2. Shows a simple block chain of the whole process
of classifying the stages of DR. There is a large dataset is
needed for deep learning to training and testing. Here Kaggle
dataset is used for detection. Kaggle dataset is a publicly
available retinal image. It contains both healthy and infected
images of numerous diabetic people around the world. There
are more than 80,000 retinal images in Kaggle dataset[11].
a) Input
These fundus photographs of both healthy and diabetic
patients are available in public. This fundus images are given
as input in this proposed method. Kaggle dataset consists of
colour images with different widths, resolution and weights
which are then filtered before passing to the neural networks.
The images are labelled from 0 to 4 (NPDR, mild NPDR,
moderate NPDR, severe NPDR and PDR).
b) Image Pre-processing
In this section, the images are filtered by removing noises
and other unwanted features. All images are of different
resolutions when they are passing to pre-processing stage. So
the work of this stage is to make sure that all images are of
same resolution and there are no unwanted features other
than the retinal areas[12]. The photographs are cropped and
cut out the remaining areas and highlight the useful areas by
blurring the background. Thus more clear and perfect images
are obtained to test. Some filters like Gaussian filter is used
to noise reduction and fixing the resolution. Rescaling,
rotation, flipping, adjusting brightness and contrast
enhancement are done during data augmentation. Images are
subjected to normalization as well. Normalization eliminates
the flaws in the images and resize into wanted dimensions.
This resized images, with perfect dimension and highlighting
features like blood vessels, micro aneurysms etc., are then
passed to the Convolutional neural network architecture for
further process and classification.
c) Convolutional Neural Network (CNN)
CNN is the deep learning based method which is widely
used and contains series of convolutional layers. CNN are
used mostly for image based processing and classification.
CNN focus on the tiny portions of the input instead of
looking a whole image. The input given to CNN will filtered
in each layer using kernels and gives a robust and accurate
result in the end. Convolution layer, pooling layer and fully
connected layer are the three types of main layers included in
CNN[13].
Fig 3. Convolutional Neural Network Architecture
Fig 3 shows CNN technology which contains complex
neural networks or layers .Each of the layer extract the useful
information and observe the lesions in the retina which
results in the multi-level classification of DR.
a) Convolution layer: - This layer is the initial layer
and the pre-processed input is firstly given to this layer[13].
Each convolution layer consists of local receptive field and
shared weights and biases. Foundation of the neural layers is
these two. During classification. Tiny characteristics of the
image are identified by the help of different layers of neuron.
Convolutional layer contains Kernel, which is the filter.
Kernel extracts the features of the input image and forms ne
activation map. Each of these maps represents different
characteristics of the image. These layers are set before
pooling layers. Some most important features are
characterised in this combined convolution layers before
moving to pooling.
b) Pooling layer: - Pooling layer is the most important
layer in this complex architecture. This layer prevent over
fitting by computation process. Pooling layer selects most
useful features. This layer generally check whether some of
the characteristics in the image are present or not,
Rectified Linear Unit Level (ReLU) is an activation
function which is in the form of layer. This activation
function can improve the efficiency of the end result.
c) Dropout layer: - This layer reduces the over fitting
in fully connected layers by using regularization technique.
There is a chance of increased number of parameters. This
can be avoided by this dropout layer[14].
d) Fully connected layer: - Fully connected layer
comes after convolutional and pooling layers. All neurons of
the last layer are connected to this layer‟s neurons. The main
classification process is done in this layer. This layer looks
like one dimensional and is not connected to any other
layers.
e) Softback layer or classification layer: - This layer
comes after fully connected layers and all other complex
architecture of CNN. Fundus images are classified in this
layer.
B. Hardware and Software
CNN architecture runs on NVDIA Graphic processing Unit
and an Intel core i7 CPU. The programming language used
is Python programming language and runs on PyCharm
platform
C. Performance assessment
In deep learning, most frequently used performance
evaluation are specificity, sensitivity and accuracy.
Fig 4. Performance measurement
TP, TN, FP, FN are the parameters used in the evaluation of
specificity, sensitivity and accuracy.TP or True Positive is
the number of perfectly identified DR pictures. True
Negatives or TN is the number of perfectly detected non DR
picures. False Positive or FP is the number of wrongly
detected DR images as positive which is actually non DR.
False Negative or FN is the number of wrongly detected non
DR which is actually DR. Fig 4 shows the measurements
using these parameters. Sensitivity is the percentage of
positive cases and specificity is the percentage of negative
cases. Accuracy is the percentage of correctly identified
cases.
By using the Kaggle dataset in this automated CNN
complex architecture, an accuracy of 80 to 90 % can be
obtained.
CONCLUSION AND FUTURE WORKS
AI is emerging dramatically into the various fields of
healthcare. In this rapidly growing world AI is playing a
major role in lifting up the health sector in a safe and robust
way. In addition, it requires less time, cheap and gives
powerful results. In this paper, proposed an idea of
identifying diabetic retina with the help of deep learning.
Around 40 percentages of the diabetic patients are suffering
with diabetic retinopathy which even leads to blindness. This
issue can be resolve using the above mentioned CNN
technology. Early detection is vital for this illness and can be
cured by laser technology. CNN based medical imaging
diagnosis is more effective nowadays and can be solved
quickly and easily. There is no traditional and manual
process like eye angiography is needed. The whole
classification of DR can be obtained using this method. By
using this technique, regular examination of patients with [4]
diabetes mellitus can be done as this method is cost effective.
This brings a relaxation for both patients and concerned
doctors.
The ophthalmologists should try to utilise this
[5]
fundus photography and AI system so that they can save
more lives without going into dark. Moreover, local optical [6]
centres can invest on fundus cameras so that they can
identify more number of diabetic retinopathy victims.
Additionally, in future three dimensional images of retina [7]
could replace the current two dimensional images which may
results in more accuracy percentage. As this method is cost
effective, this method can adapt in rural areas. Thus obtain
large datasets to apply this method in future with upgraded [8]
algorithms.
ACKNOWLEDGMENT [9]
I would like to express my sincere gratitude to my
professor Dr Philip Davies and my advisor Festus Adedoyin [10]
for the continuous support throughout this research.
Moreover ,I thank my classmates for supporting me without
any hesitation .
[11]
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