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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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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 learning and Natural language processing (NLP) can find
with a chronic disease which is Diabetes mellitus .This possible solutions in an efficient way. Additionally, robotics
dangerous disease can affect the heart functioning and can also added with AI which helps the doctors in a numerous
affect the eye functioning as well. Diabetes is one of the reasons way including surgery .Even though robots cannot replace
for the damage of retina and results in diabetic retinopathy. human doctors, however, they can assist them in many ways.
This infects the eye very badly and even causes blindness. AI with deep learning successfully sets a milestone in
Early detection of diabetic retinopathy can save people from different fields like dermatology, pathology, radiology,
even blindness by using laser technology. But early detection is ophthalmology etc [3].
a challenging one for the ophthalmologists with the traditional
methods. This paper review about the Diabetic Retinopathy AI plays a significant role in the field of ophthalmology
and the method of Deep Learning approach used to detect this as it depend mostly on image based diagnosis [4]. Eye
condition of eye accurately with less expense and time. diseases are generally combined with age related diseases
Convolutional neural networks are used to classify the stages of like diabetics. Early detection of this type of illness can
Diabetic Retinopathy. Moreover, the classification of DR prevent even the loss of eyesight. Deep Learning (DL) which
according to the severity of the condition of DR is also is mentioned earlier can be used to detect several eye
discussed. This all process can be done with the help of Fundus problems with the help of Fundus photography. Diabetic
photography retinopathy is a common disease which affects millions of
Keywords— Deep Learning, Convolutional Neural Networks,
people as most of the aged people and even the adults are
Diabetic Retinopathy, Fundus photography suffering with diabetic mellitus. Conventional method of
treating diabetic retinopathy is time consuming, expensive
Introduction and low efficient as it doesn‟t have an accurate data for
Artificial Intelligence (AI) becomes the most common classification of severity of disease[5]. Diabetic retinopathy
word in this rapidly developing world as the technology is results in swelling of blood vessels in retina and leads to
improving day by day. AI is the technology used to perform leakage of blood. Thus early detection of this chronic illness
tasks of human beings by the help of machines which are is vital [6]. Convolutional neural network (CNN) is a highly
developed with algorithms and programming. As AI is effective deep learning based method and it is cost effective
performing tasks which need human intelligence therefore image based analysis to detect eye diseases. Deep learning
the term itself contains the word „intelligence‟. The based algorithm can classify the DR according to the severity
suggestion of Artificial intelligence is not so recent. There of the condition.
are so many fields which need human hands replaces AI
since 1960s.AI is more powerful and attractive recently I. BRIEF OUTLINE OF DIABETIC RETINOPATHY
because of the availability of strong and economical
computing hardware and software. Moreover, the researchers Millions of people around the world are affected with
are developing improved algorithms to perform chores which diabetes mellitus which results in serious health problems.
need human intelligence. AI is emerging faster into many One of the most common diseases affected due to diabetes is
fields and results even more perfection than the one with Diabetic retinopathy (DR). Retina of the eye damages by the
human hands. The most recent field in which AI researchers swelling of blood vessels which leads to leakage of fluid and
concentrating more is healthcare and medicine like image blood [7]. Some lesions like exudates, haemorrhages,
based diagnosing, online consultation and even in microaneuryms etc. occurs in the retinal area. This gradually
administration[1]. results in the loss of vision if the stage becomes worse. The
Health care can use AI for number of needs which could severity of this disease is classified into several levels. These
benefit in positive ways. Some of the multinational are:-
companies like IBM also contribute more on AI for the a) Non proliferative Diabetic Retinopathy (NPDR): -
improvement of clinical sector . They developed a No symptoms are present in the retinal area which may or
technology named Watson for diagnosing cancer patients by may not lead to mild NPDR.
collecting data from patients, analyse from this information
and giving opinions with the help of data received from the b) Mild non proliferative Diabetic retinopathy: - At
concerned doctors. Most of the developing and developed least one microaneuryms exists in or around retina. All other
countries are now adapting AI for efficient healthcare lesions may or may not present .This simple phase of DR is
system. Thus AI can do the most complex work in a quick, affected by half of the diabetic people around the world.
efficient and cost effective manner even better than
humans[2].AI works together with machine learning, deep

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c) Moderate non proliferative Diabetic retinopathy: - This same process is done in classifying the levels of
In this stage numerous retinal haemorrhages and Diabetic retinopathy according to the severity of the disease.
microaneurysms are found which may leads to next stage in The retinal images captured with the help of fundus cameras
3-5 years if not treated. are given as input. These images are passed to several
processes including filtering. The final results are the
d) Severe non proliferative Diabetic retinopathy: - classification of different stages of DR[10].
High number of lesions can be seen in this stage and also
cotton wool spots can be seen in almost every part of retina. Fundus Photography: It is the procedure of capturing two
dimensional images of retina and other parts of eye using
e) Proliferative Diabetic retinopathy (PDR): - This is retinal cameras. These photographs are examined using CNN
the last stag of DR which damages the retina and some extra to detect diabetic retinopathy which results in blindness.
blood vessels also grow in and around retina. The blood Earlier, for taking photographs of eye parts a liquid is used to
vessels may leak blood and fluids which results in swelling widen the pupil which as time consuming and painful
of retina and develops unwanted blood vessels in and around .Fundus photography completes within two to three minutes
retinal and it uses a beam of reflected light to take the photographs
area

Fig 1: Stages of Diabetic Retinopathy Fig 2. Blockchain of DR detection


There is a high chance that people with long term
diabetes can cause any of the above symptoms. Longer the A. The detection method and process
duration of this disease, higher the chance to affect DR. Fig 1 Fig 2. Shows a simple block chain of the whole process
shows the different stages of DR. of classifying the stages of DR. There is a large dataset is
needed for deep learning to training and testing. Here Kaggle
II. TREATMENT dataset is used for detection. Kaggle dataset is a publicly
The traditional method of diagnosis is done by available retinal image. It contains both healthy and infected
ophthalmologists. They put a drops into the eye for widen images of numerous diabetic people around the world. There
the pupil so that the retina can be easily seen through a are more than 80,000 retinal images in Kaggle dataset[11].
special lens. They came to know about any blood vessels a) Input
leakage or any extra blood vessels etc. The also do eye
angiography for any further observation. A flourescent like These fundus photographs of both healthy and diabetic
fluid is injected into the blood veins of upper arm and took patients are available in public. This fundus images are given
photo of the retinal area. Thus the ophthalmologist can as input in this proposed method. Kaggle dataset consists of
clearly see what parts of the eye gets infected and decide the colour images with different widths, resolution and weights
further treatments. This usually takes more time, observation which are then filtered before passing to the neural networks.
and money[6]. The images are labelled from 0 to 4 (NPDR, mild NPDR,
moderate NPDR, severe NPDR and PDR).
This can be resolved by the approach of Artificial
Intelligence with the help of machine learning and deep b) Image Pre-processing
learning[8]. This method is more efficient and cost effective. In this section, the images are filtered by removing noises
It will take only less time as well. Machine learning is the and other unwanted features. All images are of different
branch of AI which allows system to learn and improve from resolutions when they are passing to pre-processing stage. So
experience without human hands. However, deep learning is the work of this stage is to make sure that all images are of
the upgraded version of machine learning which acts like same resolution and there are no unwanted features other
human brain to make decisions. Deep learning uses artificial than the retinal areas[12]. The photographs are cropped and
neural networks to deeply evaluate the processes and make cut out the remaining areas and highlight the useful areas by
decisions more accurately and efficiently. In deep learning, blurring the background. Thus more clear and perfect images
there are a number of neural networks which extracts the are obtained to test. Some filters like Gaussian filter is used
useful data from the given input by several processes and to noise reduction and fixing the resolution. Rescaling,
pass to the classifier. This method took comparatively more rotation, flipping, adjusting brightness and contrast
time than machine learning and use complex algorithms, but enhancement are done during data augmentation. Images are
results more efficiently and accurately. Deep learning only subjected to normalization as well. Normalization eliminates
focuses on the useful information from the input data by the flaws in the images and resize into wanted dimensions.
eliminating the unwanted information. This is done by the This resized images, with perfect dimension and highlighting
Convolution neural networks[9]. features like blood vessels, micro aneurysms etc., are then
passed to the Convolutional neural network architecture for e) Softback layer or classification layer: - This layer
further process and classification. comes after fully connected layers and all other complex
architecture of CNN. Fundus images are classified in this
c) Convolutional Neural Network (CNN) layer.
CNN is the deep learning based method which is widely
used and contains series of convolutional layers. CNN are B. Hardware and Software
used mostly for image based processing and classification.
CNN architecture runs on NVDIA Graphic processing Unit
CNN focus on the tiny portions of the input instead of
looking a whole image. The input given to CNN will filtered and an Intel core i7 CPU. The programming language used
in each layer using kernels and gives a robust and accurate is Python programming language and runs on PyCharm
result in the end. Convolution layer, pooling layer and fully platform
connected layer are the three types of main layers included in C. Performance assessment
CNN[13].
In deep learning, most frequently used performance
evaluation are specificity, sensitivity and accuracy.

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.
Fig 4. Performance measurement
a) Convolution layer: - This layer is the initial layer TP, TN, FP, FN are the parameters used in the evaluation of
and the pre-processed input is firstly given to this layer[13]. specificity, sensitivity and accuracy.TP or True Positive is
Each convolution layer consists of local receptive field and the number of perfectly identified DR pictures. True
shared weights and biases. Foundation of the neural layers is Negatives or TN is the number of perfectly detected non DR
these two. During classification. Tiny characteristics of the picures. False Positive or FP is the number of wrongly
image are identified by the help of different layers of neuron. detected DR images as positive which is actually non DR.
Convolutional layer contains Kernel, which is the filter. False Negative or FN is the number of wrongly detected non
Kernel extracts the features of the input image and forms ne DR which is actually DR. Fig 4 shows the measurements
activation map. Each of these maps represents different using these parameters. Sensitivity is the percentage of
characteristics of the image. These layers are set before
positive cases and specificity is the percentage of negative
pooling layers. Some most important features are
characterised in this combined convolution layers before cases. Accuracy is the percentage of correctly identified
moving to pooling. cases.

b) Pooling layer: - Pooling layer is the most important By using the Kaggle dataset in this automated CNN
layer in this complex architecture. This layer prevent over complex architecture, an accuracy of 80 to 90 % can be
fitting by computation process. Pooling layer selects most obtained.
useful features. This layer generally check whether some of
the characteristics in the image are present or not, CONCLUSION AND FUTURE WORKS
Rectified Linear Unit Level (ReLU) is an activation AI is emerging dramatically into the various fields of
function which is in the form of layer. This activation healthcare. In this rapidly growing world AI is playing a
function can improve the efficiency of the end result. major role in lifting up the health sector in a safe and robust
way. In addition, it requires less time, cheap and gives
c) Dropout layer: - This layer reduces the over fitting powerful results. In this paper, proposed an idea of
in fully connected layers by using regularization technique. identifying diabetic retina with the help of deep learning.
There is a chance of increased number of parameters. This Around 40 percentages of the diabetic patients are suffering
can be avoided by this dropout layer[14]. with diabetic retinopathy which even leads to blindness. This
d) Fully connected layer: - Fully connected layer issue can be resolve using the above mentioned CNN
comes after convolutional and pooling layers. All neurons of technology. Early detection is vital for this illness and can be
the last layer are connected to this layer‟s neurons. The main cured by laser technology. CNN based medical imaging
classification process is done in this layer. This layer looks diagnosis is more effective nowadays and can be solved
like one dimensional and is not connected to any other quickly and easily. There is no traditional and manual
layers. 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] Daniel Shu Wei TING MD PhD, Louis R PASQUALE MD, Lily
diabetes mellitus can be done as this method is cost effective. PENG MD PhD, Peter CAMPBELL MD MPH, Aaron LEE MD
MSc, Rajiv RAMAN MS DNB, Gavin Siew Wei TAN MD, Leopold
This brings a relaxation for both patients and concerned SCHMETTERER PhD,7-9 Pearse A. KEANE MD FRCO, Tien Yin
doctors. WONG MD PhD, ”Artificial Intelligence and Deep Learning in
Ophthalmology” , October 2018
The ophthalmologists should try to utilise this
[5] Su Jeong Song, Tien Yin Wong “Current Concepts in Diabetic
fundus photography and AI system so that they can save Retinopathy” December 2014
more lives without going into dark. Moreover, local optical [6] G.S. Scotland, ”Costs and consequences of automated algorithms
centres can invest on fundus cameras so that they can versus manual grading for the detectionof referable diabetic
identify more number of diabetic retinopathy victims. retinopathy” Br J Ophthalmol, 94 (6) (2010), pp. 712-719
Additionally, in future three dimensional images of retina [7] Zsolt Torok, Tunde Peto, Eva Csosz, Edit Tukacs, Agnes M. Molnar,
could replace the current two dimensional images which may Andras Berta,Jozsef Tozser, Andras Hajdu, Valeria Nagy, Balint
results in more accuracy percentage. As this method is cost Domokos, and Adrienne Csutak “Combined Methods for Diabetic
Retinopathy Screening, Using Retina Photographs and Tear Fluid
effective, this method can adapt in rural areas. Thus obtain Proteomics Biomarkers” September 2014
large datasets to apply this method in future with upgraded [8] Y. Guo, Y. Liu, A. Oerlemans, S. Lao, S. Wu, M.S. Lew “Deep
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(2016), pp. 27-48
ACKNOWLEDGMENT [9] A. V Vasilakos, Y. Tang, Y. Yao “Neural networks for computer-
aided diagnosis in medicine : a review” Neurocomputing, 216 (2016),
I would like to express my sincere gratitude to my pp. 700-708
professor Dr Philip Davies and my advisor Festus Adedoyin [10] G.Gardner,D.Keating, T.H.Willamson, A.T.Elliott,
for the continuous support throughout this research. “Automaticdetection of diabetic retinopathy using an artificial neural
Moreover ,I thank my classmates for supporting me without network: a screening Tool”, Brithish Journal of
Opthalmology,(1996);80:940-944
any hesitation .
[11] Kaggle dataset[Online]. Available https://kaggle.com/c/diabetic-
retinopathy-detection
REFERENCES [12] S. Dutta, B.C. Manideep, S.M. Basha, R.D. Caytiles, N.C.S.N.
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1958

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