RESEARCH ARTICLE

Copyright © 2020 American Scientific Publishers Journal of Medical Imaging and

All rights reserved
Printed in the United States of America
Health Informatics
Vol. 10, 566–571, 2020

Feature Based Differentiator for Fluid Filled Retinal

Abnormalities in Retina Using Optical
Coherence Tomography Images
K. Venkatraman1 ∗ and M. Sumathi2
1
Research Scholar, Sathyabama Institute of Science and Technology, Chennai 119, India
2
School of Electronics and Communication Engineering, Sathyabama Institute of Science and Technology, Chennai 119, India

Introduction: The Optical Coherence Tomography is widely used in ophthalmic imaging to assess the condition
of retina. It serves as an effective tool in diagnosing various fluid related abnormalities in retina, which are prior
stages to vision loss. The overall pattern of fluid collection is a vital tool in disease identification. Aim: To classify
various fluid filled retinal abnormalities, like, Cystoid Macular Edema (CME), Choroidal Neo Vascular Membrane
(CNVM), and Macular Hole (MH) based on various features. Materials and Methods: A total of 114 images
were acquired using TOPCONN and ZEISS OCT devices. The obtained images were converted to grayscale
and subjected to pre-processing technique. Homomorphic Wiener filter was used to remove the speckle noises.
The Region of Interest was then identified by basic edge detection algorithm, for which, various features were
extracted and utilised for classification. Outputs were cross verified with a medical expert and the performance
of the proposed system was evaluated. Results: Based on the proposed system of classification of various fluid
filled retinal disorders, the input image was classified as Class 0—Normal, Class 1—CME, Class 2—CNVM, and
Class 3—MH based on the pattern of fluid accumulation. The overall performance was compared and evaluated
and it was identified that the system exhibited 91.65% accuracy, 90.36% Sensitivity, 92.95% Specificity and
Youden’s Index value of 0.83. Conclusion: As OCT serves an important tool for pre-screening of blindness,
automations in these areas remains of higher potential. The classification is based on the features used, which
showed a significant difference between the various classes as classified. The overall performance seems to
be satisfactory and would thus help in early detection of fluid related abnormalities and also can be used as an
expert tool to analyse the efficiency of the therapies.

Keywords: Classifier, Medical Imaging, Retina.

1. INTRODUCTION the longitudinal location of the reflection sites. Briefly, it could

Loss of vision being one among the common disorders, is caused
due to excess or deficit of fluids within the layers of retina [1].
Retina is the interior layer of eye, which converts the incident
light signal into neural signal. Any damage or deformations
in the retinal layers serve high risk for vision loss. Few such
abnormalities include Cystoid Macular Edema (CME), Choroidal
Neo Vascular Membrane (CNVM), and Macular Hole (MH). To
understand and analyse such abnormalities a device named, Opti-
cal Coherence Tomography (OCT) is used [2, 3]. OCT images
produce high sensitive micron scale resolution images and hence
these are preferred over fundus photographs [4]. Optical reflec-
tions from the internal structures of the tissues are cross section-
ally measured in the OCT procedure. Essential information of
the time of flight delay is obtained from the coherence property
of the reflected light [5]. This information is utilised to identify
∗ though was significant, failed to act as a classifier for a wider
Author to whom correspondence should be addressed.
be understood that OCT is an imaging modality, used to view
the condition of various layers of retina. Automations in analysis
of the images acquired from these modalities may help in earlier
diagnosis and prevention of vision loss.
The system described is an effective automated tool towards
the OCT image analysis, for earlier detection of severe disor-
ders including CME, CNVM, and MH. Also to accurately eval-
uate the pre therapeutic and post therapeutic effects the system
described would serve an efficient tool. Preprocessing with a
vital role in the overall system designed, was implemented using
Anisotropic Diffusion filters in previous works of Wang et al. [6].
Several other filtering methodologies for reduction of speckle
noises were also implemented by Sarode et al. [7]. Retinal layers
were individually identified for deeper analysis of retinal layer
deformations by Hussain et al. [8] and Niu et al. [9]. Various
tools were earlier designed by Guo et al. [10] to segment and
classify the input image using adaboost filter whose accuracy

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J. Med. Imaging Health Inf. 10, 566–571, 2020
range of abnormality conditions. With reference to the works
of Kafieh et al. [11] and Miri et al. [12], the developed sys-
tem restricted itself only to segmentation and was not further
extended for classification for a huge dataset. Few systems devel-
oped by Agrawal et al. [13] and Achariya et al. [14] restricted
towards metric estimations and was not developed as a classi-
fier to provide an expert comment on the presented input image.
The various tools and techniques used by the proposed system
are described in the future section and drawn with the conclu-
sion based on implementation of the same. The novelty of the
proposed research work is that it focuses on a wider range of
abnormalities and had also been evaluated for a comparatively
higher dataset thereby promising the stringent evaluation of the
proposed system performance and efficiency.
2. MATERIALS AND METHODS
The proposed image processing algorithm implements the pre-
processing, segmentation, features optimisation and classification
of the ophthalmic retinal images obtained from the OCT Devices.
The overall process is described in Figure 1.
Various steps of the algorithm are explained in this section.
The proposed system was evaluated with a total of 114 images,
which were acquired using TOPCONN and ZEISS OCT devices
during March 2018. The images were obtained from various
patients affected by CME, CNVM and MH with different age
groups with their personal data being confidential with approval
from the institution.
2.1. Preprocessing and Segmentation
Preprocessing is the step that makes the raw input image eli-
gible for further processing. The images acquired from the
OCT devices utilises ultrasound as the source of imaging.
As known, the ultrasound based imaging modalities are suscep-
tible to speckle noises and hence a speckle filter is mandatory
to optimally remove the speckle noises by pertaining the image
information. Various filters like Mean, Adaptive Smoothing,
Anisotropic Diffusion, Frost, Gaussian, Homomorphic Wiener,
Fig. 1. Flow diagram of system.
RESEARCH ARTICLE
and Homomorphic Wavelet filters were implemented [10] for
this purpose and their efficiencies were evaluated using various
parameters like SNR and PSNR. After preprocessing the areas
of interest (fluid filled retinal layers) was highlighted by basic
segmentation algorithm, say, sobel edge detection algorithm. The
sobel edge detector proved sufficient enough to highlight the reti-
nal volume. This operator is technically a differentiation operator
for discrete data and computes the approximation of the gradi-
ent function of the input image. The Sobel operator could be
defined as:
−1 0 +1 −1 −2 −1
Gx = −2 0 +2 Gy = 0 0 0
−1 0 +1 +1 +2 +1

G = Gx 2 + Gy 2 
2.2. Features and Classifier
From the segmented images, those of specific abnormalities were
identified for their common features. Various features that have
been used in the proposed system include zernike moments,
bulkiness, compactness and convexity. The features like bulki-
ness, compactness and convexity identified the fluid filled volume
that could be used as a vital feature for classification. Zernike
moments of second order were used, as these moments were bet-
ter shape descriptors and were more suggestible for supervised
classification algorithms. The Zernike polynomials are given by,
the following equations:

G  = am n Znm   + bm n Zn−m  
m n
where the coefficients are calculated as:

F  G = F  G dd
2n + 2
am n = G  Znm  
m
2n + 2
bm n = G  Zn−m  
m
The Zernike moments are most commonly used as shape descrip-
tors and hence for our applications, Zernike moments seem to be
a promising feature to be taken into consideration. The classifier
implemented in the algorithm was k-NN Classifier that catego-
rizes the test data based on the inputs acquired through previous
data of training.
2.3. Performance Index
The developed system’s efficiency was quantified using various
indicators, namely, sensitivity, specificity, accuracy and Youden’s
index [11].
Sensitivity refers to the amount of true positive cases with
the abnormality in the total subjects and serves a parameter to
evaluate the potential of the system to identify the diseases.
It gives the probability that an affected image is classified prop-
erly. Specificity refers to the amount of negative cases being
properly classified as negative. It is a parameter to evaluate the
system’s ability to classify the normal image properly. Accuracy
refers to the correctly classified subjects among the overall data
presented.
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RESEARCH ARTICLE
The system overall efficiency was evaluated using Youden’s
index, which is a measure of diagnostic accuracy. It evaluated
the overall ability of discrimination for any diagnostic proce-
dure [10]. Youden’s index (YI) was deduced by deducting 1
from the sum of test’s sensitivity and specificity [11], YI =
(sensitivity + specificity) − 1. For a test with poor ability of diag-
nosis, Youden’s index value equals 0, and for a perfect test
Youden’s index equals 1.
3. RESULTS
The evaluation of the proposed system with the samples obtained
was done as stated in the previous section. The results of various
steps in the overall algorithm is discussed in this section.
3.1. Preprocessing Results
As the OCT image acquisition utilises ultrasound as the source
of imaging, these are more prone to speckle noises. Optimal
filtering is essential to reduce the speckles without loss of the
image edges. Various noise filters including Mean, Adaptive
Smoothing, Anisotropic Diffusion, Frost, Gaussian, Homomor-
phic Wiener, and Homomorphic Wavelet filters were evaluated
for optimal elimination of speckles. These filters were assessed
by adding speckle noises and then evaluating their efficiency
and performance towards removal of the same with reference to
(a)
Fig. 2. (a) SNR of preprocessing filters, (b) PSNR of preprocessing filters.
(a)
Fig. 3. (a) Input gray image, (b) homomorphic wiener filtered image.
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J. Med. Imaging Health Inf. 10, 566–571, 2020
various parameters like SNR and PSNR, whose average values
are represented in Figures 2(a) and (b).
It could be understood from the above results that Homo-
morphic Wiener filters are ideal for our application. The sam-
ple graylevel input image and filtered images are shown in
Figures 3(a) and (b). It could be understood that the speckle
noises that are generated by the source of ultrasound are signifi-
cantly reduced with optimized edge preservation as shown in the
images.
3.2. Segmentation
Further to removal of the speckle noises, the fluid filled/void
regions were identified and separated by a basic segmentation
algorithm, using sobel edge detector. Sample images of normal,
CME, CNVM, and MH images with their segmentation outputs
are shown in Figure 4.
Though the segmentation uses a very basic edge detection
technique, it seems to be very satisfying and sufficient for the
selected application. Various features were extracted from these
segmented images in order to further grade them into several
classes.
3.3. Features for Differentiation
From the image segmentation, it could be understood that
the process of grading/classification could be done by extract-
ing and selecting certain features from the segmented image.
(b)
(b)
J. Med. Imaging Health Inf. 10, 566–571, 2020 RESEARCH ARTICLE

(a) (e)

(b) (f)

(c) (g)

(d) (h)
Fig. 4. (a) Normal input image, (b) CME input image, (c) CNVM input image, (d) MH input image, (e) normal segmented image, (f) CME segmented image,
(g) CNVM segmented image, (h) MH segmented image.

Few I.features
Table likeand
Minimum zernike moments
maximum (M1
values of and extracted.
features M2), and bulki- ness express some notable differences for various abnormalities,
whereas compactness and convexity was not so efficient as a
Class Zernike M1 Zernike M2 Bulkiness Compactness Convexity
feature that would be used for classification. The minimum and
Normal 144048 181844 474445 544952 0784913
145719 183266 557237 631129 0799744
maximum values of the samples evaluated for various abnormal-
MH 544148 134054 27520 1360133 0511427 ities used for training are tabulated in Table I.
573641 145046 44272 148144 0531051
CNVM 421747 112947 375654 384652 0972651
From Table I, it is clearly understandable that the zernike
488738 129495 393409 693773 108419 moments, M1 or M2 are sufficing to proceed with further clas-
CME 131296 0932434 22166 635546 0812045
193525 155279 310024 643805 0997265
sification. Taking this into consideration, in order to optimise
the time taken for processing, we ignore the other features and

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Table II. System performance metrics.
Disorder TP FP FN TN
CME 8/9 1/25 24/25 1/9
CNVM 7/8 2/26 24/26 1/8
MH 8/9 1/25 24/25 1/9
Normal 7/8 1/26 25/26 1/8
Overall performance of the system
evaluate our system performance by taking only Zernike moment
M1 into consideration for classification.
3.4. Performance Evaluation
Based on the proposed system of classification of various fluid
filled retinal disorders, the input image was classified as Class
0—Normal, Class 1—CME, Class 2—CNVM, Class 3—MH,
based on the pattern of fluid accumulation. These features were
used for classification by k-NN classifier, using which True Pos-
itive, False Positive, False Negative and True Negative were
derived for various abnormalities individually. The overall perfor-
mance was then evaluated with 70% data (80 images) as training
data and 30% (34 images) data as test data in terms of Youden’s
Index, accuracy, sensitivity and specificity. The performance met-
rics of the 34 images used as test data is tabulated in Table II.
From the tabulated values, the mean Performance evaluation
parameters were deduced to summarise the overall system perfor-
mance that contributes to 91.65% accuracy, 90.36% Sensitivity
and 92.95% Specificity. The overall performance could be justi-
fied by the Youden’s Index Value of 0.83.
4. DISCUSSION
As the overall system was restricted to identification and clas-
sification of fluid filled abnormalities, like CME, CNVM, MH
and Normal retina, the features that have been used in classifica-
tion seem to be well performing. As previous studies [6, 9–10]
have been restricted to one or two disorders, the proposed system
assures to be efficient for a comparatively wider range of abnor-
malities. Though the overall accuracy of the system matches the
earlier works, the improvisation could be seen with the num-
ber of abnormalities that had been included in the process of
classification. With overall system accuracy of around 91.65%
the proposed system seems to be significantly in match with the
existing systems whose accuracies lie in the range of 88–94%.
Earlier works focussed on morphological parameters alone which
restricted the number of disorders taken into consideration for
categorisation. Instead of the morphological parameters of bulk-
iness, compactness and convexity, the evaluated system used
Zernike moments which seem to be widely varying feature for
the disorders chosen. Based on the excess or deficit of fluids in
the retinal layers, the overall features also varied accordingly, so
as to enable the classifier to remain comparatively more accu-
rate for the proposed system. The classifier that has been used
is a basic supervised classifier, yet seems to be more appropriate
for the application proposed. The accuracy, sensitivity and speci-
ficity seem to be acceptable for the system proposed. The average
Youden’s index shows that the algorithm proposed is reliable in
retinal analysis and could be used in automated analysis of OCT
Image analysis. The proposed system could be further extended
for other disorders in retina and integrated with OCT device as
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J. Med. Imaging Health Inf. 10, 566–571, 2020
Accuracy (%) Sensitivity (%) Specificity (%) Youden’s index
92.44 88.89 96.00 0.85
83.65 89.90 92.31 0.80
92.44 88.89 96.00 0.85
91.83 96.15 87.50 0.84
91.65 90.36 92.95 0.83
an additional software for instantaneous evaluation of the retinal
disorders and the therapeutic efficiencies.
5. CONCLUSION
The developed system seems to be promising for the selected
application. The overall performance indices are also satisfac-
tory and matchable with the existing results derived from similar
works. The developed system has also covered a considerable
number of fluid related disorders which are caused due to exces-
sive or deficit fluids within the layers of retina. As OCT is an
efficient tool for detection of prior stages of blindness, the pro-
posed algorithm remains an expert system for earlier identifica-
tion and accurate evaluation of the retinal fluid volumes. Zernike
moments are most commonly used shape descriptors and were
hence used for the proposed application, in order to detect the
shape based changes that occur in retina due to accumulation or
lack of fluid within the retinal layers.
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Received: 20 May 2019. Revised/Accepted: 16 September 2019.
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