Computing Conference 2017

18-20 July 2017 | London, UK

An Overview of Automated Glaucoma Detection

Tehmina Khalil Samina Khalid
Software Engineering Department Software Engineering Department
Bahria University Bahria University
Islamabad, Pakistan Islamabad, Pakistan
tehmina_khalil08@yahoo.com noshi_mir@yahoo.com

Dr. Muhammad Usman Akram Amina Jameel

Department of Computer Engineering Department of Computer Engineering
College of E&ME, NUST Bahria University
Islamabad, Pakistan Islamabad, Pakistan
usmakram@gmail.com aminajameel.bahria@gmail.com

Abstract—Glaucoma is a neurotic condition of optic nerve

impairment and second foremost cause of vision loss worldwide.
This study is meta-analysis of 37 existing automated glaucoma
detection systems proposed in last 10 years. The aim of the study
was to compare existing system on the base of ophthalmic
imaging technology, functional and structural features of eye,
Machine Learning techniques, accuracy and data set used for
evaluation. Results showed that glaucoma detection has been
mostly done using Fundus images and structural feature Cup to
Disc ratio at final stage. There is no known cure of glaucoma at (a) Normal Vision (b) Glaucoma Vision
final stage. There is a need to develop automated glaucoma
Fig. 1. Glaucoma Vision [12]
detection systems that are able to detect glaucoma at an early
stage where it can be treated. Glaucoma detection can be
In 400 B.C. Hippocrates, famous Greek physician and
effectively achieved using Optical Coherence Tomography (OCT)
Father of Medicine, uses the term “glaucosis” in his work
at an early stage where it could be treated. We found evidence
that automated glaucoma detection at the last stage is at a
“Aphorisms” to describe conditions correlated with the
mature level using Fundus images however there is a great dimming of vision. Later in 1622, English ophthalmologist
margin of improvement in automated glaucoma detection using Richard Banister, known as the ‘Father of British
OCT .It was proposed to use a hybrid feature set consisting of Ophthalmology’ provides the first, clear description of
both structural and texture features of retinal image for more absolute glaucoma, and establishes the connection between
accurate glaucoma detection. increased tension of the eyeball and glaucoma. The important
invention of the ophthalmoscope by von Helmholtz in 1850
Keywords—Glaucoma Detection; Functional Features; made it possible to diagnose glaucomatous changes in the
Structural features; Machine Learning Techniques; Fundus; OCT; fundus. The first effective treatment of glaucoma was
CSLT achieved in 1857 medical therapy for glaucoma was delayed
for centuries because causes of glaucoma could not be
I. INTRODUCTION revealed properly [1]. Today, science still does not know the
Glaucoma is one of the most hazardous ocular diseases. It exact causes of glaucoma but however with detection of
is a set of disorders, categorized mostly by high intraocular glaucoma at early stage, complete vision loss could be
pressure (IOP) causing damage to the optic nerve. According prevented with medication.
to the World Health Organization it is second foremost cause
The automated diagnose glaucoma was introduced in
of blindness worldwide. Glaucoma is also known as snitch
1970s to automatically detect glaucomatous visual filed loss
thief of sight because resembling a hushed slayer it usually has
[2, 3]. Later in 1990s focus shifted towards early diagnosis of
no indicators till permanent vision loss occurs. Figure 1(a) and
glaucoma using structural changes in optic disc so that
(b) shows normal vision and vision with glaucoma effected
glaucoma can be detected before it affects visual field [5, 7-
eye respectively.
9].In early 2000 OCT was proposed to get internal layers
The term ‘glaucoma’ can be traced back to Greek and information of retina so that glaucoma can be detected early
Byzantine Eras. It is derived from the Greek word “glaukos.” enough and can be treated in time to avoid blindness.
first appearing in the works of Homer in 762 B.C. where it is
Estimates of the number of possible glaucoma patients
stated as “a sparkling silver glare,” and later, as a description
worldwide in forthcoming decades have shown frightening
for the colours sky-blue or green.

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escalation. Figure 2 shows a chart representing estimated II. TYPES OF GLAUCOMA
glaucoma patients in next decades. In 2010 estimated
glaucoma patients were 60 million based on data derived from
UN world population projections for 2010 and 2020 [10].
According to a research done in 2013 [11] it was estimated
using Bayesian meta regression model that in 2013 there were
around 64.5 million glaucoma patients worldwide and will
increase up to 76 million in 2020 and will further rise up to
111.8 million in 2040. However, evidences have shown that
manual detection and prediction of glaucoma is very
challenging and delicate in nature and entirely depends on
proficiency of professionals. Considering the huge number of
increase in glaucoma patient its need of the time that efficient
automated glaucoma detection systems should be developed
that are able to detect glaucoma at early stages so that early (a) Angle-Closure glaucoma (b) Open-angle glaucoma
treatment can prevent blindness. Fig. 3. Open-angle glaucoma VS Angle-Closure glaucoma

There are a range of different categories of glaucoma.

Some communal forms are explained in Table 1. The peak
common form of glaucoma globally is open-angle glaucoma,
accounting for at least 90% of all glaucoma cases. Angle -
closure glaucoma is most common in Asia. Figure 3 (a) and
(b) represents angle-closure glaucoma and open-angle
glaucoma respectively. Open-angle glaucoma develops slowly
and don’t have noticeable symptoms whereas angle-closure
glaucoma develops quickly and has noticeable symptoms [13].
Primary open-angle glaucoma signs and symptoms include
gradual loss of peripheral vision, usually in both eyes and
tunnel vision in the advanced stages whereas acute angle-
Fig. 2. Estimated Increases in Glaucoma Patients Worldwide closure glaucoma signs and symptoms include eye pain,
nausea and vomiting (accompanied by the severe eye pain),
This study is a meta-analysis of existing automated sudden onset of visual disturbance often in low light, blurred
glaucoma systems proposed in last 10 years. 42 research vision, halos around lights, reddening of the eye [14].
papers mainly from IEEE, ACM and Springer digital libraries
were thoroughly analysed out of which 37 were purely TABLE I. TYPES OF GLAUCOMA
automated glaucoma detection systems[23-29, 30-33, 35, 39- Glaucoma
Cause
64] and 5 of them were review papers[28, 34, 36-38]. Type
Open Angle Abnormality in trabecular meshwork causes inter ocular
Research publications related automated glaucoma Glaucoma pressure to increase.
detection systems were thoroughly analysed in the following Normal
section. Whereas in [28] review of different ophthalmic Less blood flows to optic nerve causes damage to optic
Tension
nerve
imaging technologies used for glaucoma detection was Glaucoma
conducted. A comparison of different Machine Learning (ML) Closed Angle The angle between iris and lens closes causing inter
techniques was done in [34]. In [36] a survey was conducted Glaucoma ocular pressure to rise.
on the use of OCT for glaucoma detection. A study was Acute Sudden rise in inter ocular pressure due to excess
Glaucoma generation of aqueous humor in hours.
conducted on Scan Laser Polarimetry and its applicability for Near sighted eye have concave shaped iris that causes
glaucoma detection [37]. In [38] a survey was conducted to Pigmentary
aqueous humor to shed on trabecular meshwork causing
make a list of referral detection feature and equipment used Glaucoma
blockage to it.
for glaucoma detection. Exfoliations Whitish material builds up on lens this material causes
Syndrome blockage to trabecular meshwork.
This paper is outlined as follows: Section 2 explains Trauma Related Physical changes within eye drainage system due to
different glaucoma types and its causes. Section 3 describes Glaucoma some injury.
different ophthalmic imaging technologies used for automated
glaucoma detection. Section 4 discuses structural and III. OPHTHALMIC IMAGING TECHNOLOGY USED FOR
functional features of eye used for automated glaucoma AUTOMATED GLAUCOMA DETECTION
diagnosis in detail. In Section 5 a comprehensive comparison Automated diagnostics of glaucoma has been mostly done
of ML techniques used for glaucoma detection and prediction using Fundus, OCT and Confocal Scan Laser Tomography
is done. In Section 6 survey results are summarized. Paper (CSLT).
concluded in Section 7.

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Fig. 4. Fundus Camera Optics [17]
Fundus is the bottom or base of anything. The ocular
fundus is the inner lining of the eye. A fundus camera is a
specialized low power microscope with an attached camera. In
fundus photography, pupil is used as both an entrance and exit
for the fundus camera's illuminating and imaging light rays
[16].
(a) Fundus Image of Normal Eye (b) Fundus Image of Glaucoma Eye
Fig. 5. Fundus Image of Healthy VS Glaucoma Eye [17]
Figure 4 shows fundus camera optics. The painless
procedure produces a sharp view of the retina, the retinal
vasculature, and the optic nerve head (optic disc) from which
the retinal vessels enter the eye [17]. Figure 5 shows fundus
images of healthy and glaucoma effected eye.
In CSLT, a 670-nm diode laser is used to acquire images
of the posterior segment. The emitted beam is redirected in the
x-axis and y-axis along a plane of focus perpendicular to the
optic axis (z-axis) using two oscillating mirrors to obtain a 15°
X 15°, two-dimensional image reflected from the surface of
the retina and optic disc [18].
Fig. 6. Michelson type interferometer [22]
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Computing Conference 2017
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OCT is an emerging technology for performing high-
resolution cross-sectional imaging. OCT is analogous to
ultrasound imaging, except that it uses light instead of sound.
OCT can provide cross-sectional images of tissue structure on
the micron scale in real time [19]. OCT imaging technique can
be used to detect glaucoma at an early stage. It can also an
assessment of macular and ocular pathology as it shows a
cross sectional region of macula and optic disc [20]. OCT
imaging technology primarily consists of OCT camera which
uses a low coherence interferometry in which low coherence
visible light is allowed to pierce human retina and it is
reflected back to interferometer producing a cross sectional
image of retina [21].
Fig. 7. OCT image of Retina
High resolution images are generated using low coherence
light. Michelson type interferometer is the elementary
principle of OCT imaging technique shown in Figure 6. A
beam splitter is used to divide light in to waves. One part goes
to reference mirror and other goes to the patient’s eye. A-scan
is produced by combination of both reflected beams, which is
detected by detector as shown in Figure 6 [21]. Time Domain
– OCT (TD-OCT) and Spectral Domain – OCT (SD-OCT) are
two main types of OCT imaging technology. An example of
retinal OCT image is displayed in Figure 7.
IV. AUTOMATED GLAUCOMA DETECTION
Diagnosis of glaucoma has been done using structural and
functional features of eye. Automated glaucoma detection
using structural and functional features of eyes are explained
in the following sections. An overview of automated
glaucoma detection system is listed in Figure 9.
A. Automated Glaucoma Detection Using Functional
Features
Functional features of eye deal with the purpose of the eye
i.e. the vision process. Functional changes in the eye that arise
due to glaucoma can be examined and noticed using Visual
Fields (VF) testing and Inter Ocular Pressure (IOP)
measurement. Tonometry measures the pressure within your
eye. During tonometry, eye drops are used to numb the eye.
Then a doctor or technician uses a device called a tonometer
to measure the inner pressure of the eye. A small amount of
pressure is applied to the eye by a tiny device or by a warm
puff of air.
The range for normal pressure is 12-22 mm Hg (“mm Hg”
refers to millimeters of mercury, a scale used to record eye
pressure). Most glaucoma cases are diagnosed with pressure
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exceeding 20mm Hg. However, some people can have
glaucoma at pressures between 12 -22mm Hg. [4].
(a) Normal Field of Vision
(b) Field of Vision in Glaucoma
Fig. 8. Normal Visual Field VS Visual Field Loss in Glaucoma
Fig. 9. Overview of Glaucoma Diagnosis
171 experts were involved in survey. Only 68% of the
senior specialists responded. 95% experts have used age
criteria to calculate IOP where as 82% have used proper data
from visual field testing.45% specialist considered IOP of 25
or 26 mmHg as normal. 89% would refer at any level if a
visual field defect and disc cupping were present. Results
showed 45% practitioners were using IOP as referral detection
feature while 89% would refer visual field defects and disc
cupping as detection feature. Results showed significant
training and investment required for effective and timely
diagnosis of glaucoma.
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VF is the total area where human eyes can focus without
moving head and eyeballs. VF test help the ophthalmologists
to detect any abnormality in the vision. It enables the
ophthalmologists to examine VF effects and highlight the eye
as glaucoma suspect in case of any abnormality detected. VF
test measures sensitivity to stimuli at multiple locations in the
visual field. VF testing can be done manually as well as
automatically. Manual VF testing requires greater interaction
between ophthalmologist and the subject. Automated VF
testing can be done by different VF testing algorithms.
Glaucoma detection is mainly achieved with Full
Thresholding Strategy, Standard Automated Perimetry (SAP),
Short-wavelength Automated Perimetry (SWAP) and
Frequency Doubling Technology (DFT). Glaucomatous visual
field loss can occur anywhere in the visual field. Most patients
with visual field loss have some detectable field loss within
the central 24-30º [15]. Figure 8 (a) and (b) show normal
visual field and visual filed loss in glaucoma respectively.
Table 2 shows functional features of eye used for glaucoma
detection along with technique used for automated detection
of glaucoma. In year 2000 author made a postal questioner
survey to check referral detection features and equipment used
by optometrist for the detection of glaucoma in North Ireland
in [38].
In [34] a number of ML classifiers including multilayer
perceptron (MLP), support vector machine (SVM), and linear
(LDA) and quadratic discriminant analysis (QDA), Parzen
window, mixture of Gaussian (MOG), and mixture of
generalized Gaussian (MGG) were applied to glaucoma
diagnosis from Standard Automated Perimetry (SAP) (SAP is
common computerized visual-field test whose output is
amenable to ML) and compared with STATPAC a
specialized statistical analyses package currently employed by
clinicians to interpret SAP. Results showed better performance
of machine learning algorithms.
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Authors introduced a new approach in 2010 for glaucoma A comparison of automated detection of glaucoma at early
prediction based on artificial time series known as pseudo stage using Nerve Fiber Layer Defects (NFLDs) and
time series form cross section data in [38]. VF develops with computerized risk assessment based on patient clinical
passage of time. This temporal nature of VF can be used for information was done in [62]. Glaucoma risk assessment was
glaucoma prediction. Humphrey VF testing with 24-2 program done using ML techniques including artificial neural network,
was done for VF measurements. Shortest-path algorithm on radial basis function (RBF) network, k-nearest neighbour
several samples of data was applied to generate trajectories algorithm, and support vector machine (SVM). Results have
from records. Results obtained by proposed method were shown highest performance of glaucoma risk assessment
tested with real world medical data from VF tests with very based on clinical data using technique.
encouraging results.
B. Automated Glaucoma Detection Based on Structural
TABLE II. F UNCTIONAL F EATURES U SED FOR A UTOMATED Features
G LAUCOMA D ETECTION Several image processing techniques have been used to
Detection/ extract structure of cup and disc as shown in Table 3.Optic
Yr. Data Tech.
Prediction disc (OD) plays fundamental part in vision process. Visual
2000
IOP NA Detection information is transmitted through fiber nerves to the brain. In
[38] glaucoma due to degeneration of fiber nerves OD is damaged
2002 Machine Learning
[34]
Visual Field
Technique
Detection causing permanent blindness. This decay of fiber nerves
2010 caused cup size to increase and a result Cup to Disc Ratio
Visual Field Pseudo time series Prediction (CDR) increases in glaucoma as shown in Figure 10.
[50]
2014 Generally if CDR is less than 0.5 it is considered as normal
Visual Field Clustering Prediction
[29] otherwise greater than 0.5 are considered as glaucomatous.
2014 Figure 10 (c) shows CDR of normal eye whereas Figure 10 (d)
Visual Field Clustering Prediction
[28]
shows CDR of a glaucoma eye.
2002 Patient
Fuzzy Logic Prediction
[53] Clinical Data In a recent work in 2015, CDR extraction was done using
2012 Patient Sparse Dissimilarity Constrained with 88%
Machine Learning Prediction
[62] Clinical Data

Glaucoma progression was detected using visual field TABLE III. STRUCTURAL FEATURES USED FOR AUTOMATED GLAUCOMA
DETECTION USING FUNDUS IMAGES
measurement in [29]. The visual field data were modelled
using a mixture of Gaussian and modelled parameters were Yr. RFD Tech. Acc.
estimated using expectation maximization. In the analysis 2015
Sparse
phase three stages were involved including clustering, CDR Dissimilarity 88%
[25]
Constrained
glaucoma boundary limit detection and glaucoma progression 2014 Super Intensity
detection testing. In clustering phase three clusters were made CDR 90%
[43] Pixel
based on EM-estimated parameters. PCA was used to further Thresholding &
2013
decompose clusters into several axes. Glaucoma cut off limits [47]
CDR Counting White 94%
were calculated on all identified glaucoma axis and were used pixels
to detect glaucoma at early stage. Results of proposed system Disc,
2012 Histogram
Cup,PPA 92%
were compared with commercially available glaucoma [63]
Size
Distribution
progression software and clinically available glaucoma 2011 Vessel Bends for
progression detection software. The proposed system was able CDR 88%
[33] cup boundary
to give better results than available software. 2012
Retinal Surface
CDR depth NA
In [28] early classification of glaucoma was proposed [32]
Discontinuity
based on clustering using Bayesian Network. Classification 2011
CDR
Active Contour
NA
was done using two independent datasets both consist of 52- [39] Model
point VF raw sensitivity values obtained with Humphrey field 2010 Canny Edge
CDR 85%
[56] Detector
Analyzer II. A novel learning algorithm was proposed that
2015 Rim Vessel bends for
combined clustering and quasi-greedy search. Performance of [48] Width Cup Boundary
95%
prosed algorithm was then evaluated on independent data set 2014 Cup Canny Edge
while the clusters were compared to K-means, previous NA
[46] Shape Detector
publications and direct knowledge. 2010 Cup
Symbolic
Aggregation NA
V. Nicolae et al. have presented a solution for automated [60] Shape
Approximation
detection and prediction of open-angle glaucoma using fuzzy accuracy [25]. Similarly in 2014, CDR was calculated
logic in [53]. 22 fuzzy IF-THEN rules were extracted based on using Super Intensity Pixel with 90% accuracy [43]. CDR was
expert knowledge for the prediction of glaucoma. Results of computed using Thresholding & Counting White pixels and
proposed systems were finally evaluated by experts in field of achieved 94% accuracy in year 2013[47]. In [63] First Region
ophthalmology and results showed a clear accuracy in of Interest (ROI) has been extracted automatically around the
detection and prediction of glaucoma. Optic Disk automatically. Next Generalized Moment pattern

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was applied on ROI to boost the variation caused by
abnormalities such as bright lesions. Rotational motion was
applied based on circular shape of disk. Pivot was placed at
outer edge to highlight structural variation in glaucoma
because in glaucoma we have more bright lesions and this
approach will make prominent all such variations. Radon
transform was applied on ROI to get a feature vector to
address variation in the size of optic disk. Histogram of
intensity clusters were developed using k-mean algorithm to
differentiate cup, disk and Peripapillary Atrophy (PPA).PPA
is shown in Figure 10 (b) highlighted in yellow. PPA occurs
due to atrophy of retinal cells around optic disc. Some atro-
phy appears in both normal and glaucomatous eyes but it is
more commonly observed closer in glaucomatous cases. One
class classification was done using Principal Component
Analysis Data Description.
Optic Disk segmentation was done based on local
information of image around each point of interest in
multidimensional feature space. Cup segmentation was done
using anatomical evidence such as vessel bends. Cup
boundary was obtained using a multi-stage strategy to derive a
reliable subset of vessel bends followed by local spline fitting
and achieved 88% accuracy [33].
Computing Conference 2017
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considered to compute cup to disk ratio. If CDR was less than
or equal to 0.4 than sample was considered as normal and if
CDR was greater than 0.7 it was considered as glaucomatous.
In year 2010, Optic disc extraction was done using P-tile
threshold method. The Canny edge detector technique was
applied to enhance the edges of optic disk. The spline
interpolation method was used to generate boundary line of
Optic Disc and achieved 85% accuracy [56].
In case of myopia eye, only CDR may not be effective for
glaucoma detection. Rim width based on ISNT rule was
proposed for classification to support these cases in [48]. Rim
width is the area between cup and disc boundary known as
neuro retinal rim as shown in Figure 10. (a).
(a) Normal Rim (b) Glaucoma Rim
Fig. 11. Rim Width in ISNT region of Optic Nerve

Figure 11. shows inferior, superior, nasal and temporal

(a) Optic Disc on Retina
part of rim. ISNT rule is defined as inferior • superior • nasal
• temporal, where as in glaucoma eye we have violation of
this rule as shown in Figure 11. (b). Vessel bends to detect cup
was done using multi-scale vessel tracking technique and
showed 95% accuracy.
(b) RNFL and PPA on retina

(c) Normal CDR (d) Glaucoma CDR

Fig. 10. Optic Disc

A new approach for glaucoma detection based on retinal

surface depth discontinuity for assessment of the cup
boundary was introduced in [32]. Set of acquired sequential
images were related via relative motion model. Indicators like
motion boundary and partial occlusion were used to find depth
discontinuity at cup boundary. On the base of these indicators
cup boundary is estimated with a set of best-fitting circles.
Final cup boundary was generated considering the points on
these circles at different sectors using a confidence measure.
In [39] cup was detected considering the brightest block of
pixels as cup centre and then with the help of region growing
algorithm whole cup is identified. Next using histogram
distribution image is divided into three bins including dark as
background, medium as rim and bright as cup. The borders of
cup and disk were further detected using Active Contour
Model. Only horizontal diagonals of cup and disk were
(a) Normal Cup Surface Contour (b) Glaucoma Cup Surface Contour
Fig. 12. Cup Shape [60]
In [46] cup shape was proposed for glaucoma detection. It
was observed that glaucomatous eye shape of cup perimeter
was more regular whereas for normal eye it was more
irregular as shown in Figure 12.
In 2010, MATLAB software was used to unwrap contour
of optic cup considering the centroid of the cup surface which
converts 2-D cup surface contour to 1-D data series using
Symbolic Aggregation Approximation in [60], results shown
in Table 4. Results have shown that rim width structural
feature using vessel bends for cup boundary detection was

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able to achieve maximum accuracy of 95% for glaucoma missing data problem. Image deconvolution technique was
detection. used to deal with overlapping of the BM and boarder tissues
of Elschnig layer. Optic Disk size rim area is tackled with an
Different structural referral detection features of eye used inverse artificial neural network ANN-PCA approach to
for glaucoma detection using OCT imaging technology are model the elliptical shape of BMO curve and to overcome
listed in Table 4. In 2014 it was proposed that OCT images problem of inaccurate BMO estimation.
can be used to measure Optic Nerve Head Tissue Properties of
retina that were previously unmeasurable because of lack of In [58] a new algorithm for glaucoma detection using OCT
internal details of retina in [26]. images was proposed. Algorithm was based on identifying
retinal vitreal boundary using sobel edge detector. Two mask
TABLE IV. STRUCTURAL FEATURES USED FOR AUTOMATED GLAUCOMA images were created to identify the region of retinal choroid.
DETECTION USING OCT IMAGES Input image was converted into binary using thresholding.
Year RFD Accuracy After performing opening and closing and connecting non-
Optic Nerve zero pixels only area above 500 pixels was considered as area
2014[26] Head Tissue NA of interest. After region identification horizontal and vertical
Properties lines were drawn and boundary was marked. Distance
2014[44] CDR NA
2011[58] CDR NA
between intersection lines gave CDR, as shown in Figure 14.
Anterior
2014[45] Chamber 85%
Angle
Anterior
2013[51] Chamber 97%
Angle
Macula Layer
2012[35] NA
Thickness
RNFL
2012[54] NA
thickness
Biomechanical
(a) Normal CDR in OCT
2008[42] Corneal NA
Properties
2010[52] RNFL NA

Twenty effects of the IOP were measured for each model

including eye radius, Anterior Lamina Cribrosa (LC) radius
LC modulus, Scleral Modulus, Scleral Thickness, Neural
Tissue Modulus and Central LC depth. Results showed that
IOP-induced changes in LC depth, Sclera canal width, and
prelaminar neural tissue thickness.
(b) Glaucoma CDR in OCT
Fig. 14. CDR in OCT

In [45] Quantitative index, iridocorneal angle was used for

(a) Anterior Chamber Angle
(b) Effect of IOP on Lamina Cribrosa
Fig. 13. Anterior Chamber Angle & Lamina Cribrosa
Figure 13(b) shows effects of high and low inter ocular
pressure on LC. In glaucoma due to high intraocular pressure
LC bulges out. Bruch’s Membrane Opening (BMO) as a
reference point was used to compute Optic Nerve Head
(ONH) in [44]. BMO segmentation was done considering as
detection. The angle closure was measured by Fractal
Dimension (FD) Analysis. In pre-processing vertical
saturation artefacts were removed. Thresh holding was done to
separate inter class variations and intra class variations.
Connected Component Labelling and morphological images
processing was done to separate iris and cornea. Region of
Interest (RIO) Anterior Chamber Angle (ACA) was selected
based on ACA apex point. Results showed 85% accuracy of
system.
Classification of glaucoma was done using fuzzy min-max
neural network based on data core (DCFMN) in [51].
Classification process included three layers. Input layer takes
images and remove noise using median filter. Middle layer is
based on a hyper box fuzzy set. DCFMN consist of two
classes i.e. Classifying Neuron (CNs) and Overlapping
Neurons (OLNs). CNs is used to control noise and density of
data and OLNs was used for classification. Further
segmentation was done using thresh hold method. Open angle
glaucoma and angle closure glaucoma were distinguished
based on angle range less than 20 as closed angle and greater

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than 40. Results attained a total of 97% accuracy. Figure 13(a)
shows Anterior Chamber Angle highlighted in yellow box.
A study was conducted to evaluate the diagnostic ability
and capacity of Macula Layer Thickness for detection of
glaucoma progression in [35]. The segmented macula layers
were Macula Layer Fiber Nerve, Ganglion Cell, Inner
Plexiform Layer (GCA) and Outer Retinal Layer (ORL). A
comparison of these outcomes with those obtained using
conventional measures of cRNFL and Total Macula Thickness
(TMT) was made. Glaucoma in each eye was determined by
linear regression against patient age using serial TMT and
cRNFL. It was found that the thickness at baseline of a
segmented RGC layer (the GCA) had signi¿cantly difference
between glaucomatous and healthy eyes.
Novel methods that can align an OCT scan circle on the
retinal fundus image by special image registration algorithm
have been proposed in [54]. The scan circle alignment consists
of two task, vessel matching and displacement parameter
inference. Maximum likelihood between vessels of both types
of images was obtained using Expectation-Maximization
(EM) algorithm. Vessel matching was done using probability
calculation. Circle scan obtained by proposed method gives
less variation while calculating Retinal Nerve Fiber Layer
(RNFL) thickness on OCT images.
Author proposed biomechanical corneal properties
analysis for prediction of glaucoma in [42]. Corneal
Hysteresis which deals with elastic nature of cornea was used
to calculate dumping capacity. Using IOP and dumping rate a
graphical representation named Corneal Effort Staging System
(CESS) was developed. In this case the eye mechanical stress
is proportional with the IOP, and is inversely proportional
with damping capacity. This chart represents six stages. The
stage 0, 1 shows normal one, stage 2, 3 shows possible ill,
stage 4, 5 shows glaucoma patient. These defined stages were
further verified by group of patients with tested results using
RFNL with OCT images and results showed good response of
CESS system.
In [52] automatic retinal layer segmentation was done
using OCT images. In first step image was cut into multiple
vessels and no vessel sections based on retinal blood vessels.
Bilateral and median filters were applied to smooth non vessel
section. Retinal layer boundaries were detected using canny
edge detector and completed trough interpolation. The
thickness of RNFL was determined by distance between fitted
upper and lower boundary. System was able to segment five
retinal layers accurately. Figure 15 shows primary layers of
the retina including Inner Plexiform Layer (IPL), Outer
Plexiform Layer (OPL), Inner Nuclear Layer (INL), Outer
Nuclear Layer (ONL) Inner Segment/Outer Segment (IS/OS)
junction layer, Retinal Pigment Epithelium (RPE) cell layer
and Nerve Fiber Layer (NFL). NFL thickness is most
commonly used for glaucoma detection using OCT images.
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CSLT has been used in glaucoma detection and prediction.
Table 5 shows different structural detection features and ML
techniques used for automated glaucoma detection using
CSLT.
In [30] it was proposed that inner plexiform layer could be
used as an early sign of glaucoma damage using CSLT. In
2008, a review of Scan Laser Polarimetry based on principle
of operation, examination procedures, clinical role and results
of main diagnostic procedures was conducted in [37]. Author
concluded that this approach can be effectively used for early
diagnostics of glaucoma using detection features like RNLF
and parapapillary area.
Fig. 15. Retinal Layer in OCT image
In scan laser tomography laser light is used to illuminate
tissues and capture series of high definition images. In [41] in
order to control degenerated border pixels and outlier points
over the three image samples a median image is calculated
from available three sample images. Similarly border of image
is replaced by the median image average intensity value. Next
features like invariance to translation, rotation and scale of
overall image geometry were extracted using orthogonal
Zernike moments. Classification was done using ML
techniques and proposed system showed 78% accuracy.
Y. Jin et al. presented a solution for automated detection of
glaucoma using Confocal Scanning Laser Tomography
(CSLT) imaging technology in [57]. HRT scanner was used to
capture images. Feature extraction was done directly from
images using moment methods and feature like mean, median
of images were extracted automatically. Feature selection was
done using wrappers and filters. Classification was done using
Support Vector Machine (SVM) and system achieved 86%
accuracy.
TABLE V. STRUCTURAL FEATURES U SED FOR A UTOMATED
G LAUCOMA D ETECTION U SING CSLT I MAGES
Yr. RFD Tech. Acc. D/P
Inner
2012
Plexiform NA NA D
[30]
Layer(IPL)
2008 RNFL and
[37] papillary area
NA NA P

Confocal Scan Laser Tomography (CSLT) uses a laser 2005 Zernike

Perceptron 78% D
light. Confocal imaging is the process of scanning object part [41] Moments
by part by a focused laser beam and capturing the reflected 2004 Moment
SVM 86% D
light through a small operator known as confocal pin hole. [57] Methods

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V. MACHINE LEARNING TECHNIQUES USED FOR
GLAUCOMA DETECTION
Machine Learning (ML) techniques have been widely used
for detection and prediction of glaucoma. ML techniques have
proven to be effective and have shown a clear increase in
accuracy rate of detection process. Different ML techniques
with ophthalmic imaging type and referral detection feature
along with accuracy are listed in Table 6. Automated
glaucoma detection was done using fundus images and
statistical features using SVM classifier and achieved 93.10%
accuracy in 2015. In year 2007, 2010 and 2012 glaucoma
detection was done using fundus imaging technology based on
spatial and frequency information using naïve Bayes classifier
achieving a total of 80% accuracy, SVM classifier obtained
88% accuracy and C-SVM classifier showed 93.33% accuracy
respectively. PCA Data Description gained 94% accuracy
using local and global intensity variations across images
(texture). In year 2011, automated detection was done using
texture features and classifier SVM with a total of 91%
accuracy using fundus images. A hybrid feature set consisting
of statistical and texture features extracted from fundus images
using KNN classifier was able to achieve accuracy of 98%. In
2010, structural feature CDR from fundus images was
classified using spline interpolation method and gained 80%
accuracy. Prediction of glaucoma was done in 2010, using
Nerve Fiber Layer Defects using artificial neural networks and
further work was modified in 2012, by combining clinical data
and Nerve Fiber Layer Defects again using artificial neural
networks and achieved a total of 80% accuracy. RNFL is
highlighted in green in Figure 10 (b)
In 2013, automated glaucoma detection was done using
OCT images based on Anterior Chamber Angle using Neural
Network ML techniques and showed 97% accuracy. In 2012,
and 2014, prediction of glaucoma was done based on Macula
Layer Thickness using SVM classifier and ONH tissue
properties using Multi-variate adaptive regression spline ML
technique.
In 2000, and 2005, CSLT was used based on statistical
features using SVM classifier and achieved 78% and 86%
accuracy respectively. A Bayesian frame work was proposed
for early glaucoma detection using texture features of CSLT
images and gained 89% accuracy. In 2011, Gonioscopy
images were used for automated glaucoma detection based on
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Anterior Chamber Angle using SVM classifier and achieved
88% accuracy
VI. SURVEY RESULTS
In this study 42 research papers, published in last 10 years
were thoroughly analysed to check current status of automated
glaucoma detection. Figure 16 shows percentage of work done
in last 10 years using structural and functional features of eye.
Fig. 16. Percentage of work done using Structural/Functional Features
As this chart demonstrates that structural feature CDR is
most commonly used as referral detection feature for
glaucoma detection accounting 36% of total work covered in
this study. Texture features come next to CDR with 23%.
Retinal layers are at third position with 10%. Visual Field and
anterior chamber angle are at third position with 8% each.
Similarly, next we have clinical data and NFLD with 5% each.
At last we have ONH tissue properties and biomechanical
corneal properties with 3% and 2%, respectively. Similarly, an
analysis was made to compare performance and accuracy of
different automated glaucoma detection systems. In Figure 17
a graph is showing accuracy plotted against each referral
detection feature. According to this study texture features
using fundus images using KNN techniques was able to
achieve maximum accuracy of 98% (Green bar in Figure 17)
[49]. CSLT using texture and perceptron ML technique gave
minimum accuracy of 78% ( Red bar in Figure 17) [41]. This
accuracy graph confirms ML techniques can be used to
develop efficient and more accurate automated glaucoma
detection systems.
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TABLE VI. MACHINE LEARNING TECHNIQUES U SED FOR A UTOMATED G LAUCOMA D ETECTION AND P REDICTION
Imaging
Year Reason Referral Detection Feature Classifier Accuracy
Type
2015[23] Fundus Detection Texture features SVM 93.10%
CDR and Spatial and Frequency
2007[40] Fundus Detection SVM 86%
Information
2010[24] Fundus Detection Spatial and Frequency Information SVM 88%
PCA Data
2012[63] Fundus Detection Texture 94%
Description
2012[27] Fundus Detection Spatial and Frequency Information C-SVM 93.33%
2011[31] Fundus Detection Texture Features SVM 91%
2014[49] Fundus Detection Texture Features KNN 98%
2010[64] Fundus Prediction NFLD Neural Network NA
2012[62] Fundus Prediction NFLD and Clinical Data Neural Network 80%
2013[51] OCT Detection Anterior Chamber Angle Neural Networks 97%
2012[35] OCT Prediction Macula Layer Thickness SVM NA
Multi-variate
2014[26] OCT Prediction ONH tissue properties Adaptive NA
Regression Splines
2004[41] CSLT Detection Texture Features Perceptron 78%
2005[57] CSLT Detection Texture Features SVM 86%
2013[55] CSLT Prediction Texture Features Bayesian 89%
Gonioscopy
2011[59] Detection Anterior Chamber Angle SVM 88%
Images
whereas, there is a great margin of improvement in automated
glaucoma detection using OCT and CSLT images.
Different ML technique along with frequency of usage for
glaucoma detection has been shown in Figure 19. According
to this study most frequently and widely used ML technique
for glaucoma detection is SVM accounting 57% of automated
glaucoma detection work. Neural networks are at second
position with a total of 15% of total work. Whereas PCA Data
Description, KNN, Regression Spline and Perceptron all have
contributed 7% each of total work.

Fig. 17. Accuracy chart for automated glaucoma detection

Fig. 19. Percentage of ML techniques used for glaucoma detection

Fig. 18. Data set used for glaucoma detection
Figure 18 shows data set used for evaluation of automated
glaucoma detection systems. In [25] a vast data set of 1676
images was used for evaluation of system and achieved 88%
accuracy using fundus images and simple thresholding
technique for classification. Similarly, in [68] 93% accuracy
was achieved using data set of 1192 images again using
fundus images and thresh holding technique for classification.
Considering Figure 18 we can conclude that automated
glaucoma detection is at a mature level using fundus images
Figure 20 shows a graph showing number of publications
related to detection and prediction of glaucoma in different
fields. According to this survey relatively less work has been
done using CSLT. In CSLT more work has been done for
detecting glaucoma at early stages. Similarly a smaller amount
of focus has been found on functional feature of eye for
glaucoma detection. Functional feature of eye were also
mostly used for early diagnosis of glaucoma. Results of this
survey showed that in last ten years focus of researchers is
mainly on Fundus and OCT imaging technology for glaucoma

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