DIABETIC RETINOPATHY

GROUP PARTICIPANTS: CHIRAG GARG, HARSH, SAHIL NEGI, MAYANK

PROBLEM STATEMENT: TO CLASSIFY DATASET IMAGES OF DIABETIC
PATIENTS INTO DIFFERENT STAGES

ABSTRACT
Diabetic Retinopathy is one of the common eye diseases and
is a diabetes complication that affects eyes. Diabetic
retinopathy may cause no symptoms or only mild vision
problems. Eventually, it can cause blindness. So early
detection of symptoms could help to avoid blindness. In this
thesis, we present some experiments on some features of
Diabetic Retinopathy like properties of exudates, properties of
blood vessels and properties of microaneurysm. Using these
features, we can classify healthy, mild non-proliferative,
moderate nonproliferative, severe non-proliferative and
proliferative stages.

INTRODUCTION
People with diabetes can have an eye disease called diabetic
retinopathy. It happens when high blood sugar levels cause damage
to blood vessels in the retina. It can damage the patient’s vision,
even leading to blindness. Our aim is to develop a system that will
be able to identify patients with Diabetic Retinopathy from retinal
colour fundus images.
● The four diabetic retinopathy stages are classified as mild, moderate,
and severe nonproliferative and proliferative. Baseline – No Diabetic
Retinopathy is found: Non-proliferative diabetic retinopathy (NPDR).
1. Mild NPDR

Mild NPDR
The first of the diabetic retinopathy stages is characterized by a balloon-like
swelling in certain areas of the blood vessels in the retina called
microaneurysms. This stage rarely affects vision or needs treatment, but it
does signal diabetes damage has occurred and an increased risk of disease
progression.
At this stage, the patient must become educated on the possible ramifications
of diabetes, while taking steps to better control their blood sugar and diet and
decrease the risk of diabetic retinopathy progression and vision loss. Entities
like health systems, health risk assessment companies, and insurance payors
should ensure that patients are getting regularly tested for the presence of
diabetic retinopathy to catch it as early as possible. Preventative screenings
performed by healthcare professionals during in-home examinations or in
primary care visits are excellent ways to catch diabetic retinopathy as early as
possible in a way that saves money and patient time.

2. Moderate NPDR
Moderate NPDR
The next diabetic retinopathy stage is characterized by damage to some of the
blood vessels in the retina, resulting in leakage of blood and fluid into the
retina tissue. This fluid can cause a loss of vision.
The use of fundus photography during a retinal screening, either as a part of
an in-home evaluation or at a healthcare organization, can allow patients to
receive a quick and accurate evaluation. When needed, referral to a specialist
for further evaluation and possible treatment may be appropriate and
recommended. Better control of blood sugar and obtaining further evaluation
are key to potentially improving and ultimately saving the patient’s sight.

3. Severe NPDR

Severe NPDR
If there is continued inadequate control of diabetes, more blood vessels are
damaged and blocked with even more leakage of blood and fluid into the
retina, resulting in a much greater impact on vision. At this stage, a timely
referral to an eye specialist is nearly always appropriate. The good news is that
often, some, if not all, of the lost vision can be improved with appropriate
treatment.
4. Proliferative Diabetic Retinopathy

Proliferative Diabetic Retinopathy

The final stage of Diabetic Retinopathy is Proliferative Diabetic Retinopathy. At
this point, the disease has advanced significantly and is very threatening to
one’s vision. Because of additional damage to the eye’s blood vessels, there is
worsening circulation inside the eye. In response, the retina then grows new
blood vessels; however, they are abnormal and can cause severe damage,
possibly resulting in vision loss and potentially blindness.
At this stage, patients require immediate referral to a retina specialist for
further examination and treatment.
LITERATURE SURVEY
● PAPER ONE:
# literature review of predicting diabetic retinopathy, nephropathy and
neuropathy in patients with type 1 diabetes using machine learning
Methods: A targeted review of English literature was undertaken in PubMed
(http://www.ncbi.nlm.nih.gov/pubmed) and Google Scholar (http://scholar.google.com/)
from January 1, 2016 to May 31, 2019. Eligible articles were also identified from cross-
references. Following concepts were used in combination to conduct the search queries:
diabetes, retinopathy, nephropathy, neuropathy, microvascular complication, risk/predictive
model, and ML/artificial intelligence/data mining.

Results: A total of 3,769 hits were found from all sources combined, duplicates were
removed, titles and abstracts were screened, 61 studies underwent full-text review and a
total of six studies met the eligibility criteria. Among them, four studies had developed risk
models using data obtained from T1D patients alone, whereas two used data from both T1D
and type 2 diabetes (T2D) patients. There was only one study that evaluated all three types
of microvascular complications while the other five focused on one individual complication,
i.e., either diabetic retinopathy, nephropathy or neuropathy. Only two studies evaluated
time to developing a complication. The other four studies assessed complications as either
binary (yes/no) or categorical (multiple levels). Prediction models were built using cross-
sectional data from survey questionnaire (n=1, Iran) and longitudinal data (n=5) which were
further classified as sources of electronic medical records (EMR) (n=3, US: 1, Europe: 2),
clinical trial (n=1, US) and prospective study (n=1, Europe). Common predictors across
studies as well as across types of microvascular complications included age, gender, diabetes
duration, BMI, blood pressure, lipid level, and mean or a single HbA1C value. Commonly
used ML algorithms included classification and regression tree (CART) and random forest
(RF) (CART/RF, n=3), support vector machines (SVMs, n=2), logistic regression (LR, n=2) and
neural networks (NNs, n=1). Model performance was evaluated using area under curve
(AUC, n=4) and accuracy (n=2). Only half (n=3) of the included studies tested their developed
models in an external dataset of patients with T1D.

● paper two
# Literature Review on Diabetic Retinopathy Using an Artificial
Intelligence Approach
Automated methods for DR identification play a significant role in the early diagnosis
of DR. A detailed review has been carried out, including 178 research studies found
in Scopus, WOS, ophthalmology journals, Jama, PubMed, etc., to find the primary
studies using the PRISMA approach. This review critically focuses on publicly
available datasets, classification techniques used in ML and DL, and various
traditional and currently used feature extraction methods, followed by various
performance metrics used in DR. Traditional and novel biomarkers used in DR are
highlighted. This study discovered and reported on several publicly available
datasets with distinctive properties. In ML-based techniques, better performance is
 given by statistical-based characteristics also followed by shape and structure. ANN
gives better performance for classification over SVM and, in the case of ML
techniques, ensemble classifiers perform better. When this concerns DL, CNN was
primarily applied to automatically extract and categorize the DR images. Accuracy,
sensitivity, specificity, and area under the curve are the widely used performance
metrics in DR. This review also described four novel research challenges in the DR
detection field. This comprehensive review provides a profound overview of the
topic of DR detection approaches and helpful insights to researchers working in this
field. The scope of the evaluation can be expanded in the future to overcome
limitations. Concepts such as transfer learning, ensemble learning, explainable AI,
multi-task learning, and domain adaptation can be widely used in the future to
detect DR at its early stages. Intelligent health monitoring technologies decrease the
time to detect diagnoses, sparing ophthalmologists’ time and cost, and allowing
patients to communicate more quickly.

● paper three
Literature Survey on Deep-Learning-Based Diabetic Retinopathy
Classification
Diabetic retinopathy detection methods are performed on datasets of two
classes that represent the images with diabetic retinopathy and the images
without diabetic retinopathy. To show that, they compare some DR-detection-
based studies. Most studies used Kaggle’s APTOS and EyePACS datasets, due
to their size, which is large compared to the others. The binary classification to
detect the fundus images that have DR lesions and, thus, detect the presence
of DR is performed by the proposed methods. For that reason, we can see that
all the methods can classify diabetic retinopathy with good performance in
accuracy, while the sensitivity and specificity values were not mentioned in
some of the studies. From the table of the obtained results using the
proposed method on the Kaggle APTOS dataset, we can find that they
achieved the best accuracy value of 94% with a difference of 4% better than
the accuracy obtained and more than 8% for the other methods. Using the
sensitivity and specificity metrics, the method achieved the best results. On
the MESSIDOR and MESIDOR2 datasets, the methods used achieved the best
accuracy, respectively. However, we can see that, for MESSIDOR2, the
accuracies were lower than the obtained accuracies on MESSIDOR, due to the
fact that the size of MESSDOR2 is larger than MESSIDOR, which can explain
the difference between the accuracy on MESSDOR2 being 91% and 99% on
MESSIDOR. The same observation is made for Kaggle EyePACS, which is a
large-scale dataset; the accuracy performances were generally less than 91%
except they achieved an accuracy of up to 97%. For all the datasets including
STARE, HRF, and IDRid, the performance of the proposed methods needs
 improvements due to the importance of the topic, as well as the impact of the
error if these techniques are used in real-world diagnostics.

● paper four
Deep learning is regarded as an effective technique for offering technical solutions in
disease prediction and classification. This study discusses various machine and deep
learning techniques for the early diagnosis of diabetic retinopathy. These studies
were conducted in various geographical locations wherein various DL applications for
medical image processing were implemented in the last century. DL has been used
to achieve DR identification solutions employing medical imaging techniques such as
classification, detection, segmentation, and registration. But, all these various
applications of DL incorporating medical image processing methods require
enhancement in accuracy, performance, and reduction in computational cost. This
study presents an exhaustive review of the various deep learning and image
processing-based techniques and relevant applications of the same in DR detection.
It also enlists the challenges identified in the earlier studies, namely, relevant to the
availability of real-time data, computational power, network size, and various others.
Finally, the study mentions certain recommendations for future scope in research
that would enable diabetic retinopathy detection at an early stage. These research
detections involved facilitating effective hybridization techniques and the
implementation of advanced hyperparameter tuning methods to overcome some of
the prominent challenges identified in DR detection using DL techniques.

● paper five
The study was initiated by collecting DR datasets from different sources and by clinical
experts labeling the dataset. The state-of-the-art deep learning model is developed. The
model is trained and validated on the labelled dataset, which achieved an accuracy of
93.40%, a sensitivity of 97.42%, and a specificity of 89.45%. The model was deployed, and
the patients were tested in real time at SIOVS. The high quality of the images is ensured by
the intelligent system. The images are classified into DR-Positive and DR-Negative ones by
the model, which are further analyzed by clinical experts to evaluate the performance of the
model in real time. Based on the results of the clinical experts, the model achieves an
accuracy of 93.30%, a sensitivity of 97.30%, and a specificity of 92.90%. The value of the AUC
for all the patients and the male and female patients as well shows the impressive
performance of the model.
paper name sample size data technology used evaluation sensitivity specificity accuracy
source
name
A Prospective 11,525 fundus Diabetic DR 97.30% 92.90% 93.72%
Study on Diabetic confusion images. Retinopathy screening sensitivity. specificity. accuracy.
Retinopathy matrix, 398 screening, of 89.47%
Detection Based samples for convolutional was
on Modify type 2 neural network, recorded
Convolutional (57,625 DR deep learning,
Neural Network images.) ophthalmology.
Using Fundus
Images at Sindh
Institute of
Ophthalmology
& Visual
Sciences.
Awais Bajwa,
Methodology,
Neelam
Nosheen, Data
curation, Khalid
Iqbal Talpur,
Validation,
Sheeraz Akram
(2023)
Deep Learning internal fundus CNN, transfer Hyper- Sensitivity  Specificity  Accuracy 
and Medical validation images. learning, DNN, parameter = 99 = 98 = 99
Image 3678 and EyePACS ML tuning
Processing external dataset inception
Techniques for validation from the V4 model
Diabetic 2345 Kaggle yielded
Retinopathy: A repository. the best
Survey of results
Applications,
Challenges, and
Future Trends.
Posham
Uppamma,
Sweta
Bhattacharya
(2023)
Diabetic 2500 fundus fundus CNN, image Model recall _ accuracy
Retinopathy photographs, images. classification Testing score rating
Detection Using 1000 for and feature With 20 0.9147 0.8441
Machine model extraction epochs,
Learning-G. U. training and 91.5
Parthasharathi, 200 external accurate
K. Vasantha images for and loss
Kumar, Prem testing 3.8%.
Nivas R, Jasmine
Kj (2022)
Diabetic The Kaggle fundus Diabetic features Recall Hybrid the
Retinopathy dataset images. Retinopathy, calculated score of approach- highest
Detection using contain 1000 KNN, SVM, and feed 0.8116 precision accuracy
Machine images with Random Forest to both 0.8119, f- values
Learning diabetic SVM, KNN, measure 82%
Authors : retinopathy Random score of
Revathy R , and 1000 Forest 0.8028.
Nithya B S , images classifier.
Reshma J J , without
Ragendhu S S, diabetic
Sumithra M D retinopathy.
(2020) From the total
images we
have chosen
122 images
with diabetic
retinopathy
and 122
normal
images.
MOTIVATION
MotivationDiabetic Retinopathy (DR) is one of the common eye
diseases andis a diabetes complication that affects eyes.
Diabetic retinopathy may cause no symptoms or only mild vision
problems.
Eventually, it can cause blindness. So early detection of symptoms
could help to avoid blindness

OBJECTIVES
Process colour fundus retinal images for Diabetic Retinopathy
Detection.
Extract key features from the pre-processed images.
Detects the presence of Diabetic Retinopathy.Classify whether the
Diabetic Retinopathy Mild, Moderate, Severe Proliferative.
 RESEARCH GAP
The pertinence of machine learning for further research in healthcare settings is necessary, and the
utilization of automated screening processes should be there to diagnose the disease in the early
stages. To find lesions in fundus images and grade these fundus images for disease severity. These
identified images can then be referred to human experts for review, reducing their burden,
examining time, and avoiding further complications by giving them timely prompt treatment.

The adoption of OCT with DR is still in its infancy for screening purposes. However, developing the
automated DR classification provides better results in terms of various performance metrics. Smart
healthcare solutions are available in various ophthalmic practices. However, decision making can be
improved by making use of clinical data that has been stored electronically in a large amount.

Challenges exist for DR research in ophthalmology. So, implementing an AI program with DR results
in automatic grading of DR. However, the more the number of training images, the better the
prediction is obtained. Detection of OD, Blood vessels, etc., to provide a single technique to cover
retinal structure and changes. Various imaging modalities do not predominantly capture the
peripheral lesions. To improve the outcomes, there is a need for improved detection and
classification of DR.

The efficiency of the training dataset reduces due to the inordinate dataset. Moreover, external
validity should be done on wide demographic images. So the algorithm should be designed so that it
may not be broadly applicable. The rapid expansion of this program over the next 5 years into a
clinical environment would include a new interpretation of success and a deeper understanding of
clinically relevant knowledge in digital imaging.

AI is a complicated field of research. It can create various science fields such as computer and
medical science. The research associated with the fields is focused and applicable to a particular
field. Future research focuses on the amalgamation of both fields to reduce the heterogeneity
between the fields.

There are various challenges associated with this disease. However, one such challenge includes the
improvement in the screening of DR. Thereafter, cost-effective treatments need the hour to
automate the system by extracting the pathologies that appear in the retinal surface. The
advancement of community-specific retinal imaging solutions, such as cell phone technology for
mHealth, and the enhancement of image quality and diffusion technology promise to resolve the
problem of obtaining affordable, high-quality retinal images.

Present studies focus on NPDR lesions for detecting DR. Additional lesion measurement can be
implemented in the current classification system for accurate characterization of NPDR.

Various other techniques are associated with better visualization of retinal circulation, such as
adaptive optics, SS-OCT. Therefore, there is an urge to determine new biomarkers, genetic
determinants, and retinal markers to understand pathogenesis better.
MODEL DESIGN
Convolution NN (Harsh)

Alexnet (Sahil Negi)

InceptionV3 (Chirag Garg)
EfficientNet (Mayank)
 Proposed Methodology

Figure 13 METHODOLOGY

This section describes the steps involved in prediction of diabetic retinopathy. Model diagram shows
the workflow Image collection is the beginning step, where different fundus images of patients are
collected to be further analysed. After collecting and analysing the data, it is pre-processed for
model training. Model training includes the use of machine learning algorithms to process the pre-
processed data. After the model is trained, the dataset is then split into Train and Validation. The last
step includes model evaluation in which the overall model is mapped around different scores for
overall analysis

A. IMAGE COLLECTION AND PROCESSING

We took a data of 35000 fundus images from kaggle and worked on it. Fundus images are typically
processed before being used in a machine learning model to extract relevant features and reduce
noise. Fundus imaging allows the identification of the main ocular structures, such as the optic disc
(OD), optic disc cup (OD-cup), macula region , fovea, and blood vessels . This test may also detect
abnormal conditions, including microaneurysms, bleeding, exudates, and cotton wool spots. As for
the main advantages of retinal imaging, the non-invasiveness, safety, low cost, ease of adoption by
ophthalmologists for diagnosis purpose, full coloration, and better detection of disk haemorrhage
may be highlighted.[8]

Above fig shows that after processing data which and what kind of images were labelled as 'No_DR',
'Mild', 'Moderate', 'Severe', 'Proliferate_DR'.
 B. IMAGE PRE-PROCESSING

For image pre-processing, we used the methods of augmentation to increase the size and diversity
of the training dataset, data augmentation techniques such as rotation, flipping, and cropping may
be applied, normalisation so that the brightness and color balance of the image are normalized to
account for differences in lighting conditions and camera settings and rescaling which is the
technique used to create a new version of an image with a different size. Increasing the dataset size
is called upsampling, and reducing the dataset size is called downsampling.

C. MODEL TRAINING

Various models have been applied to predict diabetic retinopathy in patients. Some models have
shown good performance with specific properties, and poor performance with others. Some deep
learning models that have been used are ResNet [1], CNN[2], [4], [7], transfer learning
models(VGG16)[3] and many more. Table 1 shows the models we applied on the images with their
accuracies and loss.

VGG16 is a convolutional neural network model that is utilized for picture acknowledgment. It's
special in that it has just 16 layers that have weights, rather than depending on countless hyper-
boundaries. It's viewed as one of the most outstanding vision model architectures.The Alexnet has
eight layers with learnable boundaries. The model comprises of five layers with a mix of max pooling
followed by 3 completely associated layers and they use Relu enactment in every one of these layers
aside from the result layer.Inception v3 is a picture acknowledgment model that has been displayed
to achieve more noteworthy than 78.1% precision on the ImageNet dataset. The model is the finish
of numerous thoughts created by different specialists over the years.Residual Organization (ResNet)
is a profound learning model utilized for PC vision applications. It is a Convolutional Brain
Organization (CNN) engineering intended to help hundreds or thousands of convolutional layers. We
likewise dealt with a " independent" model which chipped away at 3 layers - rescaling(A
preprocessing layer which rescales input values to another reach. This layer rescales each worth of
an info (frequently a picture) by duplicating by scale and adding offset), conv2d(A channel or a
portion in a conv2D layer "slides" over the 2D info information, playing out an elementwise increase.
Thus, it will summarize the outcomes into a solitary result pixel. )furthermore, maxpooling (a pooling
activity that computes the most extreme, or biggest, esteem in each fix of each component map)

After model fitting we did hyperparameter tuning of the multitude of models to build it's precision as
it's is the method involved with choosing the best arrangement of hyperparameters for an AI
calculation to accomplish ideal execution on a given errand. Hyperparameters are boundaries of an
AI model that are set prior to preparing and control the growing experience, like learning rate,
number of stowed away layers, number of neurons, regularization boundary, and so on.

D. MODEL EVALUATION

Table 1 shows the accuracies we achieved while fitting all the 5 models. We ran 50 epochs for all the
models and received the best accuracy from InceptionV3 model . All the following graph shows that
no to very less overfitting happened in the model and the accuracies achieved were unbiased.Table
2 shows the results after applying hyperparameter tuning to all the models.

Convolution NN (Harsh)

InceptionV3 (Chirag)
EfficientNet (Mayank)

AlexNet (Sahil)
 CONCLUSION

In conclusion, the use of deep learning models for diabetic

retinopathy detection has shown promising results in the
field of medical imaging. With the increasing prevalence of
diabetes and its associated complications, the development
of accurate and efficient diagnostic tools is essential for early
detection and timely treatment. Deep learning models, such
as convolutional neural networks, have demonstrated high
accuracy in detecting diabetic retinopathy from retinal
images, providing a valuable screening tool for patients at
risk of vision loss. While further research is needed to
validate these findings, the potential of deep learning in
improving healthcare outcomes for patients with diabetes is
significant.
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