International Journal of Scientific Research Engineering & Technology (IJSRET), ISSN 2278 0882

Volume 3, Issue 2, May 2014

A Novel Approach towards Automatic Glaucoma Assessment

Darsana S1, Rahul M Nair2
1

1,2

MTech Student, 2Assistant Professor,

Department of ECE, Nehru College of Engineering and Research Centre Thrissur ,
University of Calicut, Kerala

ABSTRACT
Glaucoma is a progressive eye disease and is called
Silent Theif of Sight. As it cannot be cured, detecting
the disease in time is very important. Currently,
glaucoma assessment is manually performed by trained
ophthalmologists limiting its potential for population
based glaucoma screening. Thus there is a need for an
efficient automatic glaucoma assessment technique.
This paper proposes automatic glaucoma assessment by
combined analysis of fundus eye image and patient data.
Fundus image feature extraction and ocular parameter
evaluation are carried out for image level analysis. The
techniques used for feature extraction include color
model analysis, morphological processing, filtering and
thresholding. Ocular parameters considered are Cup to
Disc Ratio (CDR), Rim to Disc Ratio(RDR), cup to disc
area ratio and Inferior Superior Nasal Temporal(ISNT)
ratio of bloodvessels in disc region. The CDR, RDR and
cup to disc area ratio based on optic disc, cup and rim
are calculated using image measuring techniques. Mask
generation and feature segmentation based on ArrayCentroid method is proposed for RDR and ISNT ratio
calculation. Image level classification makes use of
ocular parameters and SVM is used to classify the
images as normal or glaucoma suspect. Data level
analysis uses patient data and classification is done with
the help of risk calculator. Then a combined glaucoma
risk analysis is performed to label a risk class to the
patient. MATLAB software is used for developing user
interface for the proposed approach. Performance
analysis is carried out for image level, data level and
combined glaucoma analysis.
Keywords - Array- Centroid Method, Classification,
Fundus Image, Glaucoma, Patient Data,

I.

INTRODUCTION

The recent rapid advances in medical imaging and

automated image analysis allow us to make significant
advances in our understanding of life and disease
processes, and our ability to deliver quality healthcare.

Fundus eye image processing is now a core field of

research for diagnosis of various eye disorders.
Glaucoma assessment is one of the applications of
fundus image processing. Glaucoma is a chronic and
irreversible neurodegenerative disease in which the
nerve that connects the eye to the brain is progressively
damaged. Progression of the disease leads to loss of
vision, which occurs gradually over a long period of
time. Unawareness about the disease until it reaches the
advanced stage is a major problem as it cannot be cured.
According to World Health Organization, glaucoma is
the leading cause of blindness that contributes to
approximately 5.2 million cases of blindness and will
increase to 11.2 million people by 2020[2] . So detecting
the disease in time is critical and population based
glaucoma assessment is very relevant to save the vision
of millions. Glaucoma assessment performed by trained
ophthalmologists limits its potential for population based
glaucoma screening. There comes the need for an
efficient automatic glaucoma assessment technique. The
main ocular indicators of glaucoma are Optic CDR,
RDR, ISNT rule, ISNT ratio, PPA, Notching etc. There
are some nonocular factors like age, race, family history
etc which determine the risk of glaucoma. Research is
being done to fully automate the glaucoma assessment.
J Cheng et al, (2013) [1] proposed a superpixel
classification based disc and cup segmentations for
glaucoma screening. C.B. Anusorn et al, (2013) [2]
proposed a method to calculate the CDR automatically
from fundus images. To automatically extract the disc,
two methods making use of edge detection and
variational level set are proposed and cup segmentation
is evaluated using color component analysis and
threshold level set method. K. Narasimhan et al, (2012)
[3] proposed a semi automated method for glaucoma
detection using CDR and ISNT ratio of a fundus image.
O.Sheeba et.al (2014)[4] proposed automatic detection
using artificial neural network. In the proposed method
neural network is trained to recognize the parameters for
the detection of different stages of the disease. The

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International Journal of Scientific Research Engineering & Technology (IJSRET), ISSN 2278 0882
Volume 3, Issue 2, May 2014

neuron model has been developed using feed forward

backpropagation network.
This paper proposes a novel approach towards automatic
glaucoma assessment. The efforts taken to develop an
automatic glaucoma assessment technique have an
integration of fundus image analysis and patient data
analysis. Finally a combined glaucoma risk analysis is
performed and a risk class is labelled for each set of
input. In fundus image analysis fundus image is
preprocessed and features are extracted. The feature
extraction involves optic disc segmentation, optic cup
segmentation, optic rim segmentation and blood vessel
extraction. An array centroid method is proposed to
segment the extracted features into ISNT quadrants.
Then ocular parameters such as CDR, cup to disc area
ratio, Inferior RDR, Superior RDR and ISNT Ratio are
calculated. SVM classifier is proposed for classification
of image as glaucoma suspect or normal. A risk
calculator analyses a set of patient data in the next stage
and a risk level is assigned to each set. The patient data
considered are age, race, family history related to
glaucoma and last eye examination record. Finally
glaucoma risk is analysed based on the results of image
and data analysis. The five classes defined
in this
analysis include no risk, low risk, moderate risk, high
risk and very highrisk. Development of an user interface
allows any user to take advantage of the proposed
technique.

race, family history and medical examination records of

the person being examined. Data level classification
classifies the patient into one of the three classes, low
risk, medium risk, high risk. The results of image level
classification and data level classification is used for
final glaucoma risk analysis.

.
Fig. 1 Flowchart of Proposed Method
2.1

The paper is organized as follows. Section II describes

the various stages of the proposed method. Section III
shows experimental results. Conclusion and future scope
are presented in section IV. Acknowledgement is given
in section V.

II.

FUNDUS IMAGE PROCESSING

The fundus eye image represents the interior surface of

the eye and is used as the input for processing. A sample
input image is shown in Fig 2

METHODOLOGY

The flow chart for the proposed method is shown in

Fig. 1 The image level and data level processing are
carried out inorder to analyse the glaucoma risk of a
patient. In image level processing fundus eye image is
used as input. Fundus image processing involves
preprocessing and feature extraction. Ocular parameters
to be estimated are Optic CDR, Optic RDR, cup to disk
area ratio and ISNT ratio. Image level classification
make use of SVM classifier and classify image as
normal or glaucoma suspect. Data level processing uses
patients personal data as input. The risk calculator is
used for patient data analysis. Patient data involves age,

Fig. 2 Input Image

The fundus image processing involves preprocessing and
feature extraction. The four feature extraction processes
are optic disc segmentation, optic cup segmentation,
optic rim segmentation and blood vessel extraction. The
block diagram in Fig 3 illustrates the entire process of
fundus image processing.

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International Journal of Scientific Research Engineering & Technology (IJSRET), ISSN 2278 0882
Volume 3, Issue 2, May 2014

The value channel is used for optic disc segmentation.

The morphological closing operation is performed in the
value channel image in order to remove the blood
vessels. Then median filtering is done to remove noise
and preserve edges. After filtering, thresholding is done
using a manually selected threshold value, as the prior
information about the region to be segmented is known.
The optimum threshold value used is the top 1/10 of the
normalized grayscale intensity. Again morphological
opening is done inorder to remove the unwanted pixels
around the segmented optic disc[2]. Fig. 4 shows the
segmented optic disc.

Fig. 3 Fundus Image Processing

2.1.1 IMAGE PREPROCESSING
Pre-processing includes RGB (Red Green Blue)
separation, RGB to HSV (Hue Saturation Value)
conversion, RGB to CMY (Cyan Magenta Yellow)
conversion, histogram representation and channel
selection. The RGB model provides three channel maps,
Red, Green and Blue. Each of the channel represents the
image in a different manner. HSV model also provides
three channels, Hue, Saturation and Value, each with its
own characteristics. CMY color space is the complement
color space of RGB which also highlights the features
within the image. From RGB, HSV and CMY color
space the best channel has to be selected for
segmentation of optic disc and cup and blood vessel
extraction. The main aim of channel selection is to select
the most appropriate channel which best describes the
optic disc, optic cup and blood vessels. The channel
selection depends on the color or intensity characteristics
of optic disc, optic cup and blood vessels. The optic disc
represents the brightest region within the retina and optic
cup is the white region inside the optic disc. Blood
vessels appear as thick red vessels within the image. By
evaluating each channel it is found that the value
channel best describes the brightest region in the fundus
image and can be used for optic disc segmentation. The
magenta channel in CMY color space best describes the
white cup region and blood vessels within the fundus
image. So this channel is selected for optic cup
segmentation and blood vessel extraction.

(a)
(b)
Fig. 4 Segmented Optic Disc (a) Before Morphological
Opening (b) After Morphological Opening
2.1.3 OPTIC CUP SEGMENTATION
The magenta channel is selected for optic cup
segmentation. The contrast of the magenta channel is
enhanced inorder to better represent the optic cup region.
The morphological opening operation is done in the
magenta channel inorder to remove the blood vessels in
the cup region. Median filter is used to reduce the noise
in the morphologically processed image. Then the cup
region is segmented by thresholding where the threshold
value is selected as the bottom 1/10 of the grayscale
intensity. The segmented optic cup is shown in Fig 5.

Fig. 5 Segmented Optic Cup

2.1.4 OPTIC RIM SEGMENTATION

2.1.2 OPTIC DISC SEGMENTATION

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International Journal of Scientific Research Engineering & Technology (IJSRET), ISSN 2278 0882
Volume 3, Issue 2, May 2014

Optic rim is the region between the optic disc and optic
cup. Once the optic disc and optic cup are segmented the
rim region can be obtained by subtracting the optic cup
from optic disc as shown in Fig 6.

temporal quadrant is the left quadrant in right eye and

right quadrant in left eye. Inorder to get segments in
ISNT quadrants a new Array Centroid method is
proposed.
2.2.1 ARRAY CENTROID METHOD
The array-centroid method based mask generation and
feature segmentation is proposed to segment the optic
disc, optic rim and blood vessels in disc region into four
different quadrants (inferior, superior, nasal, temporal).
The flow chart of method is shown in Fig 8.

Fig. 6 Segmented Optic Rim Region

2.1.5 BLOOD VESSEL EXTRACTION
The blood vessels in the optic disc region have to be
extracted inorder to calculate the ISNT ratio. The first
step in blood vessel extraction is the contrast
enhancement of selected magenta channel. The
morphological filtering can filter out the blood vessels
within the image. Thus tophat filtering is done using a
square structuring element. The image is further
enhanced and the histogram is analysed to set a
threshold for thresholding. The blood vessels in the disc
region as shown in Fig. 7 are obtained by
complementing the disc region and then subtracting it
from the blood vessel image.

Fig 8 Flow Chart of Array Centroid Method

The first step of mask generation is to find the centroid
of the binary image. Then an array of size same as that
of the image is considered and initialized with all its
elements zero. Then the masks for the different
quadrants are generated exploiting the characteristics of
an array and the centroid values[5]. The mask generated
using the above method is shown in Fig 9.

Fig. 7 Blood Vessels in Disc Region

2.2 OCULAR PARAMETER EVALUATION
For ocular parameter evaluation disc diameter, cup
diameter, disc area and cup area are to be calculated
using image measuring techniques. RDR and ISNT ratio
calculation make use of the disc region, rim region and
blood vessels in ISNT quadrants. Inferior quadrant is the
lowermost quadrant and superior quadrant is the
uppermost quadrant. The nasal quadrant is the right
quadrant in right eye and left quadrant in left eye. The

(a)

(b)

(c)

(d)

Fig. 9 Mask in Four Quadrants (a) Inferior (b) superior

(c ) Right (d) Left
The generated masks are further multiplied with the
segmented features and thus obtain the segments in four
quadrants

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International Journal of Scientific Research Engineering & Technology (IJSRET), ISSN 2278 0882
Volume 3, Issue 2, May 2014

TABLE 1.RISK CALCULATOR CHART

2.2.2 CUP TO DISC RATIO

CDR is defined as the ratio of vertical cup diameter to
vertical disc diameter. CDR is one of the important
indicator of glaucoma because as glaucoma advance the
cup enlarges until it occupies most of the disc area and
there will be no change for optic disc. Thus increase in
CDR indicates the pathological condition. For normal
eye it is found to be 0.3 to 0.5. As the neuro-retinal
degeneration occurs the ratio increases and at the CDR
value of 0.8 the vision will be lost completely. CDR is
obtained by taking the ratio of cup diameter and disc
diameter in the vertical direction.

Parameters

Category

Weight
Point
0
1
2
3

Age

<40
40-64
65-74
>75

Race

Caucasian/Other
African/American
in non relative
+for parent(s)
+for sibling(s)
+for parent(s)
and sibling(s)

0
2
0
2
3
3

Within past two

years
2-5 years
>5 years

Family
History of
Glaucoma

2.2.3 RIM TO DISC RATIO

The cardinal clinical sign of glaucomatous optic
neuropathy is thinning of the neuroretinal rim, with the
regional preference for the superior and inferior poles of
the optic disc. RDR is calculated for the inferior and
superior quadrant as the ratio of rim area to disc area.

Non Ocular Parameter Evaluation

Last Eye
Exaination
Record

Risk Based on
Total Score

High Risk

=3

Moderate
Risk

Low Risk

1
2

2.2.4 CUP TO DISC AREA RATIO

2.4 CLASSIFICATION

The cup to disc area ratio is determined by taking the

ratio of total cup area to total disc area. This area ratio is
selected to assess the overall segmentation accuracy
achieved in all directions unlike the CDR which reflects
accuracy only in vertical direction.

The classification of fundus image as normal or

pathological is not a simple task. The main reason is that
there are many factors to be evaluated to suspect
glaucoma. Thus here an image level classification, data
level classification and a combined glaucoma risk
analysis is performed.

2.2.5 ISNT RATIO

2.4.1 IMAGE LEVEL CLASSIFICATION
ISNT ratio is calculated using the ratio of area of blood
vessels in inferior superior to nasal temporal side of
optic disc. There may be a shift in blood vessels to nasal
side in glaucoma patients and thus the ISNT ratio will be
less compared to normal persons image[3].
2.3 RISK CALCULATOR DEVELOPMENT
The non ocular parameters which determine the risk of
glaucoma involves age, race, family history and last eye
examination record. According to these patient data
some weights are assigned for each case and finally total
weight is calculated and risk level is decided as low,
moderate or high. The standard risk calculator chart for
this evaluation is given in Table 1

The term image classification refers to the labeling of

images into one of a number of predefined
categories.Here image level classification makes use of
SVM classifier to classify the image into normal or
glaucoma suspect. Classification is based on the ocular
parameters evaluated. Here training of SVM is carried
out with a set of 30 images. SVM is trained first with the
15 normal images and then with 15 glaucoma images.
After training the SVM, testing is done with 70 images.
SVM classified each image into either normal or
glaucoma suspect. After classification a weighting score
is assigned for each class as shown in Table 2.

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TABLE I.IMAGE LEVEL CLASSIFICATION

Class
Score
Normal
0
Glaucoma Suspect
2

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International Journal of Scientific Research Engineering & Technology (IJSRET), ISSN 2278 0882
Volume 3, Issue 2, May 2014

2.4.2 DATA LEVEL CLASSIFICATION

Data level classification is done using the risk calculator.
Here each patient is being classified into one of the three
levels of glaucoma risk. After classification a weighting
score is assigned for each class for further analysis as in
Table 3.
TABLE 3.DATA LEVEL CLASSIFICATION
Risk Level
Score
Low
0
Moderate
1
High
2
2.4.3 COMBINED GLAUCOMA RISK ANALYSIS
This is the final classification and determines the risk of
glaucoma for the patient. It is obtained by the sum of
scores obtained in image level and data level
classification. In this approach five risk levels are
defined and each patient is assigned into one of the risk
level for glaucoma. The combined glaucoma risk
analysis chart is given in Table 4
TABLE 4.COMBINED GLAUCOMA RISK
ANALYSIS
Image
Level
Result

Data
Level
Result

Image
Level
Score

Data
Level
Score

Total
Score

Risk For
Glaucoma

Normal

Low

No Risk

Normal

Moderate

Low Risk

Normal

High

Glaucoma
Suspect
Glaucoma
Suspect
Glaucoma
Suspect

Low

Moderate

Moderate
Risk
Moderate
Risk
High Risk

High

III.

Very High
Risk

EXPERIMENTAL RESULTS

The development of an efficient user interactive

environment for automatic glaucoma assessment is the
solid outcome of this work. The user interface is
developed using MATLAB GUI. The developed user
interface is shown in Fig 10.

Fig. 10 Developed User Interface

The performance of the proposed technique is analysed
in three sections. In the first section the performance of
image based classification is analysed. A total of 70
images are tested using the trained SVM which include
25 glaucomatous image and 45 normal images. Out of
70 images 67 images are classified correctly. The

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International Journal of Scientific Research Engineering & Technology (IJSRET), ISSN 2278 0882
Volume 3, Issue 2, May 2014

performance analysis is done by calculating sensitivity,

specificity and accuracy. The results obtained are 97.7%
sensitivity, 92% specificity and 95.7% accuracy. The
performance of risk calculator is analysed in the second
section. Risk calculator effectively calculates the score
for every set of data inputs assuring high accuracy.
Finally the combined glaucoma risk analysis is analysed
in the third section. The classification accuracy of this
stage is a clear reflection of above stages. The risk
labeled to each patient at this classification level will be
a valuable reference for the clinicians for their further
assessment.

IV.

CONCLUSION AND FUTURE SCOPE

An efficient technique for automatic glaucoma

assessment is proposed in this work. The image based
and data based integrated analysis accelerates the
potential for classifying the sample inputs. In image
based analysis fundus image serves as the input. The
preprocessing of image and feature extraction which
includes optic disc segmentation, optic cup
segmentation, optic rim segmentation and blood vessel
extraction are carried out in the first stage. Then the
ocular parameters such as CDR, Cup to Disc Area ratio,
Inferior and Superior RDR, and ISNT Ratio are
calculated making use of array centroid method and
image measuring techniques. Image based classification
is performed using SVM classifier which classifies
image as either normal or glaucoma suspect and a
weighting score is assigned to each class. Data level
analysis using the patient data set including age, race ,
family history, last eye examination record is performed
with developed risk calculator. The calculator calculates
a risk score based on data input and based on that each
patient is classified into one of the three risk groups;
low, moderate and high. A weight score is assigned to
these classes also. Finally a combined glaucoma risk
analysis is done based on the results of image and data
based classification. This classification gives one of the
five risk labels; no risk, low risk, moderate risk, high
risk, and very high risk to each patient. Development of
a user interface is the highlight of this work which
enables any user to make use of the advantage of the
proposed technique. Performance analysis for the
proposed work is carried out and the results are upto the
expectations. So it can be concluded that the proposed
approach is an efficient technique for glaucoma
assessment which can save the vision of millions. The
potential limitation of this approach is that sometimes

pathological condition exists in patient without reflecting

any of the factors considered in the analysis. It is well
projected in image based classification. Out of 70
images 3 are misclassified,it is not the limitation of
classifier it is the limitation of the approach towards
classification.
The proposed work can be extended by integrating more
factors in image based analysis which reflects the
glaucoma symptoms. The factors that can be included
are notching, disc hemorrhage, inter eye symmetry,
peripappilary atrophy etc. Analysis of these factors
require in depth processing of the fundus image.
Another way to enhance the performance of automatic
assessment is to use 3D fundus images. The main barrier
for such a work is the unavailability of 3D images. The
high cost of obtaining 3D images makes it inappropriate
for a large scale screening. But 3D image based analysis
will boost the performance of glaucoma assessment as it
can assess the depth information of the eye. Thus a
compromise in cost and risk of availability can achieve
more efficient technique.

V.

ACKNOWLEDGEMENT

The authors are grateful to Dr.

M. S Ophtalmic Surgeon and
Adithya Kiran Eye Care Centre
the fundus image photographs
support given for this work.

Rajesh Radhakrishnan.
Glaucoma Consultant,
Palakkad for providing
and the guidance and

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