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Asymmetry evaluation of fundus images in right and left eyes using radon
transform and fractal analysis

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DOI: 10.1109/ICIP.2015.7350780

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ASYMMETRY EVALUATION OF FUNDUS IMAGES IN RIGHT AND LEFT EYES USING
RADON TRANSFORM AND FRACTAL ANALYSIS
Tahereh Mahmudi1, Rahele Kafieh1, Hossein Rabbani1, Alireza Mehri1, Mohammadreza Akhlagi2
1
Department of Advanced Medical Technologies, Medical Image and Signal Processing Research
Center, Isfahan University of Medical Sciences, Isfahan, Iran
2
Ophthalmology Dept., School of Medicine, Isfahan Univ. of Medical Sciences, Isfahan, Iran
ABSTRACT
Asymmetry analysis is a challenging step in computerized
early diagnosis of Diabetic retinopathy (DR) which
provides an opportunity for early treatment. In this study
to compare the patterns of vascular in right and left eyes, a
combination of fractal analysis and radon transformation
is investigated to provide both statistical distribution of
the vessel thickness, and their geometrical distribution.
For this purpose, the vessel segmentation and skeletonize-
tion are performed and the vessels' thickness map (VTM)
is obtained. Then, the fractal dimension (FD) is found on
various versions like the segmented vessels, skeletonized
vessels, VTM, and radon transform (RT) of VTM in right
and left eyes for asymmetry analysis. According to the
obtained results for mean/SD values of the differences of
FDs in right and left eyes and p-values, we conclude that
RT of VTM is able to better discriminate two eyes from
each other and accordingly, it can be used as a powerful
feature for comparison of the symmetry/asymmetry in
fundus images. Our evaluation results show that a
difference of 0.33 ± 0.11 between FD of VTM's RT in left
and right eyes is expected for normal subjects.
Index Terms— Fundus images, Asymmetry
Analysis, Radon Transform, Fractal Dimension
1. INTRODUCTION
Lots of information about microcirculation in the body
and retinal diseases can be obtained from the retinal
vessels [1-4]. A number of diseases have been identified
using selected features of the retinal vessels (like
diameter, quality of being twisted, and bifurcation angle)
in previous studies [5, 6]. To improve the diagnosis via
such features, computerized analysis can be utilized. Early
diagnosis is another advantage of computerized methods,
which can improve the inevitable problem associated with
ophthalmologists' diagnosis like being less sensitive to
detect early damage and variation of parameters among
individuals.
One of the most challenging steps in computerized early
diagnosis is asymmetry analysis which has been
introduced in [7-9]. In previous works, the asymmetry
analysis was performed on the first layer of the retina in
normal population, in order to discriminate normal/
abnormal cases. In this study, the structure of the retinal
vasculature is determined by fractal dimension (FD) as a
measure of “complexity” in a system. Fractal geometry
provides a more accurate description of the human retina
vascular network than Euclidian geometry and can be
used as part of a screening tool for early detection of
retinal diseases [10-16]. Azemin et al. [14] developed a
robust method to perform retinal vascular fractal analysis
on digital retinal images. The technique preprocessed the
green channel of the retinal images with Gabor wavelet
transform in order to enhance the images. Fourier FD is
then computed on the preprocessed images (with no need
to vessel segmentation). In another work by Talu et al.
[15], a global index of the geometric complexity of the
human retinal vascular network was determined using the
fractal geometry on the segmented version and the
skeletonized version of the retina vessels. Avakian et al
[16] proposed a diagnosis for diabetic retinopathy using
the FD, and the density of skeletonized vascular patterns
in the macular in normal and diabetic retinopathy eye.
Larsson et al. in [17] used OCT and Heidelberg retinal
tomography (HRT), and obtained normal values and
interocular differences in RNFLT around the optic nerve,
in 5–16 year old children. They show that Mean RNFL
thickness was 98.4±7.88 µm and 213.0 ± 54.0 µm for
OCT and HRT, respectively; the coefficients of variance
were 2.9% and 5.6% for OCT and HRT, respectively; and
intra-class correlations were 0.85 and 0.88, respectively.
In the same study, they achieved the limits of difference
between the two eyes from -9 µm to 9 µm with OCT and
from -109 µm to 87 µm with HRT.
In another work, Altemir in [18] used Cirrus HD-OCT and
calculated the asymmetry of retinal measurements in
children. They showed that differences in the average
RNFL between right and left eyes were not statistically
significant. Also they obtained the tolerance limits for
average RNFL and macular thicknesses to be 13.00 µm
and 23.20 µm, respectively. In addition, they also found
asymmetry on parameters related to optic disc. Al-Haddad
et al. in [19] investigated interocular symmetry on
children aged 6–17 years measured by Cirrus OCT. They
indicated that average RNFL thickness were not
statistically significant on the contrary superior, nasal and
temporal quadrants. They achieved that RNFL in right eye
was thicker in the nasal and temporal quadrants while
RNFL in left eye was thicker in the superior quadrant.
Also they showed that macular parameters in the outer
nasal and outer inferior sectors in left eyes have higher
values. But they found no significant difference in the
parameters of the optic nerve. Dalgliesh et al. in [20] used
Cirrus HD-OCT and also investigated interocular
differences of the retinal parameters in young adults (age
16-19). They demonstrated that average RNFL in right
eyes was thicker than left eyes (P=0.0074). In central
macular or macular cube, average thickness showed no
significant interocular differences. Furthermore, Alluwimi
[21] used asymmetry analysis to reduce variations
between subjects using OCT in young and old subjects.
Considering a 24- by 24-degree grid around the macula
and dividing it into five zones, asymmetry analysis was
computed as the difference between superior and inferior
zone thicknesses. They have claimed that asymmetry
analysis could reduce variation between subjects.
In this study, we present asymmetry analysis of the
vascular pattern in right and left eyes. For this purpose, we
use a vessel segmentation algorithm based on the analysis
of directional images resulting from sub-bands of Fast
Discrete Curvelet Transform (FDCT) [22-23]. The center-
lines of the vessels are found through thinning of the
binary vessel segmentation. Then the thickness of each
vessel's point is calculated by searching its 8 neighbors
Fig. 1. a) The original Fundus image, b) segmented vessels, c) Result of skeletonization, d) Thickness map.
and finding points with vertical angles. The vessels'
thickness map (VTM) was then constructed by substituting
the vessel positions in a binary segmented vessel by the
calculated vessel thickness. Using Radon transform (RT),
we obtained projection of the vessels thickness across 0-
180 degrees and the FD of the segmented vessels,
skeletonized version, VTM, and RT of the VTM were
calculated for both eyes.
2. MATERIALS
The set of images are provided in Ophthalmology Dept.,
Feiz Hospital, Isfahan, Iran. These images include color
fundus images of right and left normal eyes aimed at
comparison of vascular pattern (Fig. 1(a)). Fifty normal
subjects (age 35 ± 10yr) were visited in this study. Two
eyes of each patient were tested with a 3D OCT Topcon
device which could produce both fundus and OCT
images. The size of the obtained images is 1536×1612
pixels. The definition of a normal eye is presented in
Table I.
 Where theta is the angle of the line, and r is the
Table I. Definition of the normal eye
Number Definition of the normal eye
perpendicular offset of the line. In this stage we obtained
1 Without any ocular or systemic diseases (diabetic
the RT from the thickness map of the vessels in right and
mellitus or hypertension) left eyes (shown in Fig. 2).
2 visual acuity over 0.6
3 spherical equivalent on refraction of within ±3.0
diopters
4 Intraocular pressure lower than 21 mmHg
5 cup-disc ratio less than 0.6 (measured by OCT)

3. CALCULATION OF VESSEL THICKNESS MAP

In this study, asymmetry analysis of the vascular pattern

in right and left eyes is investigated. For this purpose, at
first a vessel segmentation algorithm in fundus images is
employed. This algorithm starts with the analysis of
directional images resulting from sub-bands of FDCT in
the similar directions and in different scales. For this
purpose, each directional image is processed by using
information of the first order derivative and eigenvalues
obtained from the Hessian matrix [22]. The final vessel
segmentation is obtained using a simple region growing
algorithm iteratively. The algorithm is successful in
segmentation of both fundus and angiograms (Fig. 1(b))
[23].
The centerlines of the vessels are found through thinning Fig. 2. The original Fundus image: a) right eye, b) left eye. (c,
d) RT of the VTM of a and b respectively.
of the binary vessel segmentation (Fig. 1(c)). For
measurement of vessel width, the direction of vessels were
5. FRACTAL DIMENSION
estimated in the first step. The direction estimation was
performed using seven consecutive vessel pixels (3 Box dimension is the most common method used to
previous and 3 next pixels) and measuring the slope of the estimate the FD in mathematical calculation. This method
line passing through these pixels. The best fitting straight is partitioning the image into square boxes of equal size
line was then obtained using least square regression. The and counting the boxes containing at least one pixel of the
angle between this line and the x-axis is considered as the function. Different box sizes are used in iterations and the
vessel's direction. To find the vessel width at each FD can be calculated as the slope of the regression line for
centerline point, the number of pixels in perpendicular the log-log plot of scanning box size and the count from a
direction to the determined vessel's direction were counted box counting scan. Fractal analysis helps us to obtain a
until reaching the vessel wall. Vessel walls were measure of complexity of the retinal vessel branching.
considered as the points where pixel intensities fall below
half of the intensity of the centerline pixel. The VTM was
then constructed by substituting the vessel positions in a
binary segmented vessel by the calculated vessel thickness,
which is shown in Fig. 1(d).

4. RADON TRANSFORM

The RT computes projections of an image matrix along

specified directions. Since in extracted thickness map, the
overall structure is changing among different subjects in
two eyes, RT can be a helpful tool to produce information
about VTM in different directions. Actually comparison
of 2-D VTMs in Radon domain can be performed more
reliable sine it can provide a 1-D signal for a specific
direction (e.g., in the approximated direction of main arc
under/above the optic disc), or a scalar after averaging,
and comparing corresponding scalars/vectors is easier
than 2-D VTMs. In general, the RT of , is the line
integral of parallel to the y′ axis.
, , sin (1)
Fig. 3. Functional block diagram. The outlined blocks contain
special versions of the image whose FD is used to produce the
results in table II.
In this study, we obtained FD of the segmented vessels,
skeletonized vessels, VTM and RT of the VTM in right
and left eye for asymmetry analysis. We also calculated p-
values for each FD to show the significance of the
asymmetry. Then we obtained limited tolerances for each
fractal value which determines a threshold for each new
retinal image to be considered as normal. As it can be seen
in Table II, p-values of the segmented version and the RT
show a good significance (less than 0.05). In order to
make a better visualization from our method, we
summarized the proposed steps in a block diagram shown
in Fig. 3.
6. RESULTS
In this work, the FD is used as a measure for comparing
the complexity of vessel structure in two eyes. For this
purpose, Mean± SD of the FD is reported for two eyes on
different input images (segmented vessels, skeletonized
vessels, thickness map of the vessels, and RT of the
thickness maps).
The result showed that FD of segmented vessels in
right and left eye were 1.15 ± 0.15 and 1.41±0.32,
respectively (with limited tolerance of 0.43±0.21 for
normal eyes). Furthermore, the FD of the RT of the VTM
in right and left eye were 1.79 ±0.22 and 1.62 ± 0.16,
respectively (with limited tolerance of 0.33±0.11 for
normal eyes).
To show the ability of each method in discrimination
of right and left eyes, two other measures are considered.
The first measure is based on Mean ± SD of difference of
values in two eyes, in which a higher mean/SD value
indicates better discrimination of the compare values. The
second measure is P-value of the measurements from both
eyes, in which the lower P-value is an indicator of better
discrimination. Furthermore, the obtained p-values can
also be considered when we aim at designing a fully
automatic system for abnormal asymmetry identification.
In such cases, we may only focus on retinal information
which has the highest p-values indicating the symmetry of
two eyes in normal population. Therefore, any asymmetry
in such information can be considered as an undeniable
sign of disorder in a referring patient. Table II shows a
summary of the mentioned values for our 50 member
database.
According to the obtained results for mean/SD value
and P-value, we can come to this conclusion that RT of
the thickness maps is able to better discriminate two eyes
from each other (mean/SD = 3) and accordingly, this
value can be used as a powerful feature for comparison of
the symmetry/ asymmetry in fundus images. It means that
for normal subjects a difference of 0.33 ± 0.11 between FD
of VTM's RT is occurred and a difference out of this
range can be referred to abnormal subjects.
7. RELATION TO PRIOR WORK
In previous works, geometric complexity of the human
retinal vascular network in one eye was determined using
the fractal geometry on the segmented vessels and their
skeletonized version [15]. In another work [16], a normal
eye was compared to a diabetic retinopathy in one eye,
and in an earlier work [10], Fourier FD was computed on
the preprocessed images. However, any comparison has
ever been reported neither on fractal analysis of two eyes,
nor based on thickness map of the vessels.
In this study, the structure of the retinal vasculature
was summarized by FD as a measure of “complexity” in a
system. We present asymmetry analysis of the vascular
pattern in right and left eye. The centerlines of the vessels
are found through thinning of the binary vessel
segmentation. Then the thickness of vessels was obtained
and the retinal VTM was constructed. Using the RT, we
obtained projection of the vessels thickness across 0-180
degrees and the FD of the segmented vessels, skeletonized
version, VTM and RTs were calculated for both eyes.
8. CONCLUSION
In particular, the fractal analysis provides statistical
distribution of the vessel thickness in the image domain,
but not the geometrical distribution. Furthermore, fractal
analysis can be easily misled into low SNR images. The
proposed RT is used to address these two problems. RT
reflects geometrical properties; in addition, averaging in a
specific direction will reduce the noise.
As it can be seen in the results section, FD on RT
provides higher mean/SD, which suggests better
discrimination. Using thickness map instead of the retinal
image is also more informative since the information in
each pixel of the thickness map is directly related to the
thickness of each vessel, which is the information in
which we are interested. Therefore we conclude that RT
of VTM is able to better discriminate two eyes from each
other and accordingly, it can be used as a powerful feature
for comparison of the symmetry/asymmetry in fundus
images.
ACKNOWLEDGMENT
The authors would like to thank Ms. Asieh Soltanipour
and her colleagues in [23] for providing the source code of
vessel segmentation.

Table II. Mean± SD Fractal dimension in each eye, tolerances and p-values.
Input image Mean± SD Mean ±SD Unsigned mean±SD p-value
( Fractal dimension in ( Fractal dimension in differences
right eye) left eye) (mean/SD)
Segmented 1.15 ± 0.15 1.41±0.32 0.43 ± 0.21 <0.05
vessels (2.04)
Skeletonized 1.32 ±0.26 1.28 ± 0.26 0.20 ± 0.21 >0.2
vessels (0.95)
Thickness map 1.39 ±0.32 1.54 ± 0.15 0.26 ± 0.21 >0.2
(1.2)
RT of the 1.79 ±0.22 1.62 ± 0.16 0.33 ± 0.11 <0.05
thickness map (3)
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