2017 4th IEEE Uttar Pradesh Section International Conference on Electrical, Computer and Electronics (UPCON)
GLA University, Mathura, Oct 26-28, 2017
Automated detection and grading of Diabetic Macular
Edema from digital colour fundus images
Ravitej Singh Rekhi, Ashish Issac, Malay Kishore Dutta
Department of Electronics and Communication Engineering, Amity University, Noida, India
Email ID: ravitejsingh11@gmail.com, issac017@gmail.com, malaykishoredutta@gmail.com
Abstract—Diabetic Macular Edema affects vision and
eventually may lead to blindness. Early detection is vital to
prevent the ramifications of the disease requiring the need for
effective computer-aided diagnostic techniques. A robust method
is proposedin the following paper to segment exudates from
fundus images using a support vector machine for classification.
This is followed by detection of macula using morphological
features and comparing the segmented exudates against specially
created regions around the macula. The algorithm further grades
the image according to how severe the disease is. The proposed
algorithm has been tested on 89 images of DIARETDB1 database
and gives an accuracy of 92.11% in detecting severe case of DME
and 90%accuracy for the same when tested on 100 images of
MESSIDOR database.The proposed method can be used to
directly give an idea about the severity of Diabetic Macular
Edema in the image ad give a reliable and cost-effective diagnosis
in real time.
Keywords—Medical Imaging; Diabetic Macular Edema;
Fundus Image; Macula; Exudates
I. INTRODUCTION
Diabetic Macular Edema (DME)is a serious disease of the
eyeprevalent in people having Diabetes Mellitus, which can
cause rapid vision loss. Early symptoms of DMEoccur when
lipids and proteins from the blood vesselsleak in the retina
giving rise to yellowish-white exudates. When these coalesce
to form hard exudates, and extend into the macular region, they
cause Diabetic Macular Edema leading to rapid vision loss.
Hence, regular check-ups are a must for people susceptible to
diabetes. Early detection of the symptoms of DME can greatly
reduce the chances of progression of vision loss with timely
treatment. Hence, the need for automatic algorithms that can
aid in detecting this disease for a timely diagnosis and in turn,
treatment. The treatment options can be temporary in the form
of Vitreal injections, or permanent, like laser photocoagulation.
Since correction can only be done at the early stage of the
disease, hence, timely diagnosis of the disease is of paramount
importance.
Work has been continuing to detect macula by academia.A
region based method was used to detect Diabetic Macular
Edema by N. Sengar et. al. [1]. A Naïve Bayes classifier has
been used by Z. Y. Zaidi et. al. [2]. Motion pattern generation
has been used as the main method in [3] by A. Johny et. al. to
detect the macula and grade the disease-severity. The reference
position of the optic disc to detect the macula along with
morpological features has been reported in [4].An interesting
investigative method using Discrete Wavelet Transformation to
localise the blood vessels, and in turn, the macula as been
reported in [5] while an ingenuous line operator is used to
978-1-5386-3004-4/17/$31.00 ©2017 IEEE
capture the brightness profile ofmaculain [6] to acieve results
with a hig degree of accuracy.
B. Ramasubramaniam et. al. [7] propose a MATLAB
applicationfor K-means segmentation of macula and optic disc.
The symmetry of the macular region is utilized to detect the
disease severity post classification using global characteristics
in [8]. Macula detection is reported in [9] by taking the
displacement from the centre of the optic disc followed by
thresholding. [10] assesses the performance of novel
algorithms in optic disc and macula detection. T. Garduno-
Alvarado et. al. [11] utilizes template matching to detect
macula while [12] has been a useful source to assess the
accuracy of different methods for macula detection.Issac et al
[13] [14] has used adaptive intensity based threshold for optic
disc and cup segmentation from fundus images. Yadav et al
[15] has used textural features to differentiate normal from
affected fundus images. Singh et al [16] has detected glaucoma
from fundus images by analysing them in wavelet domain.
Dutta et al [17] has proposed a method for segmentation of
super pixels followed by Hough Transform which are
ultimately used for detection of Glaucoma from fundus images.
Singh et al [18] has proposed a region growing method for
optic disc segmentation from fundus images. S. Ganguly et al
[19] has proposed an adative intensity based gray level slicing
method for segmentation of red lesions from digital fundus
images for detection of Diabetic Retinopathy. Although a lot of
work has been done in this area, still tere exists a need for a
robust algorithm which is able to accurately segment the
macula from the fundus images in order to accuratelygrade the
severity of Diabetic Macular Edema.
The mostsignificant contribution of the proposed method is
in the use of an adaptive threshold for segmentation of macula
from the fundus images.The mean and standard deviation of a
particular image has been computed and strategically combined
to calculate the threshold for accurate segmentation of macula.
The use of statistical features for threshold determination
makes the algorithm image independent. The proposed
algorithm is tested on images of two different databases and is
able to correctly segment the macula from the images.
Another significant contribution lies in the use of
morphological, geometrical and orientation features to
correctly identify the exudates and macula and create a grading
algorithm for the computer aided diagnosis of diabetic macular
edema (DME). The results obtained are convincing and the
proposed work can be used in parts in some realtime screening
systems.
The remaining paper is structured as follows: Section II
talksabout the image processing and classification techniques
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which are used in the proposed method. Section III presents the
segmentation and grading results for the images of different
databases used for experimentation. Section IV discusses some
conclusions which are derived during the experimentation
process.
II. PROPOSED METHODOLOGY
The fundus of the eye can be photographed as an RGB
image using a high resolution digital fundus camera. The
photographed fundus can be analyzed to assess the presence of
abnormalities like micro-aneurysms and hemorrhages.
Depending upon the position and number of these
abnormalities in the retinal image, diseases like Diabetic
Retinopathy and Diabetic Macular Edema can be diagnosed.
Early detection and treatment through automatic computer-
aided image processing techniques is thus of vital importance,
especially in developing countries where there is a considerable
dearth of medical professionals.
Fig.1showsalabelledimageofthefundusoftheeyewhich
consists of different objects and abnormalities like optic disc,
blood vessels, exudates and red lesions (micro-aneurysms and
hemorrhages). The optic disc and blood vessels are objects
which characterize a fundus image as normal. However, the
presence of abnormalities, like exudates and red lesions, in an
image decides that a particular image is diseased. Also, the
position of such abnormalities in the image is an important
feature for diagnosis of the severity of a disease.
Fig. 1. Fundus Image of the Eye
There is a difference in the values ofthe intensity of the
regions corresponding to exudates and optic disc, as compared
to the darker areas of the image like blood vessels. This
conventional technique has been primarily used to isolate the
region of interest (ROI).
The proposed algorithm is divided into four parts-
preprocessing using image normalization, segmentation of
exudates, detection of macula and grading of Diabetic Macular
Edema. A detailed description of the methodology is presented
in the subsequent sections.
A. Pre-processing
Every fundus image been captured is different in terms of
various parameters like brightness, contrast, etc. So, there
arises a need that all fundus images are comparable with each
other. Hence, the fundus images are first normalized for
uniformity and elimination of any undesirable artifacts. The
method is similar as used in [20] which utilizes the V-channel
of the HSV color space followed by median filtering. The
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three channels of the RGB color space are updated using the
resulting smoothened V-channel and concatenated to form a
single color image from which the green channel image is
extracted.The smoothed V-channel updates all the 3 channels
in the RGB color space. This process of normalization and
final green channel is shown in Fig. 2.
Fig. 2. (a) Original input image (b) Normalized image (c) Green channel of the
normalized image
B. Segmentation of Exudates
After pre-processing, the green channel images are made to
undergo several steps that are briefly demonstrated through the
flowchart.
Anisotropic Diffusion is a non-linear filtering method that
blurs the background while preserving the edges in an image.
In the given case, blood vessels and exudates edges are
preserved and rest of the portions of the fundus image are
blurred. The filter acts as a selectively diffusion method.Post
this, an adaptive threshold converts the image into binary. This
is adaptive and independent of the type of the image being
used.
The thresholded image retains some noise post
thresholding. A part of it that is contributed because of the
optic disc is removed by multiplying the thresholded image
with a binary mask created by localizing the optic disc through
the brightness profile of the image as optic disc corresponds to
the region of maximum brightness.
The remaining noise is removed by classification using a
number of statistical and geometrical features which are
involved in training a support vector machine that differentiates
between exudate objects and non-exudate objects and segments
out the useful information in the form of exudates. This is
donealong similar lines as [21] and [22].
Input RGB Image
Normalized Grayscale Image
Pre-Processing
RGB Image
Average Filter
Anisotropic
Diffusion
Green Channel
Maximum Intensity
Adaptive
Thresholding Optic Disc
Noise removal using SVM classification
Exudates Segmented
Fig. 3. Flowchart for Segmentation of Exudates
 The image processing techniques used in the proposed structuring element should be kept approximately equal to the
work for segmentation of exudates are summarized in Fig. 3. It vessel width. This will inpaint only the blood vessels while the
shows the use of normalization, anisotropic diffusion, intensity macula, being of larger dimension, is still retained. After the
based adaptive threshold for exudates segmentation and feature application of morphological operations like closing, the
based classification for false negatives removal to correct process of adaptive thresholding is immediately followed. The
identify the exudate pixels in the image.The features used to image is inverted and the macula is successfully localized in
remove the false positives are statistical, geometrical and the image.
orientation features and are defined as follows:
Input RGB Image
S.No. Feature Approach
1 Mean Statistical Parameter
2 Standard Deviation Statistical Parameter Grayscale Image
3 Variance Statistical Parameter
4 Perimeter Object Boundary Adaptive Histogram Equalisation
5 Area No of white pixels
6 Eccentricity A measure of how elliptical an object Morphological Closing Operation
is
7 Solidity A measure of how solid an object is Intensity Based Thresholding
8 Aspect Ratio Ratio of Major Axis to Minor Axis
Length Background Removal by Mask Multiplication
9 Distance from OD Using coordinates of optic disc
10 Slope with OD Using coordinates of optic disc Macula Localized
Fig. 5. Flowchart for Macula Detection

Fig. 4. (a) Anisotropic diffusion (b) Thresholded image (c) After removal
of optic disc (d) Post classification and removal of noise

Fig. 4 shows the step-wise implementation of the

classification techniques. Fig. 4(a) shows the anisotropic
diffusion subjected green channel image. Fig. 4(b) shows the
binary image after subjecting it to an intensity based threshold.
Fig. 4(c) shows the binary image obtained after removing the
optic disc from the segmented exudates image. Fig. 4(d) shows
the finally segmented exudates which are obtained after
removing the false pixels which have been earlier detected as
exudates.
C. Detection of Macula
There is a conspicuous difference between the intensities
of the region corresponding to the macula and the rest of the
fundus image. This difference in intensity between the two
types of regions is utilized for the macula detection.
Fig. 6. (a) Adaptive Histogram Equalised Image (b) Applying
morphological operations (c) Thresholded Image (d) Inverted Image
D. Grading of DME
The next step is to divide the given image into three
regions the pixels within which are separately compared
against the segmented exudates to grade the severity of the
disease. According to [23], if exudates are encountered in the
region around the fovea that has one-third the optic disc’s
diameter, the level of DME is considered as severe.

The original colour fundus image is converted to grayscale

and adaptive histogram equalisation is applied on the image.
This effectively sharpens the contrast between the lighter and
Fig. 7. (a) Region I (b) Region II (c) Region III
the darker regions within the image which is basically of
immense utility for the detection of macula. The equalized
Furthermore, if exudates are present in the region
image is subjected to a mathematical morphological closing
surrounding the macula within the radius of the optic disc,
operation. The structuring element used for this operation is
then the level of DME can be assumed to be moderate and
chosen to be a disk shaped of size 20 pixels. The size of the
similarly, if any exudate is present in the rest of the fundus

484
image, the fundus can be labelled as one with the possibility of The primary purpose of the global database linked to the
having a mild case of DME. An image that has been found MESSIDOR project is to compare and evaluate segmentation
absent of any exudates can be safely assumed to be normal. algorithms developed for the detection of lesions in fundus
Fig. 7 shows the regions which are been used to grade a images. MESSIDOR is a research program funded by the
fundus image for DME. All these regions are centered at French Ministry of Research and Defense. There is a total of
macula and the severity of the disease is more if the distance 1200 images available that have been graded according to the
from macula is less. severity of diabetic retinopathy and macular edema. The
proposed algorithm has been tested on 100 images of the
database available in TIFF format.
The grading algorithm can be summarised in the
following flowchart. Fig. 9 shows the experimental results using the proposed
NO algorithm for exudates segmentation. Fig. 9(a) displays the
Exudates Present Fundus is Normal fundus image input which is in the RGB format. Fig. 9(b)
YES shows the segmented exudates from the input image. This
YES Severe Case of image in binary format. The results shown in the figure
Exudates Present in Region I
DME detected comprises of samples from both the databases, i.e.
NO DIARETDB1 and MESSIDOR. It can be observed that the
YES Moderate Case of segmentation algorithm and proposed set of features used are
Exudates Present in Region II
DME detected capable enough to reject the false pixels and finally segment
NO the exudates correctly.
YES Mild Case of
Exudates Present in Region III
DME detected
Fig. 8. Grading algorithm according to the severity of DME

III. EXPERIMENTAL RESULTS

The algorithm has been tested on 89 images of the
DIARETDB1 database and 100 images of the MESSIDOR
database. DIARETDB1 is a global database utilized for
benchmarking Diabetic Retinopathy. Out of the 89 images, 84
exhibit some signs of non-proliferative diabetic retinopathy
while 5 images are there that can be considered normal. The
digital fundus camera used has a field-of-view of 50 degrees.
Fig. 10Regions in Grayscale to grade severity of DME (a) Severe case of DME
characterized by exudates in Region I (b) Moderate case of DME characterized
by exudates in Region II (c) Mild case of DME characterized by exudates in
Region III
Fig. 10 shows the grayscale images of the regions which are
used to grade for severity of DME in a fundus image. Fig.
10(a) show the region around the macular area. This region
consists of highest number of light receptors and are mainly
responsible for vision. The presence of exudates in this region
will impact the vision highest. So, if an any abnormality is
present in this region, then the fundus image will be
considered as the severe case of DME. Fig. 10(b) shows the
region for which the fundus image will be graded as moderate
case of DME. The presence of exudates in this region may
affect the vision, but moderately. Finally, the mild case of
DME is shown in Fig. 10(c).

TABLE I. RESULTS OF DME ANALYSIS

DATABASE TYPE OF FUNDUS IMAGE ACCURACY (%)
Normal 95.45
DIARETDB1 Severe DME 92.11
Moderate DME 87.50
Normal 92.72
MESSIDOR Severe DME 90
Moderate DME 88.89

After testing the algorithm on DIARETDB1 database, the

accuracy pertaining to normal images was 95.45%, for severe
case of DME, the accuracy was 92.11% and for moderate
DME, the accuracy came out to be 87.5%. Among the 100
images that were tested on the MESSIDOR database, exudates
were segmented on a total of 33 images and 57 images were
Fig. 9. Exudates Segmentation Results on DIARETDB1 and MESSIDOR
database (a) Original Input Image (b) Final Exudates
detected as normal. The database is labelled for the severity of

485
DME which has been used to determine the performance
parameters. The accuracy pertaining to normal images was
92.72%, for severe case of DME, the accuracy was 90% and
for moderate DME, the accuracy came out to be 88.89%. The
results generated after testing on both the databases have been
summarized in Table I.
IV. CONCLUSION
The algorithmwas tested on 89 images of DIARETDB1
database and 100 images of the MESSIDOR database and
successfully provides an accurate idea of the severity of the
patients showing symptoms of Diabetic Macular Edema
(DME). The disease is more prone to vision loss if the location
of abnormality is near macula. Also, the disease can be
considered severe if the distance of abnormality from macula
is less than one-third of optic disc diameter. The proposed
method gives a high degree of accuracy and generates a very
low number of false positives which is a desirable quality for
use in real time diagnostic applications. The threshold is
adaptive making the process of diagnosis entirely automatic.
The images obtained from the fundus camera can be analyzed
to detect signs of disease which can help in early treatment.
ACKNOWLEDGEMENT
This work has been supported in part by the Grants from
Department of Science and Technology, No.
DST/TSG/ICT/2013/37”. Also, the authors express their
gratitude to Dr. S.C. Gupta, Medical Director of Venu Eye
research centre for his invaluable contribution in classification
of the images.
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