2023 International Conference on Integrated Intelligence and Communication Systems (ICIICS)

Preprocessing, Feature Extraction, and

Classification Methodologies on Diabetic
Retinopathy Using Fundus Images
2023 International Conference on Integrated Intelligence and Communication Systems (ICIICS) | 979-8-3503-1545-5/23/$31.00 ©2023 IEEE | DOI: 10.1109/ICIICS59993.2023.10421217

1st Veerendra Basreddy 2nd Sachinkumar Veerashetty

Dept.of Computer Science and Engineering Dept.of Computer Science and Engineering
Faculty of Engineering and Technology (Coed) Faculty of Engineering and Technology (Coed)
Sharnbasva University Sharnbasva University
Kalaburagi, India Kalaburagi, India
veerubasreddy@gmail.com sveerashetty@gmail.com

Abstract—Significant progress has been made throughout

the detection of Diabetic Retinopathy (DR) over the past few
decades because of the utilization of Deep-Learning (DL)
techniques. Accurate and economical identification of DR using
Fundus Images (FI) is made possible by combining state-of-the-
art methods for image-processing, feature-extraction, and
classification algorithms. This survey aims to explore and
analyze the latest developments in preprocessing, feature
extraction, and classification approaches, highlighting their key Fig. 1. Normal Eye and DR [7].
ideas and contributions. Novel approaches to feature extraction,
involving traditional handcrafted features and DL-based
methods, are investigated to capture relevant characteristics of
DR lesions effectively. Furthermore, the survey explores diverse
classification algorithms, including Support-Vector-Machines
(SVM), Convolutional-Neural-Networks (CNNs), and ensemble
methods, which enable accurate categorization of DR severity
levels. This survey provides valuable insights into the state-of-
the-art methodologies for DR detection, facilitating a
comprehensive understanding of the key approaches and
innovations in preprocessing, feature extraction, and Fig. 2. The Messidor-2 and Kaggle-EyePACS datasets image samples [8].
classification techniques.
Managing blood sugar, blood pressure, and cholesterol
Keywords—Feature Extraction, Diabetic Retinopathy, through lifestyle changes and medications is crucial. DR often
Classification, Fundus Images, Preprocessing
has no early warning signs, so it is crucial that people with
diabetes get frequent eye checkups [9]. The main detection
I. INTRODUCTION
methods include dilated eye examinations [10], Fundus
A collection of eye diseases known collectively as Images (FI) [11], Optical-Coherence-Tomography (OCT)
“Retinopathy” affects the retina, the membrane-covered, [12], and Fluorescein-Angiography [13]. Dilated eye exams
light-sensitive layer at the exterior of the eye that is allow eye care professionals to examine the retina for signs of
accountable for processing visual information into electrical retinopathy by widening the pupils with eye drops. Fundus
impulses [1]. It can cause changes in retinal blood vessels, photography captures high-resolution images of the retina for
leading to various vision problems and potential permanent monitoring changes. OCT provides cross-sectional images to
vision loss if untreated. The two common types are Diabetic detect retinal swelling and thickening. Fluorescein
Retinopathy (DR) [2], linked to poorly controlled blood sugar angiography involves injecting a dye to highlight blood
in diabetes, and Hypertensive Retinopathy [3], related to high vessels and identify leakage or abnormal growth. The risk of
blood pressure. Symptoms include blurred vision, floaters, irreversible blindness or vision loss can be drastically reduced
impaired color vision, difficulty seeing at night, and sudden through early identification, immediate action, and careful
vision loss. Early medical attention from an eye specialist is supervision. Adhering to healthcare provider's
crucial for early detection and treatment. Further, people recommendations for regular eye exams is crucial,
suffering from diabetes are more likely to go blind from a considering factors like age, diabetes duration, and existing
condition called DR, a form of retinopathy [4]. When blood eye conditions.
sugar levels are too high, it causes damage to the tiny veins
within the retina, which can cause fluid leakage or obstruction The use of Deep-Learning (DL) and Machine-Learning
and ultimately blurred vision. An example of normal eye and (ML) to detect DR using FI demonstrated positive outcomes
DR has been given in Figure 1 and Figure 2. There are two [14]. The workflow involves three key steps: preprocessing,
stages: non-proliferative DR [5], where damaged vessels leak where images are resized, contrast-enhanced, normalized, and
and cause swelling, and proliferative DR [6], where abnormal augmented to improve analysis; feature extraction, which
blood vessels grow and may lead to severe vision loss. employs traditional methods like vessel segmentation or DL
with CNNs to learn important features directly from raw
pixels; and classification, achieved through traditional ML
algorithms or end-to-end DL models using CNNs to classify

979-8-3503-1545-5/23/$31.00 ©2023 IEEE

Authorized licensed use limited to: Charles Darwin University. Downloaded on February 09,2024 at 19:17:36 UTC from IEEE Xplore. Restrictions apply.
DR severity levels [15]. These methods enable accurate and
efficient diagnosis, facilitating early detection and improved
patient health. Hence in this study, we present a survey on the
various present methods which are currently being used for
the preprocessing, feature-extraction, and classification of DR
using FIs. We study their methods, the dataset used, and the
results achieved using their methods. After the complete
survey, we provide the issues and challenges faced by the
existing methods and provide a novel approach for solving the
issues of the existing models. In the next section, the literature
survey has been presented. The paper is organized in the
following way. In Section II, the related work for the DR
preprocessing, feature extraction, and classification has been
discussed. In Section III, the taxonomy of the research is
presented. Further, in Section IV, the possible solutions for
improvement of the existing wok is presented. Finally, in
Section V, the conclusion of the paper is presented.
II. RELATED WORK
In this section, we have surveyed the various
methodologies, frameworks, and architectures which have
been presented from 2020 to 2023. In this survey, the primary
focus is on the three stages: preprocessing, feature extraction,
and classification, for diagnosing DR using Retinal FI.
Preprocessing involves preparing the FI by resizing, contrast
enhancement, normalization, and data-augmentation to
enhance the approach performance and prevent overfitting.
Feature extraction aims to extract relevant information from
the FIs using either traditional methods like vessel
segmentation and optic disk localization or DL approaches
with Convolutional Neural Networks (CNNs) that learn
hierarchical features directly from the raw pixels. Finally, in
the classification stage, DR severity levels are classified using
either traditional ML algorithms, such as Support-Vector-
Machines (SVM) or Random-Forest (RF), or end-to-end DL
models using CNN architectures. The ultimate goal of this
survey is to explore and analyze the effectiveness of these
techniques in accurately diagnosing DR to aid in early
detection and improve patient outcomes.
A. Preprocessing
In [16], their main objective was to present a novel CNN
method for training the segmented and processed Retinal-FIs
(RFI) to classify where the patient has a diabetic eye disease.
For achieving this, first, this work has done preprocessing by
enhancing the original RFI using illumination correction,
Contrast-Limited Adaptive Histogram Equalization
(CLAHE), and channel extraction. Further, they have
segmented the image by using the Region-of-Interest (ROI) of
optic nerves, macular regions, and blood vessels from the RFI.
Furthermore, they have selected high-performance methods
for classifying the segmented and processed RFIs. Finally,
presented the novel CNN method and trained their model to
achieve higher accuracy for the classification. The proposed
CNN method attained better results in comparison to the
VGC16, Xception, and DenseNet121 for precision,
sensitivity, accuracy, and specificity. One major issue with
this paradigm is that it loses effectiveness as a result of transfer
learning. In [17], this work has presented a DL and Internet of
Things (IoT) method for diagnosing the DR called IoTDL-
DRD. In this work, the IoT devices are used for collecting the
data and then transferring the collected data towards the cloud
for preprocessing. The contrast level as well as the noise is
removed from the RFIs during the preprocessing process.
Further, for detecting the legion area, this work has used a
Authorized licensed use limited to: Charles Darwin University. Downloaded on February 09,2024 at 19:17:36 UTC from IEEE Xplore. Restrictions apply.
segmentation method called as Mayfly-Optimization based
Region-Growing (MFORG). Finally, for extracting the
features from the RFIs, they have used Long-Shot Term-
Memory (LSTM) and Densely-Connected Network
(DenseNet) for efficiently classifying the DR patient.
Moreover, the optimization for the LSTM is done using the
Honey-Bee Optimization (HBO) method. The proposed
IoTDL-DRD attained an average accuracy of 98.97% during
training and 99.08% during testing for the MESSIDOR [18]
dataset. Also, the computation time was also reduced in
comparison to the ResNet, Inception-V3, GoogLeNet, and
AlexNet. The IoTDL-DRD attained better results in
comparison to ResNet, Inception-V3, GoogLeNet, and
AlexNet for AUC score, sensitivity, computation time
specificity, and accuracy.
In [19], in this work, their main focus was to develop
supervised as well as unsupervised learning for detecting DR.
First, the proposed work preprocessed the RFIs to discard the
variations found in the background of the RFIs for achieving
higher accuracy. Further, important features like retinal
vessels and optic nerves were identified by utilizing the multi-
overlapping windows and Radon-Transform (RT). Further,
they used SVM for the detection of the DR. Their model was
tested using three datasets, all of them merged having 749
images. The results show that the presented model attained
specificity and sensitivity of 93% and 100%. In [20], they
presented a Computer-Aided-Diagnostic (CAD) technique to
detect the DR by utilizing CNN and SVM. This work was
presented for only the Optical-Coherence Tomography (OCT)
images. In this work, they have first preprocessed the
complete image where they have extracted the input features
which will be required by the CNN. By using the Markov
Gibbs Random Field [21], they have segmented the OCT
image into 12 layers. They have evaluated the technique using
the OCT dataset. The technique was compared with the
existing Random Tree, K-Nearest Neighbor, K-Star, and RF
and the results show that the proposed technique achieved
recall, specificity, and accuracy of 100%, 88%, and 94%. The
technique In [22], they have presented a CNN-UNetwork
architecture for the identification of retinal hemorrhages from
the RFIs. This architecture presented a preprocessing stage
where they removed the black borders from the RFIs for
achieving better accuracy during identification. In addition,
they have isolated the green channel by slicing apart the red,
blue, and yellow ones [23], [24]. This is because the green
channel has better contrast for the retinal hemorrhage which
will help for better identification. The CNN-UNetwork was
trained for the segmentation and identification of the retinal
hemorrhage from the RFIs. Finally, for evaluating their
model, they used DIARETDB1 [25] and the IDRiD dataset.
By preprocessing, the results show that the CNN-UNetwork
achieved specificity, sensitivity, and accuracy of 99.68%,
80.49%, and 98.68%.
B. Feature Extraction
For DR assessment, the authors of [26] describe a
Federated-Learning (FL) model they've called DRFL. In this
work, they have used the averaging method of FL and the
median of the classification loss using the cross-entropy
method. Further, in this work, for the extraction of features,
they have proposed a central server which is utilized for
extracting the multi-scale features from the RFIs for the
identification of tiny lesions existing in the RFIs. For
evaluating their work, they have considered IDRiD [27],
MESSIDOR-2 [28], Silchar [29], and Kaggle Dataset. The
DRFL model attained specificity, accuracy, F1-score, and
precision of 99.3%, 98.6, 97.5 and 97.25% respectively. In
[30], they have presented an architecture that uses CNN along
with the Two-Fold Feature Augmentation (TFA-Net) for the
extraction of DR from the multi-modal RFIs. By using the
CNN-TFA-Net, this architecture extracts the representational
characteristics of the DR at different scales. After the feature
extraction, this work utilized Reverse Cross-Attention as well
as Weight-Sharing Convolutional Kernels. The CNN-TFA-
Net was evaluated using a private KHUMC dataset and a
MESSIDOR dataset. The findings demonstrate that CNN-
TFA-Net was successful in achieving 94.8% accuracy.
In [31], this work proposed a technique for identifying the
DR for both the binary as well as the multiclass classification
dataset. In this work, first, they used Ben-Graham’s method
for preprocessing. For the feature extraction, they have
utilized the CLAHE method which will remove noise and help
for better extraction of the different features. A hybrid CNN
Singular-Value Decomposition (SVD) technique has been
presented for reducing the feature input for the classifier.
Finally, an Extreme-Learning-Machine (ELM) algorithm has
been presented to reduce the cost of training. For evaluating
their model, the MESSIDOR-2 and APTOS 2019 [32] dataset
was considered. The CNN- SVD-ELM achieved recall and
accuracy of 100% and 99.73% for the binary classification.
For multi-class classification, for the MESSIDOR-2 and
APTOS-2019 datasets, the CNN-SVD-ELM achieved an
accuracy of 96.26% and 98.09%. In [33], a Deep Symmetrical
CNN (DSCNN) method has been proposed for detecting DR
using the RFIs. In this work, they have used the SCNN for
extracting the features. Also, they have used multiple
convolutions and poolings for extracting the features and
filtering the features. This work also addresses the imbalance
of negative and positive samples by increasing the size of the
CNN. This will avoid the issue of overfitting. For evaluation,
they have used the DIARETDB1 [34] dataset. The accuracy
attained by the average-pooling, convolution, and max-
pooling was 93.6%, 92.0%, and 93.2% by the DSCNN
method. In [35], they present a framework which is robust that
collaboratively uses the image and patch-level annotation for
the grading of DR severity. They did this by utilizing both
microscopic lesion data and information obtained from
images. This work extracts multiple features using a grading
module and lesion-attention generator. For evaluating their
model, they used the IDRiD dataset, LIQ-EyePACs dataset
[36], MESSIDOR-1 [37], and MESSIDOR-2. The results
show better results in comparison to the existing works.
C. Classification
In [38], this work aims to propose a DL model using the
CNN called RetNet-10 for classifying the RFIs into five
classes of DR. The aim objective of this work was to achieve
high accuracy and reduce the computation time. For
evaluating their model, they have considered MESSIDOR-2,
APTOS [39], and IDRiD datasets which have been all merged
into one dataset. They have pre-processed all the images to
remove the noise and artifacts from the RFIs. The RetNet-10
was compared with VGG19, Xception, VGG16, InceptionV3,
MobileNetV2 and ResNet50. The accuracy achieved by
RetNet-10, VGG19, Xception, VGG16, InceptionV3,
MobileNetV2 and ResNet50 was 98.65%, 88.21%, 89.57%,
90.16%, 87.68%, 91.42%, and 87.23%. Hyperparameter-
Tuning-Inception-v4 (HPTI-v4) was suggested by this study
[40] for classifying the DR with the use of colored RFIs. First,
they preprocessed the images to adjust the contrast level of the
Authorized licensed use limited to: Charles Darwin University. Downloaded on February 09,2024 at 19:17:36 UTC from IEEE Xplore. Restrictions apply.
RFIs using the CLAHE method. Additionally, a histogram-
segmentation technique was used to divide up the RFIs after
they were already analyzed. Lastly, the HPTI-v4 technique
employs the Multi-Layer-Perceptron (MLP) for obtaining
important characteristics from the subdivided RFIs. They have
evaluated their model using the MESSIOR dataset. The
performance of HPTI-v4 was evaluated in comparison to
several well-known models, including ResNet, GoogleNet,
VggNet-19, VggNet-16, VggNet-s, AlexNet, M-AlexNet, and
DNN-MSO. The accuracy achieved by these models varied,
with ResNet reaching 90.4%, GoogleNet achieving 93.36%,
VggNet-19 attaining 93.73%, VggNet-16 scoring 93.17%,
VggNet-s reaching 95.68%, AlexNet achieving 89.75%, M-
AlexNet performing at 96%, DNN-MSO achieving 99.12%,
and HPTI-v4 showcasing the highest accuracy of 99.49%.
In [41], they have presented an ensemble framework for
the multi-stream data for the classification of DR. This work
utilized the Principal-Component-Analysis (PCA) and deep
network technique for training the intra and inter-class
variation using the RFI images. Further, they have presented
a multi-stream network which is built using DenseNet-121
and ResNet-50 for the feature extraction. Further, they utilized
Random-Forest and AdaBoost, an ensemble method for the
classification of DR. A similar CNN framework was
developed and compared to the suggested ensemble approach.
The MESSIDOR-2 and EyePACS [42] dataset has been
utilized for evaluating this work. The results show that the
ensemble method achieved an accuracy of 95.58 % for the
MESSIDOR-2 and 89.20% for the EyePACS dataset. In [43],
they have analyzed nine Bayesian-Neural Network (BNN)
methods which have been used for classifying the DR using
the RFIs. Specifically, they have determined an entropy-based
ambiguity measure's relationship to classification risk. Using
this they have proposed a new uncertainty measure for
evaluation. For evaluation, they have used KSSHP [44],
EyePACS, APTOS, and MESSIDOR-2 for evaluation. The
accuracy of nine BNNs ranges from 99.9% to 71.02%. The
approach has also been assessed by using the Quadratic-
Weighted-Kappa (QWK) score on each set of data. In [45], a
DL technique for identifying DRs and categorizing their
severity based on Color-FIs is presented. This work has
utilized an encoder, DenseNets169 for constructing visual
embeddings. Further, utilizing the cross-entropy loss, they
have trained their model using the APTOS dataset. The
suggested model classified the DR severity level with 97%
accuracy, 94.55% specificity, 98.3% sensitivity, and 88.8%
QWK in a binary classification.
III. TAXONOMY OF THE RESEARCH
From the above study, it can be seen that the existing
models for DR diagnosis using FIs encounter several
challenges and issues during the preprocessing, feature
extraction, and classification stages. This is because of the
following issues
• FIs can vary significantly in quality, resolution, and
illumination, which can affect accurate feature
extraction. Also, precisely localizing the optic disc is
critical for subsequent analyses, but variations in shape
and appearance among individuals pose challenges.
Vessel segmentation becomes difficult when diseases
such as hemorrhages or exudates obscure vessel
borders, making it difficult to remove blood vessels
from FIs, which is necessary for retinal vasculature
study.
 • Preprocessing FIs is a crucial step in enhancing image transfer learning, attention mechanisms, ensemble methods,
quality and preparing them for analysis. However, uncertainty estimation, and collaborative studies to improve
some preprocessing techniques, such as classification accuracy. The taxonomy of the research work is
computationally intensive operations like image given in Figure 3.
resizing and contrast enhancement, can increase
processing time, impacting real-time performance.
Additionally, data augmentation during preprocessing
may introduce redundant information and distort
original features, leading to overfitting if not carefully
controlled.
• DR manifests in various lesion types, including
microaneurysms, hemorrhages, exudates, and
neovascularization. Designing feature extraction
methods to accurately capture these diverse lesions is
challenging. The complexity of FIs, with intricate
structures like blood vessels, optic discs, and lesions,
poses further difficulties in extracting relevant features
while preserving diagnostic information.
• DL models used for DR diagnosis often learn abstract
features directly from raw pixels, making it
challenging to interpret which specific patterns or
regions influence the diagnosis. Interpretable feature
extraction techniques are needed for better
understanding and clinical acceptance of model
predictions.
• Model overfitting and high dimensionality are
concerns when using handcrafted feature extraction
methods. Dimensionality reduction techniques should
be employed to address these issues and improve Fig. 3. Taxonomy of research.
model performance. Large-scale datasets with accurate
annotations are required for training DL models IV. DISCUSSION
effectively. However, collecting and annotating such Developing a preprocessing technique to improve the FIs
datasets can be resource-intensive. of the retina involves several key steps for enhancing image
• Fine-grained classification of DR severity levels is quality and preparing them for subsequent analysis.
challenging, especially when distinguishing subtle Techniques like image resizing, contrast enhancement,
differences between severity levels with limited inter- denoising, and illumination correction are crucial for
class variation. Misclassification of borderline cases achieving consistent and high-quality images. By resizing the
can have significant implications for patient FIs to a standard resolution, computational load during
management and treatment decisions. analysis can be reduced, ensuring faster processing times.
Equalization of histograms and adaptive equalization of
• The reasoning behind DL models' predictions is histograms are two contrast enhancement methods that are
sometimes obscured because of their reputation as capable of being used to bring out key details in an image. This
"black-boxes," especially in the case of deep neural- helps in highlighting subtle details that might be vital for
networks. Robust uncertainty estimation methods are accurate diagnosis. Further, to remove artifacts and blurriness
also essential for critical healthcare decisions. caused by noise, denoising algorithms like Gaussian filtering
median filtering or CLAHE can be utilized. These algorithms
• Clinical applications demand real-time or near-real- effectively clean the images, ensuring that only relevant
time diagnosis, but some complex DL models might information remains for further analysis. Also, uneven
have higher inference times, impacting their feasibility illumination in FIs can hinder accurate diagnosis, so
in real-world settings. Ensuring real-time inference correcting it is essential. Methods like top-hat filtering or
capability is crucial for practical deployment in clinical background subtraction can help in achieving uniform
environments. illumination, thus making the images suitable for analysis.
Addressing challenges in DR diagnosis using FIs involves The discovery of the optic disc is also essential since it
employing appropriate preprocessing techniques, including provides a starting point for further investigations. Hence,
advanced image processing algorithms like adaptive filtering developing an accurate and robust algorithm for automatic
and histogram equalization. The accuracy and effectiveness of optic disc detection is vital for consistent and reliable results.
automatic DL-based approaches for detecting optic discs and Also, the blood vessels play a crucial role in analyzing the
segmenting vessels appear promising. Optimized algorithms retinal vasculature, and designing sophisticated vessel
and parallel computing can reduce preprocessing time for real- segmentation methods to extract them from the FIs is a
time performance. Collaborative efforts between computer complex task. Therefore, accurate vessel segmentation is
vision experts and ophthalmologists are vital to developing essential for the proper evaluation of retinal health.
robust preprocessing pipelines. For feature extraction, Furthermore, validating the effectiveness of preprocessing
researchers can explore traditional and DL-based approaches,

Authorized licensed use limited to: Charles Darwin University. Downloaded on February 09,2024 at 19:17:36 UTC from IEEE Xplore. Restrictions apply.
techniques is essential to ensure that they indeed improve the successfully captured relevant characteristics of DR lesions.
image quality and analysis results. Thus, quantitative metrics Furthermore, the survey showcased diverse classification
and qualitative evaluation are required to measure the algorithms, ranging from SVM to CNNs and ensemble
performance of the preprocessing technique. The next step, methods. These approaches enable accurate categorization of
following preprocessing, is to create an accurate algorithm for DR severity levels, thus aiding in better patient management
locating the optic disc, as well as a complex vessel and treatment decisions. Overall, the study is a helpful
identification technique. Exudates, Hemorrhages, and resource, since it sheds light on cutting-edge preliminary
Microaneurysms can all be identified as DR symptoms by processing, feature-extraction, and classification methods for
employing a lesion segmentation method. Conventionally DR detection. These advancements offer promising results to
constructed characteristics and DL-based methods can both be enhance early diagnosis, improve patient outcomes, and
used for obtaining significant characteristics within the mitigate the risk of vision loss for individuals with diabetes.
divided regions. These techniques help in capturing essential Continued research in this area is crucial to address the
characteristics of DR lesions for accurate diagnosis. challenges and bridge the gap between cutting-edge
Furthermore, employing classification algorithms, such as technology and clinical application, ultimately benefiting
SVM or CNNs, categorizes FIs into different DR severity patients and healthcare providers alike.
levels. Cross-validation and fine-tuning optimize the
classification model for improved accuracy and reduced REFERENCES
overfitting. Ensemble methods, combining multiple [1] J. Grauslund, “Diabetic retinopathy screening in the emerging era of
classifiers, further improve classification performance and artificial intelligence,” Diabetologia, May 2022, doi: 10.1007/s00125-
enhance robustness in the diagnosis process. By following 022-05727-0.
these comprehensive steps, a methodology to detect DR in the [2] N. Tsiknakis et al., “Deep learning for diabetic retinopathy detection
and classification based on fundus images: A review,” Computers in
eye can be effectively developed, aiding in early diagnosis and Biology and Medicine, vol. 135, p. 104599, Aug. 2021, doi:
improved patient care. The comparative study of the discussed 10.1016/j.compbiomed.2021.104599.
works is given in Table 1. [3] Q. Abbas, I. Qureshi, and M. E. A. Ibrahim, “An Automatic Detection
and Classification System of Five Stages for Hypertensive Retinopathy
TABLE I. COMPARATIVE STUDY. Using Semantic and Instance Segmentation in DenseNet Architecture,”
Sensors, vol. 21, no. 20, p. 6936, Oct. 2021, doi: 10.3390/s21206936.
Ref Focus Dataset Accuracy
[4] M. Kropp et al., “Diabetic retinopathy as the leading cause of blindness
[16] CNN-based RFI classification N. A 92%
and early predictor of cascading complications—risks and mitigation,”
DL and IoT-based DR vol. 14, no. 1, pp. 21–42, Feb. 2023, doi:
[17] MESSIDOR 91%
diagnosis https://doi.org/10.1007/s13167-023-00314-8.
Supervised & Unsupervised DR
[19] Merged Dataset 93% [5] R. E. Putra, H. Tjandrasa, N. Suciati and A. Y. Wicaksono, "Non-
Detection
Proliferative Diabetic Retinopathy Classification Based on Hard
CAD Technique for DR
[20] OCT Dataset 98% Exudates Using Combination of FRCNN, Morphology, and ANFIS,"
Detection (OCT)
2020 Third International Conference on Vocational Education and
CNN-UNetwork for Retinal DIARETDB1, Electrical Engineering (ICVEE), Surabaya, Indonesia, 2020, pp. 1-6,
[22] 98.68%
Hemorrhages IDRiD doi: 10.1109/ICVEE50212.2020.9243185.
IDRiD,
DRFL Model for DR [6] G. N. Taris, A. Handayani, T. L. Mengko and B. R. Hermanto,
[26] MESSIDOR-2, 98.6
Assessment "Proliferative Diabetic Retinopathy Classification from Retinal Fundus
Silchar, Kaggle
Images Using Fractal Analysis," 2021 IEEE Region 10 Symposium
CNN-TFA-Net for Multi- KHUMC, (TENSYMP), Jeju, Korea, Republic of, 2021, pp. 1 -6, doi:
[30] 94.8
Modal RFI Extraction MESSIDOR 10.1109/TENSYMP52854.2021.9550926.
96.26%
CNN-SVD-ELM for MESSIDOR-2, [7] Rajkumar, R.S., Selvarani, A.G., Ranjithkumar, S. (2020).
[31] and
Binary/Multiclass DR Id. APTOS 2019 Comprehensive Study on Diabetic Retinopathy. In: Das, K., Bansal, J.,
98.09%
Deep, K., Nagar, A., Pathipooranam, P., Naidu, R. (eds) Soft
DSCNN Method for DR
[33] DIARETDB1 93.6% Computing for Problem Solving. Advances in Intelligent Systems and
Detection
Computing, vol 1057. Springer, Singapore.
MESSIDOR-2, https://doi.org/10.1007/978-981-15-0184-5_14
[38] RetNet-10 Model 98.65%
APTOS, IDRiD
[40] HPTI-v4 Technique MESSIOR 99.49% [8] Papadopoulos, A., Topouzis, F. & Delopoulos, A. An interpretable
multiple-instance approach for the detection of referable diabetic
MESSIDOR-2,
[41] Ensemble Framework 95.58% retinopathy in fundus images. Sci Rep 11, 14326 (2021).
EyePACS https://doi.org/10.1038/s41598-021-93632-8
KSSHP,
EyePACS, 99.9% to [9] F. Arcadu, F. Benmansour, A. Maunz, J. Willis, Z. Haskova, and M.
[43] Bayesian-NNs for DR Prunotto, “Deep learning algorithm predicts diabetic retinopathy
APTOS, 71.02%
MESSIDOR-2 progression in individual patients,” npj Digital Medicine, vol. 2, no. 1,
Sep. 2019, doi: 10.1038/s41746-019-0172-3.
[45] DR Severity Classification APTOS 97%
[10] C. C. Hortinela, J. R. Balbin, G. V. Magwili, K. O. Lencioco, J. C. M.
V. CONCLUSION Manalo and P. M. Publico, "Determination of Non-Proliferative and
Proliferative Diabetic Retinopathy through Fundoscopy using Principal
The survey has shed light on the recent advancements in Component Analysis," 2020 IEEE 12th International Conference on
DR detection using DL methodologies. The integration of Humanoid, Nanotechnology, Information Technology,
Communication and Control, Environment, and Management
preprocessing techniques, feature extraction methods, and (HNICEM), Manila, Philippines, 2020, pp. 1-6, doi:
classification algorithms has demonstrated remarkable 10.1109/HNICEM51456.2020.9400155.
progress in accurately diagnosing DR from FIs. Preprocessing [11] T. Dharani, M. P. Prasamsa, B. L. Sirisha, J. B. Vivek and B. H.
techniques have proven essential in improving image quality, Vardhan, "Diabetic Retinopathy classification through fundus images
reducing noise, correcting uneven illumination, ensuring using Deep Learning," 2023 11th International Symposium on
consistency, and enhancing subsequent analysis. Advanced Electronic Systems Devices and Computing (ESDC), Sri City, India,
2023, pp. 1-6, doi: 10.1109/ESDC56251.2023.10149877.
feature extraction approaches, encompassing both traditional
handcrafted features and DL-based methods, have

Authorized licensed use limited to: Charles Darwin University. Downloaded on February 09,2024 at 19:17:36 UTC from IEEE Xplore. Restrictions apply.
[12] P. Zang et al., "Interpretable Diabetic Retinopathy Diagnosis based on
Biomarker Activation Map," in IEEE Transactions on Biomedical
Engineering, doi: 10.1109/TBME.2023.3290541.
[13] Y. Wen et al., "Let’s Find Fluorescein: Cross-Modal Dual Attention
Learning For Fluorescein Leakage Segmentation In Fundus
Fluorescein Angiography," 2021 IEEE International Conference on
Multimedia and Expo (ICME), Shenzhen, China, 2021, pp. 1 -6, doi:
10.1109/ICME51207.2021.9428108.
[14] T. Aziz, C. Charoenlarpnopparut, and S. Mahapakulchai, “Deep
learning-based hemorrhage detection for diabetic retinopathy
screening,” Scientific Reports, vol. 13, no. 1, Jan. 2023, doi:
https://doi.org/10.1038/s41598-023-28680-3.
[15] R. H. Paradisa, D. Sarwinda, A. Bustamam and T. Argyadiva,
"Classification of Diabetic Retinopathy through Deep Feature
Extraction and Classic Machine Learning Approach," 2020 3rd
International Conference on Information and Communications
Technology (ICOIACT), Yogyakarta, Indonesia, 2020, pp. 377-381,
doi: 10.1109/ICOIACT50329.2020.9332082.
[16] Sarki, R., Ahmed, K., Wang, H. et al. Image Preprocessing in
Classification and Identification of Diabetic Eye Diseases. Data Sci.
Eng. 6, 455–471 (2021). https://doi.org/10.1007/s41019-021-00167-z
[17] T. Palaniswamy and M. Vellingiri, "Internet of Things and Deep
Learning Enabled Diabetic Retinopathy Diagnosis Using Retinal
Fundus Images," in IEEE Access, vol. 11, pp. 27590-27601, 2023, doi:
10.1109/ACCESS.2023.3257988.
[18] X. Zhang, G. Cazuguel, B. Lay, B. Cochener, C. Trone and P. Gain,
"Feedback on a publicly distributed image database: The Messidor
database", Image Anal. Stereol., vol. 33, pp. 231-234, Aug. 2014.
[19] M. Tavakoli, A. Mehdizadeh, A. Aghayan, R. P. Shahri, T. Ellis and J.
Dehmeshki, "Automated Microaneurysms Detection in Retinal Images
Using Radon Transform and Supervised Learning: Application to Mass
Screening of Diabetic Retinopathy," in IEEE Access, vol. 9, pp. 67302-
67314, 2021, doi: 10.1109/ACCESS.2021.3074458.
[20] M. Ghazal, S. S. Ali, A. H. Mahmoud, A. M. Shalaby and A. El-Baz,
"Accurate Detection of Non-Proliferative Diabetic Retinopathy in
Optical Coherence Tomography Images Using Convolutional Neural
Networks," in IEEE Access, vol. 8, pp. 34387-34397, 2020, doi:
10.1109/ACCESS.2020.2974158.
[21] A. A. Farag, A. S. El-Baz and G. Gimel’farb, "Precise segmentation of
multimodal images", IEEE Trans. Image Process., vol. 15, no. 4, pp.
952-968, Apr. 2006.
[22] Skouta, A., Elmoufidi, A., Jai-Andaloussi, S. et al. Hemorrhage
semantic segmentation in fundus images for the diagnosis of diabetic
retinopathy by using a convolutional neural network. J Big Data 9, 78
(2022). https://doi.org/10.1186/s40537-022-00632-0.
[23] Xiuqin P, Zhang Q, Zhang H, Li S. A fundus retinal vessels
segmentation scheme based on the improved deep learning U-Net
model. IEEE Access. 2019;7:122634–43.
[24] Skouta A, Elmoufidi A, Jai-Andaloussi S, Ouchetto, O. Semantic
segmentation of retinal blood vessels from fundus images by using
CNN and the random forest algorithm; 2022.
[25] Kauppi T, Kalesnykiene V, Kamarainen J-K, Lensu L, Sorri I, Raninen
A, Voutilainen R, Uusitalo H, Kälviäinen H, Pietilä J. The diaretdb1
diabetic retinopathy database and evaluation protocol. In: BMVC, vol.
1. 2007. p. 1–10.
[26] N. J. Mohan, R. Murugan, T. Goel and P. Roy, "DRFL: Federated
Learning in Diabetic Retinopathy Grading Using Fundus Images," in
IEEE Transactions on Parallel and Distributed Systems, vol. 34, no. 6,
pp. 1789-1801, June 2023, doi: 10.1109/TPDS.2023.3264473.
[27] Prasanna Porwal, Samiksha Pachade, Ravi Kamble, Manesh Kokare,
Girish Deshmukh, Vivek Sahasrabuddhe, Fabrice Meriaudeau, April
24, 2018, "Indian Diabetic Retinopathy Image Dataset (IDRiD)", IEEE
Dataport, doi: https://dx.doi.org/10.21227/H25W98.
Authorized licensed use limited to: Charles Darwin University. Downloaded on February 09,2024 at 19:17:36 UTC from IEEE Xplore. Restrictions apply.
[28] E. Decencière, X. Zhang, G. Cazuguel and B. Lay, "Feedback on a
publicly distributed image database: The Messidor database", Image
Anal. Stereol., vol. 33, no. 3, pp. 231-234, 2014.
[29] R Murugan, Sonal Yadav, February 28, 2023, "Retinal Detachment
Dataset", IEEE Dataport, doi: https://dx.doi.org/10.21227/43h2-5s10.
[30] C. -H. Hua et al., "Convolutional Network With Twofold Feature
Augmentation for Diabetic Retinopathy Recognition From Multi-
Modal Images," in IEEE Journal of Biomedical and Health Informatics,
vol. 25, no. 7, pp. 2686-2697, July 2021, doi:
10.1109/JBHI.2020.3041848.
[31] M. Nahiduzzaman, M. R. Islam, S. M. R. Islam, M. O. F. Goni, M. S.
Anower and K. -S. Kwak, "Hybrid CNN-SVD Based Prominent
Feature Extraction and Selection for Grading Diabetic Retinopathy
Using Extreme Learning Machine Algorithm," in IEEE Access, vol. 9,
pp. 152261-152274, 2021, doi: 10.1109/ACCESS.2021.3125791.
[32] “APTOS 2019 Blindness Detection,” kaggle.com.
https://www.kaggle.com/c/aptos2019-blindness-detection
[33] T. Liu et al., "A Novel Diabetic Retinopathy Detection Approach Based
on Deep Symmetric Convolutional Neural Network," in IEEE Access,
vol. 9, pp. 160552-160558, 2021, doi:
10.1109/ACCESS.2021.3131630.
[34] P. C. Bunch, J. F. Hamilton and G. K. Sanderson, "A free response
approach to the measurement and characterization of radiographic
observer performance", J. Appl. Photographic Eng., vol. 4, pp. 166-
172, Dec. 1977.
[35] Y. Yang et al., "Robust Collaborative Learning of Patch-Level and
Image-Level Annotations for Diabetic Retinopathy Grading from
Fundus Image," in IEEE Transactions on Cybernetics, vol. 52, no. 11,
pp. 11407-11417, Nov. 2022, doi: 10.1109/TCYB.2021.3062638.
[36] J. Cuadros and G. Bresnick, “EyePACS: An adaptable telemedicine
system for diabetic retinopathy screening,” J. Diabetes Sci. Technol.,
vol. 3, no. 3, pp. 509–516, 2009.
[37] E. Decenciére et al., “Feedback on a publicly distributed image
database: The messidor database,” Image Anal. Stereol., vol. 33, no. 3,
pp. 231–234, Jul. 2014.
[38] M. A. K. Raiaan et al., "A Lightweight Robust Deep Learning Model
Gained High Accuracy in Classifying a Wide Range of Diabetic
Retinopathy Images," in IEEE Access, vol. 11, pp. 42361-42388, 2023,
doi: 10.1109/ACCESS.2023.3272228.
[39] “APTOS 2019 Blindness Detection,” kaggle.com.
https://www.kaggle.com/c/aptos2019-blindness-detection
[40] K. Shankar, Y. Zhang, Y. Liu, L. Wu and C. -H. Chen,
"Hyperparameter Tuning Deep Learning for Diabetic Retinopathy
Fundus Image Classification," in IEEE Access, vol. 8, pp. 118164-
118173, 2020, doi: 10.1109/ACCESS.2020.3005152.
[41] H. Mustafa, S. F. Ali, M. Bilal and M. S. Hanif, "Multi-Stream Deep
Neural Network for Diabetic Retinopathy Severity Classification
Under a Boosting Framework," in IEEE Access, vol. 10, pp. 113172-
113183, 2022, doi: 10.1109/ACCESS.2022.3217216.
[42] “Diabetic Retinopathy Detection,”
kaggle.com. https://www.kaggle.com/c/diabetic-retinopathy-
detection/data
[43] J. Jaskari et al., "Uncertainty-Aware Deep Learning Methods for
Robust Diabetic Retinopathy Classification," in IEEE Access, vol. 10,
pp. 76669-76681, 2022, doi: 10.1109/ACCESS.2022.3192024.
[44] J. Sahlsten, J. Jaskari, K. Kaski and K. Hietala, "Diabeettisen
retinopatian ja makulaturvotuksen luokittelu syväoppivan
tekoälyjärjestelmän avulla", Aikakauskirja Duodecim, vol. 17, pp.
1971-1978, Sep. 2020, [online] Available:
https://www.duodecimlehti.fi/duo15766.
[45] M. M. Farag, M. Fouad and A. T. Abdel-Hamid, "Automatic Severity
Classification of Diabetic Retinopathy Based on DenseNet and
Convolutional Block Attention Module," in IEEE Access, vol. 10, pp.
38299-38308, 2022, doi: 10.1109/ACCESS.2022.3165193.