title: The role of haemorrhage and exudate detection in automated grading of diabetic retinopathy.
abstract: OBJECTIVE
  Automated grading has the potential to improve the efficiency of diabetic retinopathy screening services. While disease/no disease grading can be performed using only microaneurysm detection and image-quality assessment, automated recognition of other types of lesions may be advantageous. This study investigated whether inclusion of automated recognition of exudates and haemorrhages improves the detection of observable/referable diabetic retinopathy.
  
  
  METHODS
  Images from 1253 patients with observable/referable retinopathy and 6333 patients with non-referable retinopathy were obtained from three grading centres. All images were reference-graded, and automated disease/no disease assessments were made based on microaneurysm detection and combined microaneurysm, exudate and haemorrhage detection.
  
  
  RESULTS
  Introduction of algorithms for exudates and haemorrhages resulted in a statistically significant increase in the sensitivity for detection of observable/referable retinopathy from 94.9% (95% CI 93.5 to 96.0) to 96.6% (95.4 to 97.4) without affecting manual grading workload.
  
  
  CONCLUSIONS
  Automated detection of exudates and haemorrhages improved the detection of observable/referable retinopathy.
authors: Department of Bio-Medical Physics and Bio-Engineering, Aberdeen University and Grampian University Hospitals, Aberdeen, UK. a.fleming@abdn.ac.uk
authors: Alan D
authors: AD
authors: Fleming
authors: Keith A
authors: KA
authors: Goatman
authors: Sam
authors: S
authors: Philip
authors: Graeme J
authors: GJ
authors: Williams
authors: Gordon J
authors: GJ
authors: Prescott
authors: Graham S
authors: GS
authors: Scotland
authors: Paul
authors: P
authors: McNamee
authors: Graham P
authors: GP
authors: Leese
authors: William N
authors: WN
authors: Wykes
authors: Peter F
authors: PF
authors: Sharp
authors: John A
authors: JA
authors: Olson
mesh_terms: D000465:Algorithms; D003930:Diabetic Retinopathy / Q000150:complications* / Q000175:diagnosis*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D003941:Diagnostic Techniques, Ophthalmological; D005122:Exudates and Transudates / Q000378:metabolism*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008403:Mass Screening / Q000379:methods; D012015:Reference Standards; D012166:Retinal Hemorrhage / Q000209:etiology*; D012720:Severity of Illness Index