Materials Today: Proceedings 45 (2021) 5660–5664

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Materials Today: Proceedings

journal homepage: www.elsevier.com/locate/matpr

Early-stage prediction of glaucoma disease to reduce surgical

requirements using deep-learning
Niharika Thakur, Mamta Juneja ⇑
Computer Science and Engineering. University Institute of Engineering and Technology, Panjab University, Chandigarh, India

a r t i c l e i n f o a b s t r a c t

Article history: Glaucoma is an emerging retinal disease which may become the first common cause of blindness if not
Available online 11 March 2021 detected at earlier stage. Retinal examination used by ophthalmologists for diagnosis is tedious and time
consuming, thus computer vision is been progressively used for earlier diagnosis employing retinal
Keywords: images. Researchers these days are using different machine learning and deep learning approaches for
Glaucoma diagnosis. As, the machine learning techniques require extraction of handcrafted features for classifica-
Retinal images tion, use of deep learning is found to be promising for automated diagnosis. This paper presents the com-
Deep-learning
parative analysis of different state of the art deep learning techniques such as Xception, Inception,
Classification
DenseNet, ResNet and VGG. Further, the comparison of approaches is performed using parameters such
as precision, recall and accuracy. The outcome of this study could be employed for designing of handheld
diagnostic tools of glaucoma that can be used by medical practitioners and researchers for analysis of
retinal images and prediction of glaucoma. As a result, the diagnosis performed using Computer aided
diagnosis (CAD) systems using imaging modalities would perform better in presence of illuminating dis-
turbances as well and reduce diagnostic time and cost performed by conventional devices such as
tonometer, pachymeter for retinal examination. Additionally, the life of handheld diagnostic device
would increase due to ease of use, and recurrent use of retinal cameras for acquisition of fundus image
of same eye would reduce due to improved prediction at single instance. Further, these systems would
help to predict glaucoma at earlier stage, plan treatment using medications and reduce the number of
surgeries. Now, if the disease is predicted at earlier stage, this would in turn save the patient from surgery
performed at advanced stage, thereby optimizing the use of materials such as stainless steel and titanium
used for designing of surgical equipment.
Ó 2021 Elsevier Ltd. All rights reserved.
Second International Conference on Aspects of Materials Science and Engineering (ICAMSE 2021).

1. Introduction
Glaucoma is a disease of an eye caused due to optic nerve dam-
age resulting in irreversible loss of vision. The damage of optic
nerve is due to increased pressure in the eye caused due to buildup
of fluid [1]. It is the second most leading cause of vision loss after
cataracts. As per the study performed by Tham et al., it is expected
to rise further upto 111 million by 2040 if left untreated, and may
become the first common cause of blindness [2]. The patients sus-
pected with glaucoma show no initial symptoms unless progressed
to advanced stage. Thus, earlier detection of this disease may play a
significant role in its prevention. Ophthalmologists use different
approaches such as fluid measure of eye, thickness measure of cor-
⇑ Corresponding author.
E-mail address: mamtajuneja@pu.ac.in (M. Juneja).
nea and testing of side vision. But all these approaches are manual
and time consuming, so retinal fundus imaging modality which
captures the backside of retina is being used for diagnosis [3].
Fig. 1. given below shows the retinal fundus image acquired using
the fundus camera.
The retinal image comprises of optic disc and optic cup, which
are key indicators of disease prediction. Optic disc is located in
the backside of an eye where different retinal vessels merge
together and is also known as blind spot. While, optic cup is the
central depression of variable size on optic disc which increases
with increased pressure of eye. The size of optic cup increases with
the advancement of disease and covers the optic disc completely
resulting in blindness. Vision loss caused due to glaucoma cannot
be reversed once occurred, but its further progression can be
halted if diagnosed at earlier stage. The researchers across the
world are using different machine learning and deep learning

https://doi.org/10.1016/j.matpr.2021.02.458
2214-7853/Ó 2021 Elsevier Ltd. All rights reserved.
Second International Conference on Aspects of Materials Science and Engineering (ICAMSE 2021).
N. Thakur and M. Juneja
Fig. 1. Retinal fundus image.
approaches for earlier prediction of glaucoma which still requires
improvement for accurate diagnosis [4]. Hence, this study presents
the analysis of different deep learning approaches to identify the
best suitable for prediction of glaucoma and do further improvisa-
tions in future.
2. Related work
As per the recent study performed by Thakur et al. in 2020, use
of deep learning-based approaches have been suggested for classi-
fication in near future for improved performance [5]. Thus, this
section presents some of the recently used deep learning-based
approaches for classification of glaucoma in retinal images.
Benzebouchi et al. in 2017 performed classification of glaucoma
in retinal images using convolution neural network (CNN) with 25
epochs at 10 and 5 iterations respectively [6]. Also, Bander et al. in
2017 used CNN-based deep learning for extraction of features to
classify the retinal image as ‘abnormal’ or ‘normal’ using an SVM
classifer. The pre-trained Alexnet CNN model with 23 layers of con-
volution, max-pooling, fully connected, softmax and output was
used for training of feature extraction [7]. Further in 2018, Chai
et al. used combination of fully convolutional network (FCN),
recurrent convolutional network (RCNN) and CNN. The use of
hybrid approach increased the computational complexity of the
network, but improved the performance [8]. Also, in 2018 Naoto
et al. performed glaucoma classification using deep residual net-
works and found it to be better than random forest (RF) and sup-
port vector machine (SVM) [9]. Also, Raghavendra et al. in 2018
applied eighteen-layer CNN to extract deep features through reti-
nal fundus image for diagnosing glaucoma. The CNN used com-
prises of two parts, first is the convolutional and max-pooling
layer with the input of each layer as an output of the previous
layer. While the second part includes a fully connected layer with
softmax activation function for classification of extracted features
[10]. Similarly, Norouzifard et al. in 2018 also suggested deep
learning-based classification employing ResNet and VGG compris-
ing of pooling, concatenate, dropout and residual layers [11]. Fur-
ther in 2018, Kim et al. used modified VGG with batch size 32
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Materials Today: Proceedings 45 (2021) 5660–5664
and fine-tuned weights having learning rate of 0.0001 [12].
Recently, Diaz-Pinto et al. in 2019 performed classification of glau-
coma using deep learning-based networks such as Xception, Incep-
tion, VGG and ResNet. Based on the performance of different
networks, Xception was found to outperform another network
[13]. Further in 2019, Gomez- Valverde et al. [14] found VGG as
best performing classifier. Singh A in 2019 performed classification
of glaucoma using fine-tuned Inception network after augmenta-
tion to increase the sample size for effective training. The approach
was found to overcome the issue of overfitting for smaller sample
size [15]. Recently, in 2020 Juneja et al. [16] suggested modified
Xception as best performing classifier for smaller sample size. Also,
Li et al. in 2020 suggested ResNet comprising of convolutional,
pooling and fully connected layers for performing glaucoma classi-
fication. But the random initialisation here required a larger data-
set leading in high computation time [17]. Further, Judy et al. in
2020 used pre-trained alexnet with Support vector machine
(SVM) to perform classification of glaucoma on fundus images [18].
Thus, on the basis of above studies, it can be analysed that dif-
ferent researchers suggested different classifiers from time to time,
which may be due to varying datasets and experimental setup.
Hence, it necessitates generalization of things on some common
datasets which could be used for fair comparison without any
biased decisions. Hence, this study presents the comparative anal-
ysis of state-of-the-art networks on publicly available retinal
datasets.
3. Methodology
This section discusses the methodology used for performing
classification with deep learning-based approaches. Five types of
convolution networks namely Xception, Inception, ResNet, Dense-
Net and VGG were being employed for same. Fig. 2. shows the basic
deep learning architecture comprising of input, convolution, pool-
ing, fully connected and output layer.
The classification using each network initiated with preparation
of input to be fed into convolution networks. Input image of size
2896 X 1944 pixels were here initially copped to reduce the size
of image to 512 X 512 pixels and get the desired region of interest
(ROI). The cropped image was then augmented using 30-degree
rotation, shifting and flipping to increase the number of images
to 1322 from 267 (combined using two datasets) for improved per-
formance of convolution networks. A convolutional network
includes multiple layers followed by fully connected layers which
takes two-dimensional image as an input. The multiple layers here
are convolutional layer, pooling layer, activation layer, and fully
connected layer. Pooling layer is used to down sample and reduce
the image size for faster training and fetching only significant fea-
tures. Convolutional layer has filter passing over image and per-
forming dot product of original pixels with weights defined in
filter. Further, fully connected layer takes one dimensional vector
as input and output list of possible labels. Finally, the activation
layer introduces non-linearity to allow self-training. Different net-
works used here vary in ordering and size of layers. The networks
used for classification are as follows:
3.1. Xception [19]
Xception is a linear stacked architecture with depth wise sepa-
rable convolutional layers and residual connections. It has 36 lay-
ers structured into 14 modules forming base of feature extraction.
The depth wise separable performs channel wise spatial convolu-
tions followed by 3x3 convolution. The convolutional layers are
preceded by batch normalization. The ReLU activation function is
followed throughout the architecture to bring out the non-
N. Thakur and M. Juneja
Fig. 2. Basic Deep-learning architecture.
linearity in the output of each layer. The output of the architecture
has a global average pool layer which is followed by a dense net-
work and logistic regression.
3.2. Inception [20]
Inception is a 48 layered architecture comprising of 3x3 convo-
lution and 3x3 pooling layers with batch normalization and stride
2. The network tail consists of dense layer with softmax activation.
Inception layer is a combination of 1x1, 3x3 and 5x5 convolutional
layers with their output clubbed together to act as the input of the
next layer. The tail of the architecture has a dropout layer and a
dense layer having softmax as the activation function, which gives
us the final output. It uses two 3x3 convolutional layers instead of
a 5x5 convolutional layer to reduce the number of parameters
without decreasing the model efficiency.
3.3. ResNet [21]
ResNet is a 50 layered architecture comprising of convolutional,
activation, pooling, normalization and dense layer having sizes
3x3. Additionally, it has skip connections to add input blocks to
particular output block. It consists of residual blocks which include
a function f(x) and y = x as an identity mapping, i.e. the input to the
block is added to the output of the block F(x) given as the function f
(x), and y = x as an identity mapping, i.e. the input to the block is
added to the output of the block F(x)
3.4. DenseNet [22]
DenseNet as the name implies is a dense network having 121
layers, where each subsequent layer fetches input from preceding
layer. Image is passed as input to the convolution layer which is
followed by dense blocks separated by a combination of convolu-
tional layers with filter of size 1x1 and average pooling layer with
filter of size 2x2. Individually dense blocks here are grouping of
zero padding, normalization, 2x2 activation and 1x1 convolutional
layer. The block ends with a concatenation layer which concate-
nates the output of preceding layers. The network tail here
includes dropout layer and sigmoid activation.
3.5. VGg [23]
VGG is a 16 layered network with convolutional stacks, 2x2
pooling and fully connected layers. The stride of convolution is
fixed as 1 pixel, along with spatial padding to preserve the resolu-
tion. The width of convolution layers starts with 64 filters and
increases with a factor of two after every Max Pool layer, the last
layer having a width of 512. Pooling is carried out by five Max Pool
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layers over a pool size of 2x2, with a stride 2. Non-linearity is intro-
duced by ReLU activation function. The end of the network has
dropout layer, fully connected layer and uses sigmoid activation.
4. Results and discussions
4.1. Experimental setup and dataset used
The approaches used for classification were implemented in
Python version 3.7.0 with TensorFlow version 2.1. Also, the testing
was performed on Nvidia GeForce GTX TITAN Xp GPU having two
IntelÒ Xeon(R) E5-2620 2.4 GHz CPUs. Further, the datasets used
for testing comprises of DRISHTI-GS [24] and RIM-One [25] com-
prising of 101 and 166 cases respectively including both normal
and glaucomatous cases. DRISHTI dataset comprises of 30 normal
images and 71 glaucomatous images. This dataset is generated
by the researchers from IIIT Allahabad along with the association
of Arvind eye hospital situated in Madurai, India. Whereas, RIM-
One comprises of 92 normal images and 74 abnormal images
(glaucoma/suspect). This dataset has been developed by University
of La Laguna, Spain in collaboration with Hospital Universitario de
Canarias, Spain.
4.2. Performance parameters
The comparison of approaches implemented were carried out
using parameters such as precision, recall, accuracy calculated
using true positives and negatives, false positives and negatives
(TP/TN/FP/FN). Here, TP represents prediction as glaucomatous
which are true, TN represents prediction as normal which are true,
FP represents prediction as glaucomatous which are false and FN
represents prediction as normal which are false. The values of TP,
TN, FP, FN are derived from confusion matrix shown in Fig. 3.
Thus, parameters such as precision, recall and accuracy are
defined as:

Precision: It is defined as percentage of relevant predictions and
is given using Eq. (1)
TP
Precision ¼  100 ð1Þ
TP þ FP
Higher is the value of precision, better is the performance.

Recall: It is defined as percentage of relevant predictions which
are correct and is given using Eq. (2)
TP
Recall ¼  100 ð2Þ
TP þ FN
N. Thakur and M. Juneja Materials Today: Proceedings 45 (2021) 5660–5664

Output of Condition (e.g. Glaucoma/Normal) by ground truth

classification Positive Negative Total of Row
Positive Tp Fp Tp + Fp
Negative Fn Tn Fn + Tn
Total of Tp+Fn Fp+Tn N
Column (Total cases with (Total cases =Tp+Tn+Fp+Fn
the given without given (Total cases)
condition) condition)
Fig. 3. Confusion matrix.

analysed on public datasets are shown in Table 1 with correspond-

Table 1
Performance analysis of deep learning methods. ing graph plots in Fig. 4.
As per experimental analysis, the values of precision, recall and
Classification Network Performance parameters
accuracy for Xception is found to be 90.1%, 91.8% and 93.1%. Fur-
Precision Recall Accuracy ther, the Inception gave 87.3% precision, 85.7% recall and 90.6%
Xception 90.1 91.8 93.1 accuracy. Also, the values of precision, recall and accuracy for
Inception 87.3 85.7 90.6 ResNet is found to be 82.5%, 81.4% and 83.2%. Similarly, the values
ResNet 82.5 81.4 83.2 of precision, recall and accuracy for DenseNet is found to be 89.3%,
DenseNet 89.3 87.3 92.1
VGG 80.9 79.1 81.6
87.3% and 92.1%. Whereas, the VGG offers precision of 80.9%, recall
of 79.1% and accuracy of 81.6%. Thus, Xception is found to outper-
form Inception, ResNet, DenseNet and VGG. Further, the filters
used in Xception simultaneously considers a spatial dimension
Higher is the value of recall, better is the performance.
and a cross-channel or ‘‘depth” dimension. Instead of partitioning
input data into several compressed chunks, it maps the spatial cor-

Accuracy: It is defined as percentage of correct prediction and is
relations for each output channel separately, and then performs a
given using Eq. (3)
1x1 depth wise convolution to capture cross-channel correlation.
Hence, it shows improved accuracy as compared to other state of
TP þ TN the art architectures.
Accuracy ¼  100 ð3Þ
TP þ TN þ FP þ FN
Higher is the value of accuracy, better is the performance.
5. Conclusion

4.3. Performance analysis
All the networks used here 30 epochs, ReLU activation for hid-
den layers and Sigmoid activation for output layers with 135 layers
in Xception, 314 in Inception, 178 in Resnet, 430 in DenseNet and
23 in VGG. The performance of different state of the art networks
Earlier detection of glaucoma using image processing tech-
niques can assist the doctors in precise diagnosis in less amount
of time. Traditional methods employing retinal images used till
date are either less automated or less accurate. Thus, the analysis
of automated deep learning approaches such as Xception, Incep-
tion, ResNet, DenseNet and VGG has being performed in this paper

100

95 93.1
91.8 92.1
Performance Metrics

90.1 90.6
89.3
90
87.3 87.3
85.7
85 82.5 83.2
81.4 80.9 81.6
79.1
80

75

70
Xcepon Incepon ResNet DenseNet VGG
Classificaon Networks

Precision Recall Accuracy

Fig. 4. Comparative analysis of classification networks.

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N. Thakur and M. Juneja
to analyse the best one. Further, based on the experimental analy-
sis, Xception is found to give 90.1% precision, 91.8% recall and
93.1% accuracy. Thus, the Xception network could be extended
and improvised for better predictions on large number of datasets
so as to be used in real time clinical scenarios for earlier diagnosis.
Thus, the outperforming Xception can be extended for further
improvisations and embedded in handheld diagnostic tools of
glaucoma to be utilized in clinical scenarios for analysis of retinal
images. Further, these CAD systems would replace the conven-
tional diagnostic procedures performed using devices such as
tonometer and pachymeter. Also, the outcome of this study would
reduce the consumption and cost of materials such as stainless
steel and titanium used for manufacturing of surgical products,
as the surgeries would be replaced by medications due to diagnosis
at earlier stage.
Declaration of Competing Interest
The authors declare that they have no known competing finan-
cial interests or personal relationships that could have appeared
to influence the work reported in this paper.
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