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Diabetic Retinopathy (DR) is the most common complication of Diabetes Mellitus and can lead to blindness if not detected early. Since DR is often asymptomatic in its early stage, timely diagnosis is crucial. Artificial Intelligence (AI) has the potential to facilitate early disease detection and treatment, but its implementation in the medical field raises significant privacy concerns. The sensitive nature of healthcare data, which includes personal information and medical history, makes data privacy a critical issue. This paper explores the implementation of AI models to predict DR risks while incorporating common defense algorithms to enhance data privacy. An unstructured dataset, specifically the DDR dataset, was used to train Deep Learning (DL) models. Two families of DL models, ResNets and DenseNets, were trained and evaluated based on the performance metrics. ResNet 50 and DenseNet 169 demonstrated superior performance and were selected for further privacy enhancement using encryption. The results indicated that privacy-preserving methods, particularly encryption, did not significantly impact the model performance. In summary, this paper highlights the potential of privacy-preserving AI in predicting the risks of DR.

Recently, the Internet of Things (IoT) and computer vision technologies find useful in different applications, especially in healthcare. IoT driven healthcare solutions provide intelligent solutions for enabling substantial reduction of expenses and improvisation of healthcare service quality. At the same time, Diabetic Retinopathy (DR) can be described as permanent blindness and eyesight damage because of the diabetic condition in humans. Accurate and early detection of DR could decrease the loss of damage. Computer-Aided Diagnoses (CAD) model based on retinal fundus image is a powerful tool to help experts diagnose DR. Some traditional Machine Learning (ML) based DR diagnoses model has currently existed in this study. The recent developments of Deep Learning (DL) and its considerable achievement over conventional ML algorithms for different applications make it easier to design effectual DR diagnosis model. With this motivation, this paper presents a novel IoT and DL enabled diabetic retinopathy diagnosis model (IoTDL-DRD) using retinal fundus images. The presented Internet of Things Deep Learning – Diabetic Retinopathy Diagnosis (IoTDL-DRD) technique utilizes IoT devices for data collection purposes and then transfers them to the cloud server to process them. Followed by, the retinal fundus images are preprocessed to remove noise and improve contrast level. Next, mayfly optimization based region growing (MFORG) based segmentation technique is utilized to detect lesion regions in the fundus image. Moreover, densely connected network (DenseNet) based feature extractor and Long Short Term Memory (LSTM) based classifier is used for effective DR diagnosis. Furthermore, the parameter optimization of the LSTM method can be carried out by Honey Bee Optimization (HBO) algorithm. For evaluating the improved DR diagnostic outcomes of the IoTDL-DRD technique, a comprehensive set of simulations were carried out. A wide ranging comparison study reported the superior performance of the proposed method.

Diabetic retinopathy (DR) is a complication of diabetes that leads to blindness. The manual screening of color fundus images to detect DR at early stages is expensive and time consuming. Deep learning (DL) techniques have been employed for automatic DR screening on fundus images due to their outstanding performance in many applications. However, training a DL model needs a huge amount of data, which are usually unavailable in the case of DR, and overfitting is unavoidable. Employing a two-stage transfer learning method, we developed herein an intelligent computer-aided system using a pre-trained convolutional neural network (CNN) for automatic DR screening on fundus images. A CNN model learns the domain-specific hierarchy of low- to high-level features. Given this, using the regions of interest (ROIs) of lesions extracted from the annotated fundus images, the first layer of a pre-trained CNN model is re-initialized. The model is then fine-tuned, such that the low-level layers learn the local structures of the lesion and normal regions. As the fully connected layer (FC) layers encode high-level features, which are global in nature and domain specific, we replace them with a new FC layer based on the principal component analysis PCA and use it in an unsupervised manner to extract discriminate features from the fundus images. This step reduces the model complexity, significantly avoiding the overfitting problem. This step also lets the model adopt the fundus image structures, making it suitable for DR feature detection. Finally, we add a gradient boosting-based classification layer. The evaluation of the proposed system using a 10-fold cross-validation on two challenging datasets (i.e., EyePACS and Messidor) indicates that it outperforms state-of-the-art methods. It will be useful for the initial screening of DR patients and will help graders in deciding quickly as regards patient referral to an ophthalmologist for further diagnosis and treatment.

Diabetic retinopathy (DR) is a diabetes complication that affects the eye and can cause damage from mild vision problems to complete blindness. It has been observed that the eye fundus images show various kinds of color aberrations and irrelevant illuminations, which degrade the diagnostic analysis and may hinder the results. In this research, we present a methodology to eliminate these unnecessary reflectance properties of the images using a novel image processing schema and a stacked deep learning technique for the diagnosis. For the luminosity normalization of the image, the gray world color constancy algorithm is implemented which does image desaturation and improves the overall image quality. The effectiveness of the proposed image enhancement technique is evaluated based on the peak signal to noise ratio (PSNR) and mean squared error (MSE) of the normalized image. To develop a deep learning based computer-aided diagnostic system, we present a novel methodology of stacked generalization of convolution neural networks (CNN). Three custom CNN model weights are fed on the top of a single meta-learner classifier, which combines the most optimum weights of the three sub-neural networks to obtain superior metrics of evaluation and robust prediction results. The proposed stacked model reports an overall test accuracy of 97.92% (binary classification) and 87.45% (multi-class classification). Extensive experimental results in terms of accuracy, F-measure, sensitivity, specificity, recall and precision reveal that the proposed methodology of illumination normalization greatly facilitated the deep learning model and yields better results than various state-of-art techniques.

Diabetic retinopathy (DR) is one of the major causes of blindness. It is of great significance to apply deep-learning techniques for DR recognition. However, deep-learning algorithms often depend on large amounts of labeled data, which is expensive and time-consuming to obtain in the medical imaging area. In addition, the DR features are inconspicuous and spread out over high-resolution fundus images. Therefore, it is a big challenge to learn the distribution of such DR features. This article proposes a multichannel-based generative adversarial network (MGAN) with semisupervision to grade DR. The multichannel generative model is developed to generate a series of subfundus images corresponding to the scattering DR features. By minimizing the dependence on labeled data, the proposed semisupervised MGAN can identify the inconspicuous lesion features by using high-resolution fundus images without compression. Experimental results on the public Messidor data set show that the proposed model can grade DR effectively. Note to Practitioners—This article is motivated by the challenging problem due to the inadequacy of labeled data in medical image analysis and the dispersion of efficient features in high-resolution medical images. As for the inadequacy of labeled data in medical image analysis, the reasons mainly include the followings: 1) the high-quality annotation of medical imaging sample depends heavily on scarce medical expertise which is very expensive and 2) comparing with natural issues, it is more difficult to collect medical images because of privacy issues. It is of great significance to apply deep-learning techniques for diabetic retinopathy (DR) recognition. In this article, the multichannel generative adversarial network (GAN) with semisupervision is developed for DR-aided diagnosis. The proposed model can deal with DR classification problem with inadequacy of labeled data in the following ways: 1) the multichannel generative scheme is proposed to generate a series of subfundus images corresponding to the scattering DR features and 2) the proposed multichannel-based GAN (MGAN) model with semisupervision can make full use of both labeled data and unlabeled data. The experimental results demonstrate that the proposed model outperforms the other representative models in terms of accuracy, area under ROC curve (AUC), sensitivity, and specificity. [ABSTRACT FROM AUTHOR]

Though deep learning has shown successful performance in classifying the label and severity stage of certain diseases, most of them give few explanations on how to make predictions. Inspired by Koch's Postulates, the foundation in evidence-based medicine (EBM) to identify the pathogen, we propose to exploit the interpretability of deep learning application in medical diagnosis. By isolating neuron activation patterns from a diabetic retinopathy (DR) detector and visualizing them, we can determine the symptoms that the DR detector identifies as evidence to make prediction. To be specific, we first define novel pathological descriptors using activated neurons of the DR detector to encode both spatial and appearance information of lesions. Then, to visualize the symptom encoded in the descriptor, we propose Patho-GAN, a new network to synthesize medically plausible retinal images. By manipulating these descriptors, we could even arbitrarily control the position, quantity, and categories of generated lesions. We also show that our synthesized images carry the symptoms directly related to diabetic retinopathy diagnosis. Our generated images are both qualitatively and quantitatively superior to the ones by previous methods. Besides, compared to existing methods that take hours to generate an image, our second level speed endows the potential to be an effective solution for data augmentation. [ABSTRACT FROM AUTHOR]

Medical deep neural networks (DNNs) trained upon coarse image inputs are inherently insensible to fine-grained anatomic features. To enhance DNN perception on delicate microvascular structures, we proposed using a straightforward angiographic mobile-dense hybrid network (AMDenseNet) in tandem with a flexible input split, suppression, and swap perturbation (InSSS-P) framework to perform explainable diagnostics for microvascular diseases. Mechanistically, InSSS-P and AMDenseNet conjointly (1) decompose complex anatomy inputs into LEGO-like blocks, then (2) distill plexus-wise vascular block significance from the rearranged anatomy input-output samplings. To validate the robustness of the proposed model, we trained AMDenseNet to detect blind-threatening retina exudative age-related macular degeneration (exAMD) from the micrometer-scaled optic coherence tomographic angiography (OCTA), wherein our AMDenseNet annotated triple-specific (plexus, branch, and exudate activity) neovascular (NV) features at a diagnostic precision that is comparable to the gold standard dye-based angiography. Interestingly, when we applied plexus-wise InSSS-P to the AMDenseNet predictions, the permutate results demonstrated that input perturbation at deep capillary plexus (DCP) layer abrogated model-awared exAMD features and resulted in false-negative exAMD impressions. On the contrary, choroid capillary (CC) input perturbations contributed to false-positive exAMD characterization. Notably, the AMDenseNet triple-specific NV annotation functionality was disrupted by either DCP or CC input perturbations, indicating the significance of DCP and CC in the task of exAMD characterization. In sum, this study employed anatomy decomposition approaches to distill plexus-wise microvascular significance and highlighted the analytic potential of leveraging an anatomy-sensible model to discover novel disease biomarkers. [ABSTRACT FROM AUTHOR]

Automated detection of retinal structures, such as retinal vessels (RV), the foveal avascular zone (FAZ), and retinal vascular junctions (RVJ), are of great importance for understanding diseases of the eye and clinical decision-making. In this paper, we propose a novel Voting-based Adaptive Feature Fusion multi-task network (VAFF-Net) for joint segmentation, detection, and classification of RV, FAZ, and RVJ in optical coherence tomography angiography (OCTA). A task-specific voting gate module is proposed to adaptively extract and fuse different features for specific tasks at two levels: features at different spatial positions from a single encoder, and features from multiple encoders. In particular, since the complexity of the microvasculature in OCTA images makes simultaneous precise localization and classification of retinal vascular junctions into bifurcation/crossing a challenging task, we specifically design a task head by combining the heatmap regression and grid classification. We take advantage of three different en face angiograms from various retinal layers, rather than following existing methods that use only a single en face. We carry out extensive experiments on three OCTA datasets acquired using different imaging devices, and the results demonstrate that the proposed method performs on the whole better than either the state-of-the-art single-purpose methods or existing multi-task learning solutions. We also demonstrate that our multi-task learning method generalizes across other imaging modalities, such as color fundus photography, and may potentially be used as a general multi-task learning tool. We also construct three datasets for multiple structure detection, and part of these datasets with the source code and evaluation benchmark have been released for public access. [ABSTRACT FROM AUTHOR]

Presents the 2021 subject/author index for this publication. [ABSTRACT FROM AUTHOR]

Retinopathy of prematurity (ROP) is a retinal disease which frequently occurs in premature babies with low birth weight and is considered as one of the major preventable causes of childhood blindness. Although automatic and semi-automatic diagnoses of ROP based on fundus image have been researched, most of the previous studies focused on plus disease detection and ROP screening. There are few studies focusing on ROP staging, which is important for the severity evaluation of the disease. To be consistent with clinical 5-level ROP staging, a novel and effective deep neural network based 5-level ROP staging network is proposed, which consists of multi-stream based parallel feature extractor, concatenation based deep feature fuser and clinical practice based ordinal classifier. First, the three-stream parallel framework including ResNet18, DenseNet121 and EfficientNetB2 is proposed as the feature extractor, which can extract rich and diverse high-level features. Second, the features from three streams are deeply fused by concatenation and convolution to generate a more effective and comprehensive feature. Finally, in the classification stage, an ordinal classification strategy is adopted, which can effectively improve the ROP staging performance. The proposed ROP staging network was evaluated with per-image and per-examination strategies. For per-image ROP staging, the proposed method was evaluated on 635 retinal fundus images from 196 examinations, including 303 Normal, 26 Stage 1, 127 Stage 2, 106 Stage 3, 61 Stage 4 and 12 Stage 5, which achieves 0.9055 for weighted recall, 0.9092 for weighted precision, 0.9043 for weighted F1 score, 0.9827 for accuracy with 1 (ACC1) and 0.9786 for Kappa, respectively. While for per-examination ROP staging, 1173 examinations with a 4-fold cross validation strategy were used to evaluate the effectiveness of the proposed method, which prove the validity and advantage of the proposed method. [ABSTRACT FROM AUTHOR]

Advancement in healthcare solutions is one of the major success stories of our times. While biomedical science and engineering has progressed significantly, increased human longevity has created huge demands on the healthcare system, such as the workforce that is struggling to meet the needs of patients. With the advent of healthcare automation, doctor offices, hospitals, and other medical facilities have streamlined the way they deal with patients with enhanced efficiency. [ABSTRACT FROM AUTHOR]

Compared with the rapidly growing artificial intelligence (AI) research in other branches of healthcare, the pace of developing AI capacities in dental care is relatively slow. Dental care automation, especially the automated capability for dental cone beam computed tomography (CBCT) segmentation and lesion detection, is highly needed. CBCT is an important imaging modality that is experiencing ever-growing utilization in various dental specialties. However, little research has been done for segmenting different structures, restorative materials, and lesions using deep learning. This is due to multifold challenges such as content-rich oral cavity and significant within-label variation on each CBCT image as well as the inherent difficulty of obtaining many high-quality labeled images for training. On the other hand, oral-anatomical knowledge exists in dentistry, which shall be leveraged and integrated into the deep learning design. In this article, we propose a novel anatomically constrained Dense U-Net for integrating oral-anatomical knowledge with data-driven Dense U-Net. The proposed algorithm is formulated as a regularized or constrained optimization and solved using mean-field variational approximation to achieve computational efficiency. Mathematical encoding for transforming descriptive knowledge into a quantitative form is also proposed. Our experiment demonstrates that the proposed algorithm outperforms the standard Dense U-Net in both lesion detection accuracy and dice coefficient (DICE) indices in multilabel segmentation. Benefited from the integration with anatomical domain knowledge, our algorithm performs well with data from a small number of patients included in the training. Note to Practitioners—This article proposes a novel deep learning algorithm to enable the automated capability for cone beam computed tomography (CBCT) segmentation and lesion detection. Despite the growing adoption of CBCT in various dental specialties, such capability is currently lacking. The proposed work will provide tools to help reduce subjectivity and human errors, as well as streamline and expedite the clinical workflow. This will greatly facilitate dental care automation. Furthermore, due to the capacity of integrating oral-anatomical knowledge into the deep learning design, the proposed algorithm does not require many high-quality labeled images to train. The algorithm can provide good accuracy under limited training samples. This ability is highly desirable for practitioners by saving labor-intensive, costly labeling efforts, and enjoying the benefits provided by AI. [ABSTRACT FROM AUTHOR]

People with diabetes are at risk of developing an eye disease called diabetic retinopathy (DR). This disease occurs when high blood glucose levels cause damage to blood vessels in the retina. Computer-aided DR diagnosis has become a promising tool for the early detection and severity grading of DR, due to the great success of deep learning. However, most current DR diagnosis systems do not achieve satisfactory performance or interpretability for ophthalmologists, due to the lack of training data with consistent and fine-grained annotations. To address this problem, we construct a large fine-grained annotated DR dataset containing 2,842 images (FGADR). Specifically, this dataset has 1,842 images with pixel-level DR-related lesion annotations, and 1,000 images with image-level labels graded by six board-certified ophthalmologists with intra-rater consistency. The proposed dataset will enable extensive studies on DR diagnosis. Further, we establish three benchmark tasks for evaluation: 1. DR lesion segmentation; 2. DR grading by joint classification and segmentation; 3. Transfer learning for ocular multi-disease identification. Moreover, a novel inductive transfer learning method is introduced for the third task. Extensive experiments using different state-of-the-art methods are conducted on our FGADR dataset, which can serve as baselines for future research. Our dataset will be released in https://csyizhou.github.io/FGADR/. [ABSTRACT FROM AUTHOR]

Machine learning and especially deep learning techniques are dominating medical image and data analysis. This article reviews machine learning approaches proposed for diagnosing ophthalmic diseases during the last four years. Three diseases are addressed in this survey, namely diabetic retinopathy, age-related macular degeneration, and glaucoma. The review covers over 60 publications and 25 public datasets and challenges related to the detection, grading, and lesion segmentation of the three considered diseases. Each section provides a summary of the public datasets and challenges related to each pathology and the current methods that have been applied to the problem. Furthermore, the recent machine learning approaches used for retinal vessels segmentation, and methods of retinal layers and fluid segmentation are reviewed. Two main imaging modalities are considered in this survey, namely color fundus imaging, and optical coherence tomography. Machine learning approaches that use eye measurements and visual field data for glaucoma detection are also included in the survey. Finally, the authors provide their views, expectations and the limitations of the future of these techniques in the clinical practice. [ABSTRACT FROM AUTHOR]

Multispectral imaging (MSI) provides a sequence of en-face fundus spectral slices and allows for the examination of structures and signatures throughout the thickness of retina to characterize diabetic retinopathy (DR) lesions comprehensively. Manual interpretation of MSI images is commonly conducted by qualitatively analyzing both the spatial and spectral properties of multiple spectral slices. Meanwhile, there exist few computer-based algorithms that can effectively exploit the spatial and spectral information of MSI images for the diagnosis of DR. We propose a new approach that can quantify the spatial-spectral features of MSI retinal images for automatic DR lesion segmentation. It combines a generalized low-rank approximation of matrices with a supervised regularization term to generate low-dimensional spatial-spectral representations using the feature vectors in all spectral slices. Experimental results showed that the proposed approach is very effective for the segmentation of DR lesions in MSI images, which suggests it as an interesting tool for assisting ophthalmologists in diagnosing, analyzing, and managing DR lesions in MSI. [ABSTRACT FROM AUTHOR]