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Hard Exudates Detection: A Review

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 Hard Exudates Detection: A Review
Satya BhushanVerma1, Abhay Kumar Yadav2

Abstract: Hard exudates in the retina are the white or yellowish-white small de-
posits with sharp boundaries that appear as waxy, glistening or shiny surfaces.
The hard exudates are located in the outer layer of retina and in deep to the retinal
vessels. The damage on the retina of the eye, termed as retinopathy may give us a
clue to the vision injury or vision loss. Retinopathy is also evident in diabetic pa-
tients or in hypertension. This paper presents a complete review of some latest
methods for detecting hard exudates in retinal images. This paper will help the re-
searcher in studying the newest technique of various diabetic retinopathy and hy-
pertensive retinopathy screening methodologies. The previously proposed tech-
niques to detect hard exudates and retinal exudates are discussed in this present
paper and the automated identification of hard exudates in hypertensive retinopa-
thy is also discussed in the proposed paper.

Keywords: Hard Exudates; retinopathy; retinal images;

1 Introduction
The retina is a thin tissue layer located at the back side of the eye that convert light
to nerve signals, and send those nerve signals to the brain for understanding. The
term retinopathy refers to the damage in the retina of the eye which may lead to
vision impairment or vision loss. Retinopathy is also seen in hypertension or dia-
betic patient [11]. Continuous high blood pressure makes the retina’s blood vessel
walls thicken and narrow, and this places pressure on optic nerve and causes the
vision problems. Retinopathy can cause various lesions on the retina [19].

White or yellowish white minor deposits with the sudden change is called
hard exudates, this appear as shiny, waxy, or some sparkly. This is organized as
individual points, sheets, confluent patches, or in rings or horseshoes shape close
areas of retinal edema. Until now, no proper treatment for this pathology has been
accepted, and unfortunately, even after being detected hard exudates remain unre-
solved with scant or no recovery for the patient. Hence early detection of exudates
is considered to be a vital aspect in saving the patient vision. Computerized analy-

__________________________________

Satya Bhushan Verma

e-mail: satyabverma1@gmail.com
Abhay Kumar Yadav
e-mail: abhaybbdnitm01@gmail.com

1,2
Babasaheb Bhimrao Ambedkar (Central University) University, Lucknow, India
2

sis of fundus image is in use for over two decades, and this computational process
does not seem to slow down at all [17].

Figure 1:A human Eye with Diabetic Retinopathy (a)Hard Exudates (b)Soft Exudates or CWS

The image processing play an important role in any automated system [25]. There
are various type of preprocessing methods are used in any automated system [24].
It gives a non-invasive method for the detection of various retinal diseases such as
hypertensive retinopathy, diabetic retinopathy etc. The detection result will help
out to take the fast decision for automatic referrals to the ophthalmologists. Detec-
tion of contributing signs of a diseased retina from the fundus image helps in early
diagnosis of the disease and necessary treatment can be carried on further thus re-
ducing vision loss of the victim.

Plenty of works have been proposed to separate exudates from the fundus back-
ground. Firstly image segmentation approaches for exudates detection has been
based on thresholding, clustering, mixture modeling, region growing, morphology,
classification techniques and many others. Usually exudates detection approaches
begins with preprocessing and removal of the optic disc. Any of the first detection
methods provide a set of possible candidates belonging to the class of exudates.
Finally, range or procedure of classification is applied based on the features com-
puted from every sample results in only exudates.
In this paper our focus is on comparative analysis of detection of exudates and dif-
ference from other focused zones being present in the retinal image. Exudates are
present as the common early clinical signs of Diabetic Retinopathy [6]. Hence,
their detection would be considered an essential contribution in the screening
tasks[16]. Moreover, Exudates detection could assist to take first step in the direc-
tion of a whole observing and classifying of the disease.
 3

2 Literature Review
Shengchun Long et al.[26] proposed an algorithm for Hard Exudates detection. In-
itially they make an automatic retinal image preprocessing method by using the
active threshold technique and fuzzy C-means clustering (FCM) technique, then
they used a classifier named support vector machine. The proposed algorithm con-
tains four stages first is preprocessing, second is localization of the optic disc, the
third stage is the determination of candidate Hard Exudates by using dynamic
threshold in the grouping with global threshold which is based on the FCM, and
last stage is feature extraction. They used DIARETDB1[5] and the e-ophtha EX
retinal image database. On e-ophtha EX database they achieved average sensitivi-
ty 76.5%, PPV 82.7%, and F-score 76.7%, and on the DIARETDB1 retinal data-
base they achieved average sensitivity 97.5%, specificity 97.8%, and accuracy
97.7%.
An fascinating perspective to the color retinal image processing to human
recognition was given by Emil Saeed et al.[7]. In their work, a completely auto-
mated system was presented. To make retinal images invariant of scale and rota-
tion, they used SIFT in their method. Moreover, they used ICGF based prepro-
cessing method. Individual features of the retina were evaluated based on the
existence of diabetic retinopathy. Their perspective was such that their results dis-
play that the exudates were detected from a database with specificity 96.1%,
96.9% sensitivity and the accuracy was 97.38%.
Another interesting approach was of AbhilashGoudMarupally et
al[1],they put forward a Semi-automated quantification technique for the purpose
of hard exudates detection in photographs of color fundus that were diagnosed for
diabetic retinopathy. They used color fundus photographs of 30 eyes were taken
from 30 samples, 21 were from men and 9 women. They were able to develop a
semi-automated algorithm to quantify the area covered by HEs. Two different
methodology were given by them (i) top-hat filtering with second order statistical
filtering, (ii) color fundus images thresholding. They were able to detect about 60–
90% area under the Hard Exudates in 13 images and about 90–100% in other 17
images.
IqbaldeepKaur et al.[13] managed to describe different works that were
needed for the automatic identification of HEs and CWSs in retinal images for de-
tection of diabetic retinopathy and images classification based on support vector
machine (SVM). They evaluated their system on a big data records having 129
images of human retina. Their proposed method achieved sensitivity 96.9%, speci-
ficity 96.1% and accuracy 97.38% for the detected exudates from a database. A
systematic approach was given by ArjunNarang et al [2] which proposed an algo-
rithm for hard exudates detection using a Lifting wavelet Transform (LWT) .This
4

technique was based on image enhancement method and Support Vector Machine.
They described various image processing techniques, which were expected to play
an important part role in the diagnosis of retinal diseases due to diabetic retinopa-
thy. A detailed comparative study with the Support Vector Machine classifiers
gave good results. A training set of 40 data values and testing set of 20 data values
are used. Training data gave accuracy for SVM of about 92.77% and the testing
data gave the accuracy of 89.9%.
Another quite interesting approach was given by Avula Benzamin et al
[3] which implemented an algorithm based on using deep learning for hard exu-
dates detection in given fundus images of the retina. Dataset downloaded from
IDRiD was used in this method. They effectively detected Hard Exudates with an
accuracy of 98.6% by using deep learning model. Rokade P. et al[22] proposed an
algorithm that consisted of seven different steps. They performed some easy and
simple operations on the image (such as grayscale conversion or normalization of
color). Moreover some complex and advanced algorithms (such as decomposition
and reconstruction of Haar wavelet). However their approach was able to give a
very low accuracy of about 22.48% only. This algorithm had a disadvantage of not
being effective due to its very low accuracy
Kavitha et al.[15] uses the thresholding approach based on histogram.
Their technique considered histogram local minima for this operation. They ig-
nored the small changes in the histogram, and considered the last values to be the
threshold value. This threshold value was applied on the image in order to detect
exudates with the optic disk of the eye. Since the blood vessels converges at the
optic disk. So, they were able to detect the converging point of the blood vessels
using this method and the sharp bright area where this intersection point occurs
were considered as the optic disk, and the other regions were declared as exudates.
They were able to obtain an accuracy of about 89%, sensitivity of about 92.87%
and the predictive value of 96.03% was achieved.
Punnolil, A. et al[21], proposed an easy thresholding method that were
used for detection of the hard exudates with application of an appropriate thresh-
old level ,the obtained pre-processed image was accompanied and had a 0.97 val-
ue threshold value on which segmentation were performed. The binary images
were closed morphologically and were opened only for the removal of optic disk
and the blood vessels. They were able to achieve Sensitivity of about 96.89% and
specificity of 97.15% is achieved, however obtained accuracy was not reported by
them. Garcia, et al[18] proposed an automatic exudates detection technique in
fundus images. They normalized each image and a combination of global and
adaptive thresholding was proposed for the segmentation of the candidate EX. In
order to improve the performance of the proposed algorithm, innovative post pro-
cessing of the image was done to eliminate the noisy regions. They were able to
 5

achieve mean sensitivity of nearly 92.1% and mean positive predictive value of
86.4% was acquired. Considering on the image-based criterion, their system ob-
tained a mean sensitivity of about 100%, mean specificity of about 70.4% and
mean accuracy of 88.1% were recorded.
Sariera et al[28] proposed an exudates detection and classification meth-
od. For detection, masking of the optic disc (OD) is done of the presented retinal
image and then the segmentation is done based on morphological reconstruction
techniques and also on the thresholding value for the detection of the bright
patches that would further lead to hard exudates. For the purpose of classification
of different features like that of color, size, and texture are extracted from the ob-
tained segmented subjects regions dependent on these functions and the regions
are determined by using multi-layered perceptron neural network (MLP. Their
proposed model measured performance depending on average sensitivity, specific-
ity, and accuracy. They were able to obtain 86.9%, 94.8% and 93.0% for sensitivi-
ty, specificity, and accuracy respectively.
H. Wang et al.[9] presented a mathematical approach that merges statisti-
cal classification method with local-window-based verification strategy and
brightness adjustment procedure. They were able to perform them based on the
color information which states lesions presence detection by utilising MDD classi-
fier based on statistical pattern recognition techniques. They were successful in
obtaining accuracy of about 100% accuracy in detecting all lesions present in the
retinal images. They managed to obtain 70% accuracy in correct classification of
retinal images as normal which were free from any lesions.
Ruba et al[27] proposed algorithms based on the SVM classifier for the
effective identification and segmentation of exudates. Preprocessing was done ini-
tially to remove the noises. Gabor and GLCM algorithm were used for feature ex-
traction from the images. Depending on the feature values the extracted images
were classified as normal or disease affected. Their given classifier presented 82%
accuracy. For Optical Disk segmentation the obtained results were 99.63% accu-
racy and the for Exudates segmentation results were 99.35% accurate.
Sopharak et al.[4] proposed sets of different morphological operators
that were used optimally adjusted for exudates detection on DR patients which
have non-dilated pupil with low-contrast images. The operator automatically de-
tected exudates were validated by comparing with expert ophthalmologists’ hand-
drawn ground-truths. Validations were successful and the sensitivity of 80% and
specificity of 99.5% were obtained for exudates detection. Nugroho et al[8] fo-
cused separation of optic disc from exudates as exudates have similar characteris-
tic with optic disc. In order of removing false positive in exudates detection is
done. Finding the small area of the optic disc that is enlarged to cover its total area
was used for the removal of optic disc. A high pass filter is used in filtering the
6

green channel that consists of all necessary information for detection of exudates.
After that, proper segmentation of exudates is done by morphological and thresh-
olding operations. The proposed approach in exudates detection was able to obtain
accuracy of 99.99%, sensitivity of 90.15% and specificity of 99.99% respectively.
Manoj et al[23] proposed an efficient diagnostic model for identification
of feature extraction in DR. The identification of the optic disk was done by com-
bining the high disk intensity properties with the blood vessel convergence in a
cost function. On considering the algorithm on different images of rhe database
with different illumination characteristics, contrast and different DR stages were
able to successfully detect rate 90% for hemorrhage. Afterwards on many other
features they obtained has given out about 95% detection rate for microaneurysm,
95% detection rate sensitivity and 94% detection specificity for hard exudates
identification and were able to achieve 97% success rate for the optic disk locali-
zation process.
Imani E et al[13] proposed an exudates segmentation algorithm based on
dynamic thresholding and morphological operators applied in retinal images, and
they utilised Morphological Component Analysis(MCA) algorithm. They
achieved specificity of 83.5% and sensitivity of 99.8%. Harangi et al[10] used
multiple active contours and they used region wise classification, they were able
to achieve sensitivity of 92%, specificity of 68% and sensitivity of 87%, specifici-
ty of 86% on different databases. Pereira et al.[21] uses ant colony optimization
approach and they achieved accuracy of 97.8%; sensitivity of 80.8% and specifici-
ty of 99.1%
Wisaeng et al[14]proposed an algorithm to detect exudates by employing
composite features based on morphological mean shift algorithm. Their algorithm
begins with the pre normalization of the given retinal image, followed by contrast
enhancement, then noise removal, and followed the localization of the Optical
Disk. Then, a complete segmentation using mean shift is done which provides a
different set of exudates and non-exudates candidates separately. In the end, a de-
tailed classification based on mathematical morphology algorithm (MMA) proce-
dure was presented to contain only exudates pixels and eliminate other lesions.
The optimal value parameters of the MMA increased the accuracy results by
13.10%. Their methods were able to achieve an average sensitivity of 98.4%,
specificity of around 98.13, and accuracy of 98.35% in the process of detection of
exudates.
Conclusion:
In proposed paper, a detailed comparative study has been performed on the proce-
dures of automatic detection of hard exudates algorithms. It highlights the signifi-
cant improvement, achieved by the different algorithms given by different re-
 7

searchers. Based on this paper, we are able to conclude that a very little research
has been done on the usage of evolutionary algorithms to detect the hard exudates.
Usage of evolutionary algorithms will serves as a possible direction for the future
work in this field. This paper will help the researcher to understand the presently
available procedure and methods for detection of hard exudates and it will help
them in pursuing their research forward.

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