title: Automated Diabetic Retinopathy Screening and Monitoring Using Retinal Fundus Image Analysis.
abstract: BACKGROUND
  Diabetic retinopathy (DR)-a common complication of diabetes-is the leading cause of vision loss among the working-age population in the western world. DR is largely asymptomatic, but if detected at early stages the progression to vision loss can be significantly slowed. With the increasing diabetic population there is an urgent need for automated DR screening and monitoring. To address this growing need, in this article we discuss an automated DR screening tool and extend it for automated estimation of microaneurysm (MA) turnover, a potential biomarker for DR risk.
  
  
  METHODS
  The DR screening tool automatically analyzes color retinal fundus images from a patient encounter for the various DR pathologies and collates the information from all the images belonging to a patient encounter to generate a patient-level screening recommendation. The MA turnover estimation tool aligns retinal images from multiple encounters of a patient, localizes MAs, and performs MA dynamics analysis to evaluate new, persistent, and disappeared lesion maps and estimate MA turnover rates.
  
  
  RESULTS
  The DR screening tool achieves 90% sensitivity at 63.2% specificity on a data set of 40 542 images from 5084 patient encounters obtained from the EyePACS telescreening system. On a subset of 7 longitudinal pairs the MA turnover estimation tool identifies new and disappeared MAs with 100% sensitivity and average false positives of 0.43 and 1.6 respectively.
  
  
  CONCLUSIONS
  The presented automated tools have the potential to address the growing need for DR screening and monitoring, thereby saving vision of millions of diabetic patients worldwide.
authors.affiliation: Eyenuk, Inc, Los Angeles, CA, USA malavika@eyenuk.com.
authors.forename: Malavika
authors.initials: M
authors.lastname: Bhaskaranand
authors.affiliation: Eyenuk, Inc, Los Angeles, CA, USA.
authors.forename: Chaithanya
authors.initials: C
authors.lastname: Ramachandra
authors.affiliation: Eyenuk, Inc, Los Angeles, CA, USA.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Bhat
authors.affiliation: EyePACS LLC, San Jose, CA, USA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Cuadros
authors.affiliation: Doheny Eye Institute, Los Angeles, CA, USA.
authors.forename: Muneeswar Gupta
authors.initials: MG
authors.lastname: Nittala
authors.affiliation: Doheny Eye Institute, Los Angeles, CA, USA.
authors.forename: SriniVas
authors.initials: S
authors.lastname: Sadda
authors.affiliation: Eyenuk, Inc, Los Angeles, CA, USA.
authors.forename: Kaushal
authors.initials: K
authors.lastname: Solanki
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D057205:Automation, Laboratory; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008403:Mass Screening / Q000379:methods; D012680:Sensitivity and Specificity
keywords: DR monitoring; automated analysis; diabetic retinopathy; image processing; screening; turnover analysis