title: Automatic detection of diabetic retinopathy and age-related macular degeneration in digital fundus images.
abstract: OBJECTIVE
  To describe and evaluate the performance of an algorithm that automatically classifies images with pathologic features commonly found in diabetic retinopathy (DR) and age-related macular degeneration (AMD).
  
  
  METHODS
  Retinal digital photographs (N = 2247) of three fields of view (FOV) were obtained of the eyes of 822 patients at two centers: The Retina Institute of South Texas (RIST, San Antonio, TX) and The University of Texas Health Science Center San Antonio (UTHSCSA). Ground truth was provided for the presence of pathologic conditions, including microaneurysms, hemorrhages, exudates, neovascularization in the optic disc and elsewhere, drusen, abnormal pigmentation, and geographic atrophy. The algorithm was used to report on the presence or absence of disease. A detection threshold was applied to obtain different values of sensitivity and specificity with respect to ground truth and to construct a receiver operating characteristic (ROC) curve.
  
  
  RESULTS
  The system achieved an average area under the ROC curve (AUC) of 0.89 for detection of DR and of 0.92 for detection of sight-threatening DR (STDR). With a fixed specificity of 0.50, the system's sensitivity ranged from 0.92 for all DR cases to 1.00 for clinically significant macular edema (CSME).
  
  
  CONCLUSIONS
  A computer-aided algorithm was trained to detect different types of pathologic retinal conditions. The cases of hard exudates within 1 disc diameter (DD) of the fovea (surrogate for CSME) were detected with very high accuracy (sensitivity = 1, specificity = 0.50), whereas mild nonproliferative DR was the most challenging condition (sensitivity = 0.92, specificity = 0.50). The algorithm was also tested on images with signs of AMD, achieving a performance of AUC of 0.84 (sensitivity = 0.94, specificity = 0.50).
authors.affiliation: VisionQuest Biomedical LLC, Albuquerque, New Mexico 87131, USA. capaagri@unm.edu
authors.forename: Carla
authors.initials: C
authors.lastname: Agurto
authors.forename: E Simon
authors.initials: ES
authors.lastname: Barriga
authors.forename: Victor
authors.initials: V
authors.lastname: Murray
authors.forename: Sheila
authors.initials: S
authors.lastname: Nemeth
authors.forename: Robert
authors.initials: R
authors.lastname: Crammer
authors.forename: Wendall
authors.initials: W
authors.lastname: Bauman
authors.forename: Gilberto
authors.initials: G
authors.lastname: Zamora
authors.forename: Marios S
authors.initials: MS
authors.lastname: Pattichis
authors.forename: Peter
authors.initials: P
authors.lastname: Soliz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003930:Diabetic Retinopathy / Q000473:pathology*; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D007223:Infant; D007231:Infant, Newborn; D008268:Macular Degeneration / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D015588:Observer Variation; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult