Computers, Materials & Continua Tech Science Press

DOI:10.32604/cmc.2020.012008
Article

A Convolutional Neural Network Classifier VGG-19 Architecture for Lesion

Detection and Grading in Diabetic Retinopathy Based on Deep Learning
V. Sudha1,* and T. R. Ganeshbabu2

1
Department of Electronics and Communication Engineering, Pavai College of Technology, Namakkal, 637018, India
2
Department of Electronics and Communication Engineering, Muthayammal Engineering College, Rasipuram, 637408, India


Corresponding Author: V. Sudha. Email: vsudhaece@gmail.com
Received: 10 June 2020; Accepted: 16 July 2020

Abstract: Diabetic Retinopathy (DR) is a type of disease in eyes as a result of a

diabetic condition that ends up damaging the retina, leading to blindness or loss of
vision. Morphological and physiological retinal variations involving slowdown of
blood flow in the retina, elevation of leukocyte cohesion, basement membrane
dystrophy, and decline of pericyte cells, develop. As DR in its initial stage has
no symptoms, early detection and automated diagnosis can prevent further visual
damage. In this research, using a Deep Neural Network (DNN), segmentation
methods are proposed to detect the retinal defects such as exudates, hemorrhages,
microaneurysms from digital fundus images and then the conditions are classified
accurately to identify the grades as mild, moderate, severe, no PDR, PDR in DR.
Initially, saliency detection is applied on color images to detect maximum salient
foreground objects from the background. Next, structure tensor is applied power-
fully to enhance the local patterns of edge elements and intensity changes that
occur on edges of the object. Finally, active contours approximation is performed
using gradient descent to segment the lesions from the images. Afterwards, the
output images from the proposed segmentation process are subjected to evaluate
the ratio between the total contour area and the total true contour arc length to
label the classes as mild, moderate, severe, No PDR and PDR. Based on the com-
puted ratio obtained from segmented images, the severity levels were identified.
Meanwhile, statistical parameters like the mean and the standard deviation of
pixel intensities, mean of hue, saturation and deviation clustering, are estimated
through K-means, which are computed as features from the output images of
the proposed segmentation process. Using these derived feature sets as input to
the classifier, the classification of DR was performed. Finally, a VGG-19 deep
neural network was trained and tested using the derived feature sets from the KAGGLE
fundus image dataset containing 35,126 images in total. The VGG-19 is trained
with features extracted from 20,000 images and tested with features extracted from
5,000 images to achieve a sensitivity of 82% and an accuracy of 96%. The pro-
posed system was able to label and classify DR grades automatically.

Keywords: Diabetic retinopathy; saliency map; structure tensor; gradient descent

method; exudates; haemorrhages; microaneurysms; VGG-19

This work is licensed under a Creative Commons Attribution 4.0 International License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original
work is properly cited.
828 CMC, 2021, vol.66, no.1

1 Introduction
Diabetic Retinopathy (DR) is a disease that occur in eyes that can ultimately damage the retina resulting
in loss of vision. IDF (International Diabetes Federation) statistics had indicated that, the diabetic population
worldwide was recorded as 500 million in 2018 which shall increase by 9.9% approximately in the next
5 years. India has a diabetic population of 38 million in 2018 which is expected to be 79 million by the
year 2030. Type 2 diabetes largely affected the city community residents of India, but current researches
evidently indicated its growth predominance in villages. Though several diabetic diagnosed patients may
not have symptoms, there occurred morphological and physiological retinal variations. The initial clinical
symptom was a mild diabetic retinopathy characterized by microaneurysms formation. When not properly
diagnosed, it may lead to moderate diabetic retinopathy where variations in dimensions across veins and
retinal blood vessels occur. The rigor and degree of such lacerations are indicated as severe diabetic
retinopathy of non-proliferative type where the blood flow in retina gets rapidly increased. The restricted
blood flow regions across the retina will provoke fresh growth in the microvascular region, which results
in Proliferative Diabetic Retinopathy (PDR). Macular Edema (ME), appeared as retinal enlargement due
to fluid leakage inside the macula. The setback is that, image interpretation was difficult due to the
presence of image artifacts leading to poor image quality. Also, fundus photography cannot compute
membrane thickness and detect the presence of edema. Left out anomalies related to diabetic retinopathy
include neovascularization, venous beading, and intra-retinal microvascular growth. Moreover, detection
of hard exudates near the optic disk was difficult that had the same intensity values. Extraction of optic
disk from fundus image was quite challenging one. To enhance automatic diagnosis and classification of
DR, the research approaches are
 To propose an novel image preprocessing technique for detecting Region of Interest (ROI) of the
anomalies.
 To find the ratio of total contour length to true arc length of irregular blobs (white regions) as ROI in
images, for automatic prediction of DR conditions.
 Finally, classify the DR severity using extracted feature sets from segmented images using VGG-19.
Gargeya [1], developed a data-driven deep learning algorithm for automatic DR detection. The fundus
images were tested using MESSIDOR 2, E-Ophtha databases and proposed model attained AUC (area under
the receiver operating characteristic curve) value of 0.94 and 0.95 respectively. Mateen et al. [2], have
surveyed in detail with various computer aided diagnosis methods to identify the exudates. Also,
significance has been given to various datasets used to identify diabetic retinopathy and was found that
deep learning techniques yielded better results for exudates detection. Various performance metrics were
described to measure the accuracy of segmentation techniques used to detect the types of lesions. Pratt
et al. [3], detected various degrees of DR levels for classification based on intensity variations. The CNN
(Convolutional Neural Network) architecture trained using GPU processor unit with Kaggle dataset,
yielded sensitivity, accuracy results of 95% and 75% respectively when validated on nearly 5,000 images.
Somasundaram et al. [4], used a deep learning technique to classify the DR conditions at its initial phase
using an ensemble approach. In its first stage, salient features were extracted from fundus image of retina.
The second phase involved use of machine learning ensemble classifier that used derived features of the
fundus images to reduce the error. Aiki et al. [5], proposed a Graph Neural Network (GNN) based DR
severity classification to improve accuracy. Their approach was based on two features. Initially, Region of
Interest (ROI) sub-images were obtained, to reduce unnecessary information required for classification.
Next, GNN was applied for fundus image classification. Mansour [6], proposed a DR model that used a
multi-level optimization that integrates regional segmentation using gaussian mixture model based on
adaptive learning, ROI localization using connected component analysis, high dimensional feature
extraction using AlexNet DNN (Deep Neural Network). Feature selection was performed using principle
CMC, 2021, vol.66, no.1 829

component analysis (PCA) and linear discriminant analysis (LDA) followed by a five class DR classification
using support vector machine. Khojasteh et al. [7], used Resnet imagenet along with support vector machine
technique to locate the exudates automatically. Focus on Resnet yield better results in terms of sensitivity which
required small dataset to measure its performance. Orlando et al. [8], has focused on identification of red lesions
using the concept of deep learning along with identification of true lesions using random forest classifier. Most
of the literature on haemorrhages detection has showed classification using certain handcrafted features and
true, positive detections. Chowdhury et al. [9], has performed detection of retinal abnormalities using
clustering based on K-means followed by classification based on random forest algorithm. Significant
results were yielded and also comparison was made with naive bayes classifier to prove the accuracy of
classifiers used in research. Grzeszczuk [10], proposed a new method to classify datasets with sparse high
localized features by applying saliency map for enhancement of features. This method did not apply any
pre-information feature localization. Quellec et al. [11], used softmax layer to classify DR grades. This has
used ConvNet trained using back propagation technique for accurate classification of lesions. Better results
were yielded using ConvNet architecture. Liu et al. [12], presented a location-to-segmentation method for
automated exudate segmentation from color retinal fundus images, which consists of three operations of
removing anatomical structure, locating and segmenting the exudates. In addition to this, blood vessel
segmentation and a optic disk segmentation based on saliency methods were proposed. They applied a
random forest classifier to separate the patches as exudate and exudate-free patches. The histograms of local
binary patterns were obtained to characterize the texture of the patches. To segment the exudate regions out
from patches, local variance, sizes of exudate and the local contrast were applied. Santhosh Krishna et al.
[13], has proposed a new supervised model based feature extraction technique that performed better than
unsupervised models for extracting retinal blood vessels using adapted adaboost filter. To address the above
issues unique, preprocessing methods were used with deep neural network architecture, which is a sub-
category of artificial intelligence. The proposed technique firmly evolved to classify the DR conditions from
fundus images and precisely identified severity levels based on major appearances of pathology in fundus.

2 Methods and Materials

For classification of DR conditions, the model used sequence of operations as its fundamental blocks
a) Image augmentation
b) Image preprocessing
c) Deep convolutional neural network classification

2.1 Data Augmentation

Data augmentation is a key to collect the image data for experiments. As a part of analysis, a familiar
KAGGLE competition dataset is utilized for the experiments, whose sample fundus image is shown in Fig. 1.
The regular dataset of KAGGLE from EyePACS contains total of 88,700 photographs of retina. In this,
35,126 images were tagged as right and left eyes for training. Tab. 1, describes the number of the fundus
images of every class present in the KAGGLE DR Dataset. For training and testing, the distribution of
images from KAGGLE DR Dataset are used as given in Tab. 2.

3 Proposed Method
The KAGGLE dataset consists of substantial quantity of indefinable images because of the presence of
artifacts and incorrect labeling. Therefore, image segmentation methods are used to detect the type and
lesions present in order to annotate the labels, for detecting the DR severity levels in fundus images.
Tab. 3, describes the scheme based on type and severity levels from the detected lesions.
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Table 1: Distribution of images in KAGGLE DR dataset

Classes DR condition No. of images
0 Normal 25810
1 Mild 2443
2 Moderate 5292
3 Severe 873
4 Proliferative 708

Table 2: Number of images used for training and testing from KAGGLE DR dataset
Classes DR condition No. of images No. of images for training No. of images for testing
0 Normal 25810 14692 3673
1 Mild 2443 1388 347
2 Moderate 5292 3012 753
3 Severe 873 496 124
4 Proliferative 708 412 103
Total 35126 20000 5000

Figure 1: Sample input fundus images

Table 3: Commonly adopted annotation scheme to represent DR severity level from detected lesions
Amount of detected lesions from images Corresponding DR severity grades
No lesions present Normal
Few microaneurysms and soft exudates Mild NPDR
More microaneurysms and soft exudates, less hemorrhages Moderate NPDR
More hemorrhages Severe NPDR
More hemorrhages and hard exudates PDR
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Now, the main aim of image segmentation is to detect hard and soft exudates, hemorrhages and
microaneurysms as white regions for the convenience of annotating the class. Fig. 2, depicts proposed
image segmentation process to detect DR regions obtained as output from original fundus image. For
segmentation, the RGB split and contrast limited adaptive histogram adjustment [14], are initially applied
to enhance the contrast. Then, background subtraction was performed to extract region of interest that
was segmented using mask image.

Figure 2: Proposed idea of image segmentation to extract feature sets, estimate ratio for labeling DR grades
and finally classification

During the process of image segmentation, saliency detection usually extracts visually salient regions
from an image and generates the saliency map that is used as a beneficial tool for identification of visual
details of low-level luminance from color images. This method was commonly preferred for automatic
evaluation of objects and image regions without any prior knowledge. Thus, described as variations
between pixels and its neighboring locality [15,16].

3.1 Saliency Map

The image is comprised of color and brightness features. In order, to extract efficient color and
brightness details, the saliency map is applied to the region of interest (ROI). Saliency map will be
depicted as an image which displays distinct quality of every pixel. The purpose of saliency map [17],
was to facilitate and modify the image description that is significant and simpler for study. If a pixel
contains unique gray or color quality, such characteristics will be represented in saliency map. Concisely,
the saliency mapping is a type of image segmenting process. For any image I, M × N × 3 are RGB color
dimension, in which M and N are the number of rows and columns correspondingly. The features of
colors, red, green and blue are described as follows
r ¼ R  ðG þ BÞ=2 (1)
g ¼ G  ðR þ BÞ=2 (2)
b ¼ B  ðR þ GÞ=2 (3)
Consider mr, mg and mb are the values of mean for red, green and blue color features, correspondingly.
The pixel saliencies are evaluated, by squaring the difference between its feature and mean value. The
saliency maps for r, g and b colors are denoted by Sr, Sg and Sb correspondingly and their sizes by M × N.
832 CMC, 2021, vol.66, no.1

1 X M X N
mr ¼ rðx; yÞ (4)
M  N x¼1 y¼1

1 X M X N
mg ¼ gðx; yÞ (5)
M  N x¼1 y¼1

1 X M X N
mb ¼ bðx; yÞ (6)
M  N x¼1 y¼1

Sr ¼ ðr  mr Þ2 (7)
 2
S g ¼ g  mg (8)
 2
S b ¼ b  mg (9)
The final saliency color map for an image is obtained by summing Sr, Sg and Sb. Fig. 3 shows the output
after applying saliency map for input sample images.

Figure 3: Output after applying saliency map

Next, gradient based structure tensors are used to improve the intensity changes on object edges and
derive those edge elements by performing series of opening and closing, thresholding and erosion
operations. The structure tensor was used to depict the edge or gradient details. It can powerfully describe
the local patterns rather than directional derivatives along with its coherence estimation. Structure tensor
can connect the shape and structure of objects in an image and determine the features of ROI for
classification. This method the edge based active contours of smaller sizes were detected. In the regions
near edges, the tensors will have higher values of magnitude and coherence, i.e., only one eigenvalue was
larger compared with the rest, whereas corner areas has higher values of magnitude with less coherence.

3.2 Structure Tensor

Structure tensors have the ability to incorporate and retrieve magnitude information along two directions
without canceling the gradients. Anatomical features like tissue boundaries or blood vessels appear as a
collection of speckles that are correlated along a specific direction. These methods describe the
local vicinity of a pixel better than traditional derivative approaches. Structure tensor [18] are depicted by
M × M symmetric matrices which comprises of structural details about pixel intensity and orientation.
Initially, the matrix was evaluated from the gradients of grayscale image I using the gradient tensors
CMC, 2021, vol.66, no.1 833

 
Ix 2 Ix Iy
T ¼ rIrI ¼ T
(10)
Ix Iy Iy 2
In which, Ix ; Iy are spatial derivatives along the direction of x and y of image, I. But detðGÞ ¼ 0, the
2
gradient tensor will have only one non-zero eigen value, and respective eigen vector v ¼ 2 Ix Iy 2Iy 2
will have same direction as the gradient Iðx; yÞ. This depicts that, one dimension features of gradient
tensor possesses the benefit that it can be flattened with no removal in the regions where the gradients
possess contrary signed values, that is rIrI T ¼ ðrIÞðrI T Þ. In order to derive more structural details
and prevent noises, the smoothing function was used in gradient tensor to generate the structure tensor.
 
gs
Ix 2 gs
Ix Iy
Ts ¼ gs
rIrI ¼ T
(11)
gs
Ix Iy gs
Iy 2
Here, I is a grayscale image with scalar values gs , a gaussian kernel with standard deviation σ. For
M-dimensional image, the structure tensor was generated by adding up the direction of M dimension.
X
M
Ts ¼ gs
rIrIT (12)
i¼1

Moreover, orientation and structure magnitude details exist before the gradients, the structure tensor
comprises of certain additional details. These details can be obtained using smoothing operation and
estimates the orientation homogeneity within adjacent regions. Using structure tensor as a transformation
about its principal axis Ts ¼ ST AS, in which S ¼ ½v1 v2  contains eigen vectors of Tr , and respective
eigenvalues are 1 ; 2 such that 1 > 2 , forming A as diagð1 2 Þ. The 1 ; 2 describes the variation
along v1 ; v2 directions correspondingly, and the eigen vector with minimum eigen value decides the
principal orientation of structures. Here trðTr Þ, represents the trace of the magnitude structure tensor
where, Tr coherence is decided by the metric Ts ¼ ð1  2 Þ2 . The structure tensor magnitude and
coherence are utilized for structure computation. Homogeneity in image produces lesser magnitude and
coherence values. In regions near edges, tensors possess high values of magnitude and coherence, only
one eigenvalue is larger compared with the rest, whereas corner areas results in higher magnitude
however with lesser coherence values, in this case two eigen values will be of large value. Thus, a new
scaled vector qðx; yÞ ¼ ½trðGs Þ; cohðGs Þ is used to exchange the gradient values. Fig. 4 shows the
output of structure tensor of segmented morphology. After the detection of active contours, the contour
approximation is performed using level set gradient descent method to locate optimal boundary around
detected objects by minimizing the energy function. In active contour, two dimensional objects are
extracted surrounded by minimum area of contour. To delineate the contour objects, iteration is
performed in the algorithm. This algorithm is used to construct a flexible curve that varies dynamically
according to the surrounding edges in the image.

Figure 4: Applying structure tensor to segment the morphology over saliency output
834 CMC, 2021, vol.66, no.1

3.3 Optimization of Active Contour Using Gradient Descent Method

An original level contours have to be defined by inserting curves enclosing objects that needs to be
identified. The gradient operator [19], over discrete image x can be represented using first order
finite differences.
ðrxÞi ¼ ðxi1 ;i2  xi1 1;i2 ; xi1 ;i2  xi1 ;i2 1 Þ (13)
For continuous vector field v, the divergence operator can be defined using first order finite differences.
div ¼ r (14)
And its discrete form is represented by,
div ðvÞi ¼ v1 i1 þ1;i2  v1 i1 ;i2 þ v2 i1 ;i2 þ1  v2 i1 ;i2 (15)
Optimized image is got by minimizing the cost function
1
min f ðxÞ ¼ ky  xk2 þJ2 ðxÞ (16)
x2Rd 2
P 
In which, J2 ðxÞ is i ðGxÞi i is the smoothed complete variation and ðGxÞi is an image gradient
approximate over pixel i. λ > 0, is a Lagrange multiplier parameter where the weights were used to
control the term of data fit jjy  xjj2 and J2 ðxÞ, is a regularization term. Smoothing by L2 norm in R2
was used to calculate u with 1 >2> 0 by
qffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
kuk2 ¼ 22 þ kuk2 (17)

2 is a small regularization parameter and u ¼ rf ðxÞ. The gradient of any function f was defined as
rf ðxÞ ¼ x  y þ rJ2 ðxÞ (18)
The smoothed total variation gradient norm was described by
ðGxÞi
rJ2 ðxÞi ¼ G
ðuÞ; in which kuki ¼  
ðGxÞ  (19)
i 2

Concisely, in the proposed image segmentation process, saliency map was applied to the input fundus
image after limiting its boundary. Structure tensor evaluates second order moment that was applied to both
CLAHE enhanced green channel and gray scale image to evaluate the morphology gradient. The output is
then subjected to optimize the contour area and perimeter by applying level set segmentation using gradient
descent method for optimization. Fig. 5, shows the output of active contour based on segmentation.

Figure 5: Output of active contour based on segmentation

CMC, 2021, vol.66, no.1 835

4 Feature Extraction
4.1 Connected Components Analysis (CCA) Using K-means Clustering
From the output images obtained from proposed segmentation process, the statistical parameters like
mean and the standard deviation of pixel intensities, mean of hue and saturation, deviation clustering
from mean are found through K-means which are computed as features. In order to identify the size,
location and region of DR involving hard and soft exudates, hemorrhages and microaneurysms, K-means
CCA is applied. K-means clustering is applied to determine the feature sets in classification of the images
according to severity of DR disease. It is observed that, this technique is quite beneficial to detect and
differentiate the blob or object sizes, shapes and affected regions from segmented retinal images. Tab. 4,
shows the minimum difference of hemorrhage features in terms of gray scale pixel intensity standard
deviation, color channel intensities and deviation mean and cluster distance.

Table 4: Minimum difference of hemorrhage features obtained from segmented image

Differences image005 image007 image013
Standard deviation 0.51 0.96 0.12
Intensity 0.02 0.02 0.01
r-channel intensity 0.74 0.34 0.42
g-channel 0.49 0.25 0.21
deviation from mean of grayscale 0.05 0.03 0.07
K-means distance 0.96 0.97 0.99

5 Classifications of DR Grades using CNN Classifier

CNN [20] is widely used neural network architecture and has proved its significance in task of detection
and classification. Several researches applied CNN to recognize objects, face signs, and had shown its
performance was superior to humans. CNN used supervisory learning technique and hence it was trained
using labeled data along with the classes. CNN basically learns the relation between objects and their
labeled class. It contains two elements, where the hidden layers derived the features and Fully Connected
Layers (FCN) performed the classification process. In traditional neural network, every layer is
constructed using neurons and was linked to previous neuron layer. But in CNN, the hidden layer
neurons are linked to just few neurons. The VGG is abbreviation for Visual Geometry Group Net was
used in CNN that has approximately 143 million parameters, these parameters are learnt using ImageNet
dataset comprising of 1. 2 million images which contains thousands of classes for training. It is very
good architecture used for benchmarking. The VGG-19 Neural Network consists of 19 layers of deep
neural network and has more weight. The size of “VGG-19” network in terms of fully connected nodes is
574 MB. As the number of layer increases, accuracy of DNN is improved. The VGG-19 model
comprised of 19 deep trainable layers performing convolution, which is fully connected with max pooling
and dropout layers. In this paper, convolutional layer is trained to perform customized classification role
that involved densely connected classifier and to regularize a dropout layer was used. The
VGG-19 architecture was presented in Fig. 6.
VGG-19 is so beneficial and it simply uses 3 × 3 convnet arranged as above to extend the depth. In order
to decrease the size, max-pooling layers are applied as a handler. FCN layers are two in number to which
have 4096 neurons applied. VGG is trained based on individual lesions and for testing all types of lesions
were considered to reduce the number of false positives. Convolution layers perform convolution process
over images at every pixel, allowing outcome to pass through the subsequent layer. Filters are used in
836 CMC, 2021, vol.66, no.1

convolution layer is of 3 × 3 dimension which are trained for feature extraction. Every stacked convolution
layer is subsequently added with Rectified Linear Unit (ReLU) layer and max-pooling layer. ReLU is
presently the best known non-linear activation function which allows only the positive portion of the input.
f ðxÞ ¼ maxð0; xÞ (20)

Figure 6: VGG-19 architecture

While, comparing the ReLU function with sigmoid function, ReLU is quite effective in computing to
indicate the best convergence behavior that vanish the gradient issue. A down-sampling max-pooling
layer is used after ReLU activation function. Generally, the filter of 2 × 2 dimension is considered of
same step size. The output will be of maximal value in every sub-region. For dense layer, the activation
function must be designed. The dropout layer was abandoned while random activation in the layer to
make it zero value. The neurons are eliminated in random process during the training stage to reduce
over-fitting issue. This dropout is applied during training.

6 Results and Discussion

This section discussed the experimental results obtained from classifier using proposed image
preprocessing technique. For extraction and classification using features, 71% of images were used from
KAGGLE dataset. In order to assess the performance of DR classifier through training and testing, the
80:20 ratio was applied on the dataset. KAGGLE, being the standard dataset it contains fundus images of
five different DR classes namely, non-proliferative DR, mild DR, moderate DR, severe DR and
proliferative DR with distribution as depicted in Tab. 2. The lesion features extracted from KAGGLE
dataset images was annotated with the labels based on detection features described in Tab. 1. Firstly, for
effective computation of features, fundus images are re-sized to 800 × 615 pixels. Secondly, for better
performance during classification, the proposed image segmentation preprocessing techniques as stated in
Fig. 2. are applied to prepare the images for effective feature detection of soft exudates, hemorrhages,
microaneurysms [21] and hard exudates. Fig. 7 shows the intermediate image outputs obtained from this
experiment. To make the realization effective with VGG-19, CPU is utilized to acquire the desired
outcomes. For the optimal feature detection, saliency map, structure tensor and gradient descent methods
are considered as proposed techniques.
CMC, 2021, vol.66, no.1 837

Figure 7: Fundus images comprising of various retinal defects related to DR (a) Input fundus image (b)
Segmented blood vessel for removal (c) Microaneurysms (d) Soft Exudates (e) Hard exudates (f)
Hemorrhages

As 71% of KAGGLE dataset images were used for training, their labeling method is crucial. The experts
were asked to mark the areas related to the microaneurysms, hemorrhages, hard and soft exudates. The
ground truth confidence levels mostly represented the decision certainty to mark if the findings were
correct. The experts failed manually to investigate and assess the stage from symptomatic fundus images
as reported in Krause et al. [22]. So, the novel proposed method for automatic labeling the images with
the classes of DR severity will be the basis for detection of lesions over the image that was obtained from
the proposed segmentation process. Automatic labeling is performed to detect lesions like
microaneurysms, hemorrhages, hard and soft exudates, followed by their measurements in terms of
contour area and arc length. The ratio value of contour area to contour arc length is a deciding parameter
for DR severity. The ratio will be larger when identical lesions are present in the images and will be quite
lesser when different types of lesions are widely present. Tab. 5, depicts the ratio estimation based on
total contour area and total true arc length obtained from gradient descent images as depicted in Fig. 8.
Based on the ratio of A/B they are differentiated as no PDR, mild, severe, moderate and PDR. Lower the
value of A/B, higher is the severity of DR condition. Tab. 6, shows the labeling of the images with DR
conditions based on the ratio. When the upper limit is greater than 10, the class is identified as no PDR.
Likewise, when the upper limit is less than 2, the class is identified as PDR.
Tab. 7 shows confusion matrix statistics of the classifier of VGG-19 type and Fig. 9 depicts the
confusion matrix of the classifier while performing classification for DR severity.
The experiment for testing is carried out using 5000 images from KAGGLE datasets. Various DR
severity images are taken as per Tab. 2.
The performance parameters like specificity, accuracy of evaluation was based on inference from
confusion matrix. Here, diagonal values of confusion matrix depicts true values for analysis.
838 CMC, 2021, vol.66, no.1

Table 5: Estimation of ratio obtained from gradient descent images

Proposed method
Sl.No Total contour area Total true arc length A/B DR Conditions
of white edges (A) of white regions (B)
1 8433 1047 8.05 Mild
2 9000 328 27.44 No PDR
3 9113 275 33.14 No PDR
4 8336 4976 1.67 PDR
5 20212 12507 1.62 PDR
6 10072 1140 8.83 Mild
7 16272 7431 2.19 Severe
8 11618 3081 3.77 Moderate
9 10038 1877 5.35 Moderate
10 8949 322 27.79 No PDR
11 9641 1810 5.32 Moderate
12 8476 1122 7.55 Mild
13 14039 14546 0.96 PDR
14 13953 7858 1.77 PDR
15 18211 5412 3.36 Severe
16 15708 4930 3.19 Severe
17 11139 2588 4.30 Moderate
18 11664 1330 8.77 Mild

Figure 8: The images used for estimating the ratio for labeling the classes

Here number of epochs is taken as 100. Here the network fits regularly on test data and provides
maximum accuracy. The accuracy of training and validation is depicted in Fig. 10.
Fig. 11 shows the output images where the DR levels are labeled based on A/B values. From the above
results we identify DR levels more precisely.
CMC, 2021, vol.66, no.1 839

Table 6: Labeling the DR conditions based on A/B values

Label DR conditions Upper limit Lower limit
0 No PDR >10
1 Mild <10 >7
2 Moderate <7 >3
3 Severe <3 >2
4 PDR <2

Table 7: Confusion matrix statistics of the classifier

Parameters/ No Mild Moderate DR Severe Proliferative DR
Disease Condition DR DR DR
Accuracy 98.28 98.72 98.4 99.6 99.6
Precision 98.83 90.77 94.69 91.94 90.3
Specificity 96.76 99.32 99.06 99.8 99.8
Sensitivity 98.83 90.78 94.69 91.94 90.3

Figure 9: Confusion matrix of the classifier when classifying the DR severity

840 CMC, 2021, vol.66, no.1

Figure 10: (a) Depicts the accuracy of training and validation plotted between number of epochs and
accuracy (b) Depicts the loss during training and validation plotted between number of epochs and loss

Figure 11: Identification of DR levels (a) No PDR (b) Mild (c) Moderate (d) Severe (e) PDR

7 Conclusion and Future Work

The remarkable advantage of KAGGLE fundus image database for feature extraction and training the
classifier is in that, it allows classifier to directly learn more lesion features than exploring on its own
image features. The fundus image dataset labeled by experts, may lead to conflict among the diagnostics
while labeling the disease. So, the ratio of total contour area and total true arc length was used to grade
DR over segmented images. For training and testing the classifier performance, KAGGLE fundus image
CMC, 2021, vol.66, no.1 841

dataset was used. Practically, the images that are supplied to deep neural network for grading DR severity
cannot precisely predict the grades without proper preprocessing. The DNN has no problem in identifying
the healthy eye images, because quite large healthy eye images are available in the dataset. To classify
the images of extreme cases, the need for extensive training required is substantially low. Our proposed
segmentation method using VGG-19 architecture effectively identifies abnormality with accuracy of 96%
on 5000 validation images. VGG-19 efficiently distinguishes various DR levels labeled based on contour
area to true contour arc length ratio. Future research work will be focused to detect neovascularization
abnormality using concept of transfer learning.
Funding Statement: The author(s) received no specific funding for this study.

Conflicts of Interest: The authors declare that they have no conflicts of interest to report regarding the
present study.

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