J. Intell. Syst.

2019; 28(1): 43–56

Shilpa Sameer Kanse* and Dinkar Manik Yadav

Retinal Fundus Image for Glaucoma Detection:

A Review and Study
DOI 10.1515/jisys-2016-0258
Received August 10, 2016; previously published online June 2, 2017.

Abstract: Glaucoma is one of the severe visual diseases that lead to damage the eyes irreversibly by affecting
the optic nerve fibers and astrocytes. Consequently, the early detection of glaucoma plays a virtual role in
the medical field. The literature presents various techniques for the early detection of glaucoma. Among the
various techniques, retinal image-based detection plays a major role as it comes under noninvasive methods
of detection. While detecting glaucoma disorder using retinal images, various medical features of the eyes,
such as retinal nerve fiber layer, cup-to-disc ratio, apex point, optic disc, and optic nerve head, and image
features, such as Haralick texture, higher-order spectra, and wavelet energy, are used. In this paper, a review
and study were conducted for the different techniques of glaucoma detection using retinal fundus images.
Accordingly, 45 research papers were reviewed and the analysis was provided based on the extracted features,
classification accuracy, and the usage of different data sets, such as DIARETDB1 data set, MESSIDOR data set,
IPN data set, ZEISS data set, local data set, and real data set. Finally, we present the various research issues
and solutions that can be useful for the researchers to accomplish further research on glaucoma detection.

Keywords: Classification, cup-to-disc ratio, glaucoma, Haralick texture, retinal image.

1 Introduction
The World Health Organization reports that the second leading cause of blindness is glaucoma; it has affected
60 million individuals in 2010 [43] and it will affect about 70.6 million cases of blindness in 2020 [24]. Glau-
coma is one of the soundless thieves of spectacle. Hence, the timely detection of glaucoma plays a virtual role
for intercepting irretrievable damages in eyes. Especially, for aged humans, the visual disorder of glaucoma
leads to permanent blindness. Consequently, this irretrievable disorder of glaucoma is significantly detected
in early stages [57]. Several types of glaucoma can be represented as follows: (i) open-angle glaucoma, (ii)
angle-closure glaucoma, (iii) normal tension glaucoma, and (iv) congenital glaucoma [23]. Moreover, before
performing the glaucoma diagnosis, there are important factors that should be checked, such as tonometry,
ophthalmoscopy, perimetry, gonioscopy, and pachymetry. Then, the diagnosis of the glaucoma is performed
based on the medical record of the patient’s intraocular pressure (IOP), visual field loss tests, and physical
evaluation of optic nerve head (ONH) via ophthalmoscopy [9]. The testing of glaucoma can be conducted
through digital fundus camera, optical coherence tomograph (OCT), IOP measurement, ONH evaluation,
retinal nerve fiber layer (RNFL), and visual field defect [23].
Due to the malfunction of the drainage structure of the eyes, IOP is increased rapidly. Then, the pressure
of fluid in the eyes increases constantly; thus, it damages the optic nerve of the eyes [36] and causes per-
manent vision loss [1], which leads to the irretrievable disorder of glaucoma. Moreover, due to the damaged
RNFL, the thickness of the RNFL is decreased, which is also one of the main causes of glaucoma disorder
[3]. In addition, several possible ways lead to glaucoma disorder, such as ONH, nerve fiber layer, structural
changes, and the functional stoppage of the visual field concurrently [33].

*Corresponding author: Shilpa Sameer Kanse, JSPM’s Rajarshi Shahu College of Engineering, Tathawade, Pune, Maharashtra
411033, India, e-mail: shilpasameerkanse@gmail.com
Dinkar Manik Yadav: SVPM’s College of Engineering, Malegaon Budruk, Pune, Maharashtra 413115, India

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44 S.S. Kanse and D.M. Yadav: Retinal Fundus Image for Glaucoma Detection

1.1 G
 laucoma Detection Using Retinal Image

This section presents the details about retinal fundus image, in which the thickness of the RNFL [7] is used
to diagnose glaucoma. Glaucoma detection using the retinal image is one of the important noninvasive tech-
niques in the medical area [46], which includes healthy and nonhealthy retinas for ophthalmologists [42].
The major advantage of retinal fundus images is that, in most clinical environments, retinal fundus images
can be obtained easily. Then, extricating the information from the digital image analysis is used to find the
ocular diseases of glaucoma [51].
Figure 1 shows the general architecture of the glaucoma detection process using retinal fundus image.
The steps involved in glaucoma detection can be described as follows: (i) Read the input image; (ii) Pre-
process the input image based on the process of sampling, region of interest (ROI) extraction, and channel
selection; (iii) Segment input image, such as retinal vessel-based segmentation, optic disc detection, and seg-
mentation; (iv) Identify the region of analysis using segmentation; (v) Extract the texture feature and feature
selection; and (vi) Classify the input image using different classifiers, such as support vector machine (SVM),
artificial neural network (ANN), k-nearest neighbor (KNN), and naive Bayes (NB) classifiers.

2 Retinal Fundus Image for Glaucoma Detection: A Review and Study

This section presents the investigation of different classifiers, such as SVM classifier, thresholding-based
techniques, KNN classifier, NB classifier, ANN classifier, AdaBoost classifier, and random forest classifier,
which are available for glaucoma detection and diagnosis.

2.1 SVM Classifier-Based Technique

This section shows the review of the SVM classifier-based technique, which is used in the process of glau-
coma detection. Agarwal et al. [3] have developed an approach using cup-to-disc ratio (CDR) and rim-to-disc
ratio to identify glaucoma in retinal fundus images. Then, they have proposed another one important tech-
nique, called adaptive threshold-based method, which have been independent of noise and quality of the
image. In addition to, they have considered rim-to-disc ratio, which has been combined with CDR to detect
glaucoma that gives more reliability. Furthermore, the same SVM-based classification technique was used
for glaucoma detection using fundus image, which has been described by Narasimhan et al. [35]. They have
extracted the blood vessels using local entropy thresholding technique, which have been presented inside
the optic disc. Then, they have considered two features to detect glaucoma, such as CDR and inferior superior
nasal temporal (ISNT) ratio. After computing the features automatically, the classification can be done using
various classifiers such as SVM, KNN, and NB classifier. Then, the maximum classification can be done using
the SVM classifier with 95% accuracy.

ROI extraction Channel selection

Input Sampling
image Pre-processing

Feature selection Feature extraction Image segmentation

Normal image
Classification of
glaucomatous images Glaucoma image

Figure 1: General Block Diagram of Glaucoma Detection Process Using Retinal Fundus Images.

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Hussain and Holambe [23] dealt with the SVM classifier, which has been used in the eye fundus images to
detect and classify glaucoma. They have proposed computerized aid diagnosis system, which has been used
to find the malformation present in fundus images. Then, the proposed computerized aid diagnosis system
was used to check glaucoma disorder progression. The major goal of this paper was used to detect glau-
coma automatically, with the help of different parameters of fundus image measurement between glaucoma
patients and normal patients. Then, the glaucoma diagnosis using the features of higher-order spectra (HOS)
and discrete wavelet transform (DWT) based on the data mining technique was developed by Mookiah et al.
[57]. After extracting the features, statistical analysis can be done based on the independent sample t­-test.
Then, the results of these extracted features were given to the SVM classifier with different mathematical
expressions, such as linear, polynomial order 1, 2, 3, and radial basis function (RBF), to choose the best kernel
function. Mookiah et al. have used the SVM classifier with the second polynomial order of kernel function,
which have been used to detect glaucoma disorder in early stages with an accuracy of 95%.
Moreover, the evaluation of glaucoma using the optic disc and optic cup segmentation from digital
fundus images was developed by Mittapalli and Kande [32]. They have evaluated glaucoma disorder using
the optic cup properties based on the structural and grey level. In this work, they have used 59 retinal images
to detect glaucoma. Based the specific results of both optic cup and optic disc parameters, the assessment of
glaucoma disorder was calculated with an F-score of 89% using the SVM classifier. Bock et al. [9] have devel-
oped an automated glaucoma detection system, which has been widely used in digital color fundus images.
They have proposed a probabilistic two-stage classification, which has been used to extract the competitive,
reliable, and probabilistic glaucoma risk index (GRI) from the images of the low-cost digital color fundus
camera. Finally, they have compared the GRI performance to medical relevant glaucoma parameters using
the SVM classifier with 88% accuracy.
Kotowski et al. [28] have focused on imaging modalities of the optic nerve and RNFL, in which they have
discussed the imaging capabilities pertinent for the diagnosis of glaucoma. Here, the imaging process was
possible to mistakenly recognize the glaucoma and its progression; therefore, a combination of the structural
and functional measures was based on clinical management decisions. Finally, they have done the classifica-
tion of glaucoma diagnosis using the SVM classifier and achieved an accuracy of 88%. Furthermore, Kavitha
et al. [26] have examined the early detection of glaucoma using CDR in retinal images. The extraction of optic
disc was done automatically. Then, they have proposed the segmentation process based on the component
analysis and ROI, which has been used for the detection of the optic disc. In addition, they have proposed
a model of active contours, which have been used to accurately plot the boundary using the SVM classifier.
Also, the same aforementioned type of the SVM classifier was used for glaucoma detection using retina
image analysis [10]. They have used the data screening approach for large-scale screening. For the detection
of glaucoma, they have taken the mixture of healthy and glaucomatous eyes of 200 real images. Finally, the
performance of the system was compared to the human medical experts in detecting glaucoma through retina
fundus images using the SVM classifier. Then, the superpixel classification-based optic disc and optic cup
segmentation for glaucoma screening were developed by Cheng et al. [11]. They have performed the evalua-
tion using MESSIDOR database, which contains 650 images. Then, the skilled professionals marked the optic
disc and optic cup boundaries physically. Then, the Library for SVM (LibSVM)-based classification was used
to find glaucoma detection.
Septiarini and Harjoko [47] have used an online type of features to detect glaucoma disorder effectively.
They have performed the feature extraction technique in retinal fundus images based on two groups of
feature types, such as morphological and nonmorphological types. Here, the type of feature extraction tech-
nique was determined by the grouping-based methodology. Finally, they have concluded that the detection
of glaucoma with the morphological features achieved 95% accuracy with the SVM-based classifier. Then, the
segmentation of blood vessels and optic disc in retinal images has been developed by Salazar-Gonzalez et al.
[45]. They have used the graph cut technique to extract the tree of the retina vascular. Then, the location of
the optic disc was estimated by the information of the blood vessels. Here, the segmentation of optic disc was
performed based on the two different methods, such as the Markov random field (MRF) image reconstruction
method and the compensation factor method.

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Acharya et al. [2] have proposed a decision support system for the detection of glaucoma disorder using
Gabor transform. They have used a mixture of features, such as mean, variance, skewness, and energy, which
have been extracted from digital fundus images. After extracting the features, the dimensionality was reduced
using principal component analysis. Then, various ranking methods were proposed, such as Bhattacharyya
space algorithm, t-test, Wilcoxon test, receiver operating curve and entropy, to make the features in ranking
order. Finally, they have concluded that the t-test-based ranking method provided better performance. The
efficient detection of the optic cup from the intra-image learning method was proposed by Xu et al. [53]. They
have presented a superpixel-based learning framework for intra-image learning, which has been based on
the retinal structure priors. They have used the optic cup feature for the identification of glaucoma. Here, the
classification was performed based on the SVM classifier, in which the classification could not be based on
the prelabeled training samples.
Xu et al. [52] have proposed a superpixel classification for the efficient localization of optic cup in digital
fundus images. In this work, they have performed the testing process using the clinical database of ORIGA-
light, in which they have analyzed 325 images. Finally, the classification was performed based on the SVM
classifier with an accuracy of 90%. Mishra et al. [31] have proposed the active contours method, which has
been used to determine the pathological process of glaucoma. Here, the method was applied on 25 color
fundus images. Finally, the method was used to classify all the glaucoma disease images using the SVM
classifier.

2.2 Thresholding-Based Techniques

The classifier technique related to the threshold-based techniques is reviewed in this section. Ho et al. [21]
have proposed a system for an automatic fundus image analysis for the clinical diagnosis of glaucoma using
threshold-based classification. Here, the developed automatic detection system has two phases. (i) First, the
automatic digital fundus retinal image analysis was done based on various measurements, such as vessel
detection, CDR calculation, and neuroretinal rim for ISNT rule. (ii) Second, the irregular status of retinal
blood vessels from patients, which have been lead to glaucoma such as vascular thickening, vessel hem-
orrhage, occlusion of retinal vascular, and abnormal angiogenesis. Finally, they have demonstrated their
system with a number of clinical fundus retinal images that contain information of both normal and glau-
coma images. Zhang et al. [57] have proposed a method named as ARGALI (Automatic CDR Measurement
System for Glaucoma Detection and Analysis), in which glaucoma detection was performed based on the
localization of optic disc ROI. Here, the proposed threshold-based technique finds the ROI for 96% of the
images from the 1564 retinal images.
Kumar et al. [29] have designed an active contours technique for the automatic detection of glaucoma, in
which the ultrasound (US) images of the eye were used to detect glaucoma-affected patients. Then, using live
US images, the efficient angle was calculated using the proposed algorithm, which has been used to deter-
mine the exact location of the apex point of the anterior chamber region. Hence, the speckle noise problem
was eliminated for glaucoma detection with effective segmentation. The diagnosis of glaucoma on fundus
images using vertical CDR measurement was developed by Hatanaka et al. [19]. They have used Canny edge
detection filter to detect the edge of the optic disc. Then, they have erased the image blood vessels from the
image. After this initial adjustment, they have collected 20 profiles, which have been obtained from the center
of the optic disc on blue channel of the color image in the vertical direction. After that, the thresholding tech-
nique was used to determine the edge of the cup area on the vertical profile to calculate the CDR. Finally, they
have achieved an accuracy of 96% using 25 glaucoma images from the 79 images for glaucoma diagnosis.
de la Fuente-Arriaga et al. [13] have presented a methodology for glaucoma detection based on the meas-
urement of vascular bundle displacements of blood vessels within the optic disc in human retinal images.
Here, the proposed method was used to determine the position of the centroids of the ISNT and nasal vas-
cular bundle segmented zones, where the dislocation of centroid position was determined using the chess-
board distance metric. Out of the 67 images, the proposed method plays successful detection in 62 images

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with 91.34% accuracy. Pachiyappan et al. [41] have described a system using fundus and OCT images for the
automated diagnosis of diabetic retinopathy and glaucoma. Here, they have used RNFL thickness to detect
glaucoma disorder in early stage, which was extracted from the OCT images of the patient. Then, the pro-
posed algorithm of active contours-based deformable snake algorithm was used to estimate the RNFL thick-
ness with anterior and posterior boundaries segmentation. Here, the proposed method found the optical disc
detection with an accuracy of 97.75%.
Chiranjeevi and Telagarapu [12] have developed an algorithm, in which the efficient angle calculation
was done to find the precise position of the apex point of the anterior chamber region. Here, they have con-
sidered 100 images, where they have identified 97% of the clinical parameter features correctly. Then, the
major difficulty they have faced while measuring clinical parameters includes speckle noise, delineation of
the weak edge, poor resolution, and poor contrast, which are present in the US images. Finally, the proposed
method was used to reduce the various difficulties that have been presented in the clinical parameters with
97% accuracy. Besides, the detection of glaucoma using RNFL arteries have been developed by Bedke et al.
[7]. They have used two functions for glaucoma detection, such as median filter and HAAR wavelet transform.
Moreover, they have used Drishti-GS and HRF data set, which contains 101 glaucomatous images for glau-
coma analysis. Then, they have calculated the area and diameter from extracted RNFL arteries. Here, they
have used the thresholding-based classification with 71.28% accuracy.
Agarwal et al. [4] have proposed automatic glaucoma detection in fundus images using the adaptive
threshold-based technique. The authors have described an important diagnostic tool for the detection of
glaucoma, which has been mainly used to analyze the computer-aided fundus images. Here, they have
used various features, such as mean and standard deviation, which can be extracted from histogram-based
images. Then, the correlation between both features of mean and standard deviation was used to segment
the optic disc and optic cup parameters with 90% accuracy of glaucoma screening. Then, the diagnosis of
glaucoma on retinal fundus images using the automatic measurement of CDR was proposed by Poshtyar
et al. [42]. Here, the proposed method of CDR measurement was computationally more efficient, in which the
area determination of CDR measurement was used to diagnose glaucoma in retinal fundus images with 92%
accuracy.
Ahmad et al. [5] have proposed an image processing technique of retinal fundus images to detect glau-
coma. Here, they have used the features in two-fold, such as CDR and the ratio of the neuroretinal rim in ISNT
quadrants. Then, they have implemented the proposed techniques on 80 retinal images and the classification
was done based on the SVM classifier with 0.8141 s as the average computational time and an accuracy of
97.5%. The detection of glaucoma using retinal fundus images was described by Khan et al. [27]. Here, they
have used two features, such as CDR and the ratio of the neuroretinal rim in ISNT quadrants, which have been
extracted from morphological techniques. They have implemented the proposed method on 50 retinal images
and achieved 94% accuracy with a computational time of 1.42 s.
Murthi and Madheswaran [34] have presented a glaucoma detection technique based on multimodali-
ties, which have been used to evaluate the neuroretinal optic cup with various methods such as labeling,
convex hull, and ellipse fitting methods. They have processed the retinal images with their CDR values; the
results show the diagnosis of glaucoma with 70% accuracy. Dutta et al. [16] have addressed an automated
image processing approach for the detection of glaucoma, in which their proposed approach was based on
the segmentation of superpixels from fundus color retinal images. Further, they have calculated the radius of
optic disc and optic cup using Hough transform. In addition, the vertical CDR parameter was used to identify
the symptoms of glaucoma in the fundus image. Then, they have proposed effective glaucoma detection by
segmenting the superpixels from fundus color retinal images with a better accuracy of 90%.
Glaucoma detection using CDR in color fundus images was examined by Naz and Rao [38]. For that, they
have performed the preprocessing method of anisotropic filtering, in which the visual impact of reproduction
errors can be reduced. Here, they have extracted the automatic disc using three techniques, such as edge
detection, optimal thresholding, and manual threshold analysis. For detecting the optical cup, the proposed
level set method was developed by Naz and Rao [38], which was used to screen the diagnosis of glaucoma in
an early stage. Joshi et al. [25] have proposed the optic disc and cup segmentation method from monocular

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color retinal images for glaucoma assessment. Here, they have considered each point of interest in multidi-
mensional feature space. After selecting the feature space, the local image information around this space
was integrated, which has been used to provide robustness around the optic disc region. Moreover, they have
proposed a cup segmentation method, in which the segmentation process mainly depends on the anatomical
evidence. Then, the calculated segmentation shows the reliability in managing the different geometric and
photometric changes using the threshold-based technique with 97% accuracy.
Then, the neuroretinal optic cup detection in glaucoma diagnosis was proposed by Zhang et al. [58], in
which the accuracy of the neuroretinal cup detection was improved using the boundary estimation method
based on the multimodality fusion approach. Here, they have taken 71 retina fundus images, which have been
segmented manually. Finally, they have found that their developed method accurately detects the optical
cup height of 69 neuroretinal images with 97.2% accuracy. Besides, Aquino et al. [6] have derived the tem-
plate-based methodology for segmenting the optic disc from digital retinal images. To obtain circular optic
disc boundary estimation, the derived methodology used the techniques of both morphological and edge
detection. Here, the circular Hough transform (CHT) was used to extract the features, in which the pixel
was situated inside the optic disc as initial information. Due to this reason, they have proposed another one
important voting-type algorithm, which has been based on the location methodology on the massive digital
retinal database. Finally, the threshold-based technique was used to detect optic disc boundary using the
MESSIDOR data set with 97% accuracy.

2.3 ANN Classifier-Based Techniques

Zhang et al. [55] have examined the minimum redundancy maximum relevance (mRMR)-based feature selec-
tion for automatic glaucoma diagnosis. Here, they have used the features such as retinal image and eye
screening data, which were collected from the heterogeneous data sources. Then, using the measurement
score regression, the optimal feature set was derived automatically and the performance curve was plotted.
The proposed mRMR-based feature selection considers one fourth of the original features. Then, the classifi-
cation was carried out based on the ANN classifier with better accuracy and F-score.
Singh et al. [49] have proposed an automatic diagnosis of glaucoma using image processing-based
methods. Here, they have extracted the wavelet features of the segmented optic disc from fundus image.
Then, the classification of glaucoma image was measured based on the five classifiers, such as SVM, KNN,
NB, random forest, and ANN classifiers. Finally, they have concluded that the better feature selection and
evolutionary attribute selection can be performed by ANN classifiers with 94.7% accuracy. The diagnosis of
glaucoma can be performed based on digital fundus images, which have been described by Nayak et al. [37].
Here, they have extracted the features from various features, such as CDR, optic disc center distance, and the
area of the blood vessels. Then, they have used ANN classifier to classify the normal and glaucoma images
with an accuracy of 86%.

2.4 NB Classifier-Based Techniques

Based on the HOS cumulants features, Noronha et al. [39] have proposed an automated glaucoma diagno-
sis system. Here, they have extracted the features of HOS cumulants from radon transform (RT). Then, the
results of RT were applied over digital fundus images. Here, the classification was done in three ways, such
as normal, mild glaucoma, and moderate/severe glaucoma. Noronha et al. have used NB classifier-based
techniques for digital fundus image classification with 92.65% accuracy.
Based on the combination of probability models and ensembles of individual algorithms, the detection
of the optic disc in fundus images was developed by Harangi and Hajdu [18]. However, they have proposed
the modified algorithm, in which more than one candidate was presented for every member algorithm. Here,
the optic disc position and nodes of the candidates can be found based on the maximum weighted clique and
spatial weighted graph methods with 98.46% accuracy.

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2.5 R
 andom Forest Classifier-Based Technique

This section presents the random forest classifier-based technique for glaucoma detection. Based on the
features of texture and HOS, Acharya et al. [1] have proposed the automated diagnosis of glaucoma from
digital fundus images. Here, they have used the supervised classification based on the four different types
of classifiers, such as SVM, sequential minimal optimization, NB, and random forest classifiers. Then, they
have performed the classification after selecting the features and z-score normalization. Finally, they have
concluded that the classification and identification of glaucoma images using the random forest classifier
had 91% accuracy.
In the study of Hoover and Goldbaum [22], the fuzzy convergence of the blood vessels was used to locate
the optic nerve in retinal images. Then, they have considered the wavelet transform-based features for glau-
coma detection. In their method, they have performed the testing based on the healthy retinas and diseased
retinas, which was used to detect the contusion and confusing manifestations with 89% accuracy.

2.6 O
 ther Classifiers for Glaucoma Detection

This section presents glaucoma detection based on the various classifiers such as Fisher linear discriminant
classifier, two-layer fuzzy classifier, KNN classifier, and AdaBoost classifier. Belghith et al. [8] have developed
the glaucoma progression detection method using Heidelberg retinal tomograph (HRT) images. Here, they
have proposed a graphical model of MRF to handle the spatial pixel dependency. Moreover, they have imple-
mented the algorithm of variational expectation maximization (VEM) for speculating the topographic ONH
changes in glaucoma detection framework. Finally, the two-layer fuzzy classifier was used to classify the HRT
images with an accuracy of 88%.
Zhang et al. [56] have proposed an automatic glaucoma diagnosis based on the feature selection meth-
odology of mRMR. Here, they have obtained the feature sets of an optimal candidate from the data of clinical
screening and retinal fundus image. Once the feature selection was completed, they have classified retinal
fundus images based on the AdaBoost classifiers with 85% accuracy. Simonthomas et al. [48] have addressed
a method for glaucoma detection based on the image processing method. Here, they have used the features
of Haralick texture, which can be extracted from digital fundus images. In glaucoma detection, they have
performed the classification based on the KNN classifier, which was used to identify the glaucoma images
with 98% accuracy.
During the progress of glaucoma disorder, Xu et al. [54] have investigated the sequential relationship
between the ONH surface depression and RNFL thinning. Then, they have used the measuring techniques
based on two methods such as confocal scanning laser ophthalmoscopy (CSLO) and spectral-domain
OCT (SD-OCT). Here, the classification was performed using Fisher’s linear discriminant classifier with an
­accuracy of 94%.

3 Analysis and Discussion

This section shows the analysis of glaucoma disorder detection based on the literature taken for reviewing,
in which we have considered various factors for analysis, such as feature extraction-based analysis, data set
utilization, and the objective of glaucoma detection.
(a) Analysis Based on Feature Extraction: In this section, Table 1 shows the feature extraction analysis
based on the image features such as texture, Haralick texture features, HOS, wavelet energy features,
mean, variance, skewness, kurtosois, pixel, orientation and density, and residual image intensity.
Accordingly, the wavelet energy features have been examined in Refs. [22, 26, 32, 33, 55] and HOS features
were used in Refs. [1, 26, 33, 39]. In addition, another one important feature of ONH was used to perform
better glaucoma detection, which has been used in Refs. [54, 58].

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Table 1: Analysis Based on Image Features.

Features Works

Texture [1, 10]

Haralick texture features [48]
HOS [1, 26, 33, 39]
Wavelet energy features [22, 26, 32, 33, 49]
Mean, variance, skewness, and kurtosois [2]
Pixel, orientation, and density [10, 18, 37, 54, 58]
Residual image intensity [8]

Moreover, Table 2 shows the survey of medical features based on the feature extraction analysis such
as CDR, vessel, apex point, optic disc, optic disc morphology, neuroretinal rim, ONH, and optic disc hem-
orrhage or disc pallor. Optic disc pallor defines an abnormal coloration of the optic disc as visualized by
a fundoscopic examination. Consequently, the medical features of CDR were used in Refs. [3–5, 11, 16, 21,
27, 31, 35, 38, 42, 47, 52, 57], which have been given more reliability in glaucoma determination. Moreover,
in Refs. [12, 29], they have considered apex point as a medical feature to detect the disorder of glaucoma.
Then, the RNFLs of medical features extraction were described in Ref. [7], which has been used to predict
the glaucomatous images with more accuracy.
(b) Analysis Based on the Data Set Used: Figure 2 shows the bar graph based on different types of data
sets such as real data set, M-VEP data set, IPN data set, SCES data set, GRI data set [17], ORIGA data set,
local data set, ZEISS data set, DIARETDB1 data set [14], ORIGA-light clinical data set [40], DRIVE data set

Table 2: Analysis Based on Medical Features.

Features Works

RNFL [7]
CDR [3–5, 11, 16, 21, 27, 31, 35, 38, 42, 47, 52, 57]
Vessel [21]
Apex point [12, 29]
Optic disc [9, 13, 19, 23, 28, 34, 53]
Optic disc hemorrhage [28]
Optic disc morphology [6, 45]
Neuroretinal rim [5, 21, 23, 34, 57]
ONH [54, 58]

Dataset usage
12
10
Number of papers

8
6
4
2
0
Dataset usage

Figure 2: Bar Chart Based on the Data Set Used.

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[15], STARE data set [50], RIMONE data set [44], MESSIDOR data set [30], HRF data set [20], and DEMD
data set. In Figure 2, we can analyze the different data set usages for the reviewed papers. Accordingly,
the number of papers, such as Refs. [3, 12, 13, 19, 21, 26, 29, 48, 49, 55, 58], specifies the real data set for
glaucoma detection. Then, the works are done in [32] based on the two data sets, such as RIMONE data
set and DIARETDB1 data set. Moreover, the data sets of SCES, ZEISS, and IPN are effectively included in
Refs. [2, 13, 23], respectively. Finally, we concluded that most number of papers have used real data set
for the detection of glaucoma.
(c) Analysis Based on Accuracy: In this section, Table 3 shows the analysis of literature papers based on
the classification accuracy. Here, the reviewed papers are categorized in five ways based on the accuracy
values, such as below 80% accuracy, above 95% accuracy, and the ranges of accuracy between 80% and
85%, between 85% and 90%, and between 90% and 95%. Here, the four reviewed papers such as Refs. [5,
12, 41, 48] have obtained more than 95% accuracy. From Table 3, we can understand that nine reviewed
papers have achieved an accuracy between 90% and 95%.
(d) Analysis Based on Objective: This section shows the objective analysis of reviewed papers using a pie
chart, which is shown in Figure 3. Here, the pie chart can be plotted based on the various objectives such
as glaucoma detection, glaucoma stages classification, vertical CDR measurement, blood vessels seg-
mentation, optic disc boundary detection, optic cup detection, and ONH deformation. From the above
reviewed 45 papers, we concluded that 26 papers reached the objective of glaucoma detection. Then, four
papers such as Refs. [25, 52, 53, 58] reached the objective of optic cup detection. Moreover, the objective of
optic disc boundary detection was performed in Refs. [6, 21, 28, 45]. Then, the vertical CDR measurement
[19, 34] and optic cup detection [25, 32] were performed in two papers of each. Finally, we can understand
that most researchers did the work based on the objective of glaucoma detection compared to other types
of objectives such as blood vessel segmentation and optic disc boundary detection.
(e) Analysis Based on Imaging Technologies: This section discusses the different imaging technolo-
gies used for glaucoma detection. From the research study, it is revealed that four major imaging
modalities are applied for image processing-based glaucoma detection. Accordingly, fundus, HRT,
OCT, and US images are applied for glaucoma detection. Figure 4 shows the pie chart based on the

Table 3: Analysis Based on Simulation.

Accuracy level Works

Below 80% [7, 21]

80–85% [55, 56]
85–90% [1, 3, 8–10, 16, 29, 31, 37, 38, 52]
90–95% [2, 11, 13, 27, 33, 35, 39, 47, 49]
Above 95% [5, 12, 41, 48]

Glaucoma detection
Glaucoma detection

2 Glaucoma stages
3 classification
4 Vertical cup to disc ratio
measurement
Optic disc boundary
4 detection
26 Optic cup detection
2
3 Neuroretinal optic cup
detection
Optic nerve head
deformation

Figure 3: Pie Chart Based on Objective.

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52 S.S. Kanse and D.M. Yadav: Retinal Fundus Image for Glaucoma Detection

Imaging technologies for glaucoma

detection

2
2 2
Fundus
HRT
39
OCT
US

Figure 4: Pie Chart Based on Imaging Technologies.

frequency of the research works that are based on imaging modalities. Accordingly, fundus imaging
was actively applied for glaucoma detection. For example, 39 research works used fundus images for
glaucoma diagnosis. On the contrary, two research works are used the other modalities, such as HRT,
OCT, and US.
Table 4 shows the effectiveness of the imaging technologies for glaucoma detection. Here, the
maximum accuracy of 98.46% is reached by the fundus imaging-based research work. The average accu-
racy of the fundus imaging is 90%. The average accuracy of the HRT, OCT, and US imaging modalities are
91%, 97.75%, and 94%, respectively. The bold values given in Table 4 indicates the better performance.

4 Gaps and Issues

Based on the literature review conducted, we identify some of the important challenges that require a more
advanced procedure to handle it. Some of the challenges are listed here.
One of the important medical features used in the literature to find the presence of glaucoma is CDR. Usually,
the ophthalmologists determine the cup and disc areas and diagnose glaucoma using a vertical CDR. However,
the determination of the cup area is very difficult. Again, the automatic calculation of optic cup boundary is
challenging due to the interweavement of blood vessels with the surrounding tissues around the cup [58].
The broad range of CDR makes it difficult to identify early changes of ONH, and different ethnic groups
possess various features in ONH structures. Hence, it is still important to develop various detection tech-
niques to assist clinicians to diagnose glaucoma at early stages.
For the detection of glaucoma based on features, some work uses the thresholding operation. However,
fixed a thresholding is also not adequate to handle large-intensity variations in the cup region that arise
due to physiological differences across patients. The energy minimization-based deformable models are not
appropriate for this problem due to the absence of edge- or region-based information associated with the cup
region to derive energy functional [25].
Another one important indicator for glaucoma is blood vessels. Commonly, the blood vessel segments
may be modeled by line segments. The problem of finding the convergence of the vessel network may then be

Table 4: Analysis Based on Diagnostic Prediction Using Imaging Technologies.

Average accuracy (%) Maximum accuracy (%) Minimum accuracy (%)

Fundus 90 98.46 70
HRT 91 94 88
OCT 97.75 97.75 97.75
US image 94 97 90

The bold values given in Table 4 indicates the better performance.

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 S.S. Kanse and D.M. Yadav: Retinal Fundus Image for Glaucoma Detection 53

modeled as a line intersection problem. Identifying the intersection of a number of lines (a convergence) is a
fundamental geometric problem, with applications ranging from astronomy to engineering, such as model
fitting and prediction [22].
In some of the methods of glaucoma detection, features are extracted from the whole fundus image or a
subimage containing an optic disc. The features from the image portions outside the optic disc do not carry
any significant information about glaucoma and are redundant and may also adversely affect the automatic
classification [49].
The mostly used classifier called SVM performs classification by constructing an N-dimensional hyper-
plane that optimally separates the data into two categories. SVMs view the classification problem as a quad-
ratic optimization problem. However, it is very sensitive to outliers in the training samples and it requires a
long time to train the huge amount of data from large databases.
Another one important classifier called KNN classifier needs all available data. This may lead to consider-
able overhead too if the training data set is large. Also, it finds difficulty in deciding on an optimal k-value.
Again, the noisy or mislabeled data directly influence the classification of new instances.

5 Discussion
For glaucoma detection, blood vessel segmentation is an important step to be done. Although many prom-
ising techniques and algorithms have been developed, there is still room for improvement in blood vessel
segmentation methodologies. The development of techniques, which work for images acquired from dif-
ferent imaging equipment under different environmental conditions, is also an open area for research in
vessel segmentation algorithms. We have seen that the choice of classification method influences both
accuracy and efficiency. Several classification methods for the prediction of the glaucoma disease have
been proposed, while large numbers of optimization algorithms have been investigated. The question
remains how best to select and implement the classification methods. Some certain options are more prom-
ising than others, but the optimal choice also depends on the interaction between the various aspects of
the implementation.
To expand the utility of glaucoma detection algorithms for healthcare, there is a need to create larger
data sets with available ground truths, which include the labeling of vessels, other anatomical struc-
tures, and classification. The collection of large databases with different kinds of images available online
for the research purpose will open a new era in this automatic glaucoma detection. Furthermore, the
development of research software applications, which integrate various computer-assisted retinal image
analysis algorithms, such as CDR estimation, vessel extraction, feature extraction, and classification, is
a new research direction. Commonly, most of the glaucoma detection methodologies are evaluated on
the retinal images of adults. The morphological characteristics of retinal images of premature infants,
babies, and children are very different from that of the adult retina. Therefore, the analysis of the retinal
images of premature infants, babies, and children will be a good research direction for the researchers in
this field.
Over the past decade, a lot of understanding has been gained about automatic glaucoma detection.
It is not an easy procedure to understand: the underlying process of how the features influence the
learning theories is difficult to envisage. How it influences the relation between images and learning
models is even more mystifying. For instance, better results with statistical features have been reported
for glaucoma detection from the fundus images. Furthermore, it may turn out that fundus images are not
the optimal image technologies for images of thin structures. Therefore, what we have learned from past
research is that recent image technologies, such as HRT, OCT, and US images, are a useful adaptation of
automatic glaucoma detection. From the continuing interest in glaucoma detection, it can be deduced
that image processing-based methods will not be abandoned in the near future. It is already a success-
ful method for many applications and it can undoubtedly be adapted and extended to aid in many more
problems.

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54 S.S. Kanse and D.M. Yadav: Retinal Fundus Image for Glaucoma Detection

6 Conclusion
This paper presents the collective survey of different techniques used for automated glaucoma detection using
various features. The main intention of this study was to study and review glaucoma detection techniques
based on retinal images. Here, we have taken 45 research papers based on glaucoma detection and analyzed
the papers based on three factors. The first one is feature extraction using medical features, such as CDR,
apex point, neuroretinal rim, and ONH, and image features, such as wavelet energy and Haralick texture.
Second, the techniques were categorized based on the classification accuracy achieved by the various clas-
sifiers, such as SVM, KNN, NB, and AdaBoost classifier, based on the threshold technique and random forest
classifier. Finally, we have performed the analysis using different data sets, such as VEP data set, IPN data
set, SCES data set, GRI data set, ORIGA data set, local data set, ZEISS data set, DIARETDB1, and ORIGA-light
data set. Finally, we present the various research issues and solutions that can be useful for the researchers to
accomplish further research on glaucoma detection. Based on the analysis, we concluded that more number
of researchers have used the classification based on the threshold-based technique and SVM classifier.

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