This full-text paper was peer-reviewed and accepted to be presented at the IEEE WiSPNET 2016 conference.
Automatic Glaucoma Detection
by Using Funduscopic Images
Atheesan S., Yashothara S.
Department of Information Technology
University of Moratuwa
Katubedda, Sri Lanka
atheesan91@gmail.com, yashoshan@gmail.com
Abstract—This paper describes an automatic system to
identify glaucoma disease from funduscopic images using digital
image processing. Glaucoma is caused by the increased pressure
of the eye and damages the optic nerve. Since glaucoma does not
show early symptoms, it should be diagnosed by the doctor.
Through this new detection technique, doctors can quickly and
easily identify patient’s condition and carryout the treatment
necessary. This method also has the added advantage if being
affordable. Here glaucoma is identified through cup (optical
disc’s inner circle) to disc (outer circle) ratio (CDR) calculation
and by the orientation of the blood vessels. In this system firstly,
cup and disc are extracted using average and maximum grey
level pixels respectively with the use of histogram. Then contours
are found, which in turn are used to draw the best fitting circle,
thus finding the radius of cup and disc. After calculating CDR,
the abnormal image can be recognized if CDR exceeds the
threshold value. Otherwise it is a normal image. The system
extracts the blood vessels and through their orientation glaucoma
is identified.
Keywords—Glaucoma; Funduscopic Image; Image
Processinng; Cup Disc Ratio.
I. INTRODUCTION
Eyes are the organs of vision which detect light and convert
it into electro-chemical impulses in neurons. World Health
Organization (WHO) declares that Glaucoma is the second
leading cause of blindness; which contributes to approximately
5.2 million cases of blindness [1]. Glaucoma caused by
increased eye pressure and damages the optic nerve. Glaucoma
tends to develop without any symptoms until final stage. The
person may lose vision permanently, if not treated in time.
Glaucoma is commonly incurred in both eyes to different
extent. There are two types of glaucoma, the open angle
glaucoma and the angle closure glaucoma.
This project was initiated with this background to transform
this knowledge into an automated system. Such an automated
tool can be useful in health camps in rural areas in developing
countries where a large population is suffering from these
diseases. Funduscopic images which form high-resolution
images of the retina are widely used for analyzing and finding
the disease.
The information about optical disc is important to detect
glaucoma. Optic disc is the brightest component in the image.
Diameter of optic disc is usually used as a reference length for
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c IEEE
measuring distances and sizes. There are many ways to find
glaucoma such as assessment of raised intraocular pressure
(IOP), assessment of abnormal visual field, assessment of
damaged optic nerve head and calculating CDR. We focus on
CDR calculation. CDR is calculated by finding the radius of
disc and cup. According to the experimental values, if the ratio
exceeds 0.3 then the image will be detected as affected.
Otherwise it is normal.
II. RELATED RESEARCH WORK
A. Automated location of optical disc and fovea in retinal
images
Localization of the optical disc is done by means of using
the morphological operations and Hough transform. The
system uses shade correction operator to remove slow
background variations. Brightest and biggest part of the image
is calculated using thresholding. ROI is calculated using
morphological operation. The boundary and center of the optic
disc are found by Hough transform. The proposed method is
capable of localizing the optic disc correctly for 34 of these
images. So success rate is 94.4% [1]. Our approach differs
from the above approach due to the calculation of CDR in our
system.
B. An automated detection of Glaucoma using histogram
features
Early detection of Glaucoma is identified using a
combination of magnitude and phase features from the digital
fundus image. For both magnitude and phase components, the
histogram features are computed. The steps of this approach
are region of interest selection, Gabor filtering, local binary
pattern (LBP) steps to extract the features and Daugman’s
algorithm. LBP and Daugman’s algorithm are used to
accomplish the feature set extraction. Image is transformed into
an array or image of integer labels using an image operator
which forms histogram features for further image analysis. To
predict glaucoma, Euclidean distances between the feature
vectors are analyzed. The system results in 95.45% output for
sensitivity, specificity and classification [3]. Here this system
only detects features and does not calculate CDR. This system
uses a predefined value for all images.
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 This full-text paper was peer-reviewed and accepted to be presented at the IEEE WiSPNET 2016 conference.
C. Segmenting Optic Disk Cup ratio in Retinal Fundus
images
In this approach optic disc cup ratio is segmented using
gradient method, adaptive threshold and connected
component. The segmentation of optic disc is done by
observing the vasculature network inside the retina. The
system used red channel image for the image analysis. The
steps of the approach are background normalization, saturation
detection in red, blood vessel removal, bright region removal,
brighter region removal and gradient method. The region is
segmented by thresholding. The system calculated disc area,
bright area and blood vessel area form the images [5].
D. Clustering based Optic disc and Cup segmentation for
Glaucoma detection
Simple Linear Iterative Clustering (SLIC) algorithm and
K-Means clustering for glaucoma detection are proposed in
this paper. This segmentation is used to obtain accurate
boundary delineation. Histograms and center frame statistics
are used to classify each super pixel as disc or non-disc.
Location information is also added into the feature space to
boost the performance. The output of the SLIC algorithm is
given as an input to the K-Means Clustering. Gabor filter is
used for edge detection. Once the optic disc is segmented,
CDR is calculated to identify whether the image has glaucoma
or not [6].
E. Super pixel classification based optic disc and optic cup
segmentation for Glaucoma screening
This paper uses super pixel classification for glaucoma
screening. A self-assessment reliability score is computed to
evaluate the quality of the automated optic disc (OD)
segmentation. This paper mainly focuses on CDR
measurement of the 2D fundus image, OD segmentation and
blood vessel segmentation including the generation of super
pixels. Centroid calculation, stochastic watershed and region
discrimination are inside the OD segmentation [9].
III. DESIGN AND IMPLEMENTATION
This section describes how the system identifies glaucoma
when a user uploads an image of retina. There are many
procedures to decide whether the image is normal or
abnormal. The procedures and techniques are explained
below.
A. Get red and green channesl of the image seperately
An RGB image contains three channels (RGB) within it.
These channels can be extracted separately. The red channel
image hides the cup and shows only the disc. But for CDR
calculation, disc and cup should be needed. Blue channel
image is a noise and it does not give the required information.
The green channel image shows the inner and outer circles of
the optical disk. Hence, red channel image is used for disc
extraction and green channel is used for cup extraction.
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B. Convert to grey scale image
To view the features clearly than the red and green channel
images, the image is converted into grey scale image. Red
channel grey scale image shows only the disc. In the green
channel grey scale image, disk and cup are brighter than the
other parts of the image. Within the brighter part, inner and
outer circles of the optical disk are shown in different levels of
intensity and brightness. Fig. 1 shows the red and green
channel grey scale images of retina.
a b
Fig. 1. Red channel and green channel grey scale images of the retina
(a) Red channel image, (b) green channel image
C. Noise removal using median filter
Median Filter is used to remove noise from the image to get
better extraction of the feature. Median filter removes the noise
better than the other filters without losing the required data.
Here 7×7 kernel is used to filter the image. Median filter
replaces the center value in the window with the median of all
the pixel values in the window of kernel.
D. Finding the average and maximum grey level values and
histogram analysis of the grey image
Average and maximum grey level values are important in
this system. Average grey level value is used to extract the
optical disk by getting brighter points by using histogram
analysis. The cup was extracted by using the average and
maximum grey level values. After finding the maximum grey
level value, the histogram is needed to be checked and if there
is a peak in the density of pixels near the maximum value then
the range of that peak will be taken to identify the inner circle.
Histogram and the pixel value of the nearest maximum pixel
are very important to calculate the range of values. The range
of values is calculated by the algorithm I.
Similar approach is used to find the outer circle. Here
average value is used. Needed range of values is identified like
the above method. The range of needed pixels is greater than
the average value. Similar pattern is identified in histogram
when different images were examined. Those similar patterns
are shown in Fig. 2.
By using this similar feature of the histogram the value
range finding algorithm was created. For more images this
algorithm was suited.
 This full-text paper was peer-reviewed and accepted to be presented at the IEEE WiSPNET 2016 conference.

i = averageGreyLevel i=0
while i < 256 do while i < rows do
j=i j=0
while j < nonZeroDensityGreyLevel do while j = columns do
if no. of pixels at i < no. of pixels at i-1 then read grey level value of a pixel
thresholdGreyLevelValue = i if greyLevelValue > thresholdGreyLevelValue then
else pixelValue = pixelValue
continue else
end if pixelValue = 255
j = j +1 end if
end while j = j +1
i = i +1 end while
end while i = i +1
Algorithm. I. Identifying threshold value end while
Algorithm. II. Extracting needed pixels

G. Draw the best fitting circle and find the cup’s and disc’s
radius
As the final step of this procedure best fitting circle is
drawn by using the contours of derived image. Then the best
fitting circles’ (inner and outer circle) radii are calculated.
Then CDR is calculated and if it is above 0.3, the image is
glaucomatous, else the image is normal.

The best fitting circles in images are given in Fig. 4.

Fig. 2. Sample histogram for two different images: x-axis- grey level pixel
level, y-axis -number of pixels in a particular level
a b
E. Extract only the identified range of pixels from the image.
In order to extract only the needed feature, the system will
send only the found range in the above step to the new image
and all the other pixels’ values are converted to 255, meaning
that all the other pixels are converted to white color. Thus the
system extracts the features which are needed to calculate
CDR. The disc and cup are separated and they will be inputted
into different images. Fig. 3 shows the cup and disc separately
without the other parts of retina. Algorithm for getting only
the required pixels is given in algorithm II.
c d

a b

Fig. 4. Two The images with best fitting circle (a) Color image with best
Fig. 3. Separated cup and disc (a) Cup image, (b) Disc image fitting circle in disc, (b) Color image with best fitting circle in cup,
(c) Grey image with best fitting circle in disc, (d) Grey image with
best fitting circle in cup.
F. Finding the contours of the newly derived image
Then the system will find the contours of the newly derived
image using the findContours() method available in opencv;
which will be useful to find cup and disc circles.

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 This full-text paper was peer-reviewed and accepted to be presented at the IEEE WiSPNET 2016 conference.

Steps to segment the blood vessel are as follows,

a) Get green channel image
b) Convert it to grey scale
c) Use Black hat morphological operation.
Blood vessels are darker than the other pixels after
being converted to grey scale. So by using black hat
operator converts the blood vessels into brighter
pixels while surroundings are converted to black. Use
Black Hat Morphology operation with ellipse kernel
type with the kernel size of 26. Fig. 5. Blood vessels orientation of different images
d) Find the average of grey level value after doing
morphology operation. This value is used to find out
the threshold value to segment blood vessel. The g) Get the pixels in the extracted image and check how
they are oriented around the disc. A mask is drawn
algorithm to find this value is given in algorithm III.
over the cup and the disc and the orientation of the
blood vessels around the circle is identified. If the
i=0 orientation is biased to a particular range of angle,
while i < 255 do then the image is abnormal. Otherwise it is normal.
read grey level value of a pixel
sum = sum + greyLevelValue
IV. RESULTS AND DISCUSSION
pixSum = pixSum + (i * grHistogram[i])
i = i +1 There are many image processing techniques that have been
end while used to identify glaucoma disease and those techniques have
avarageGreyLevel = pixSum/sum; advantages as well as drawbacks.

Algorithm. III. Finding average grey level value Ours is a desktop application which runs in windows
operating system. The application is capable of analyzing the
e) Find threshold value to identify the needed grey level uploaded image and decides whether the image is normal or
value to extract blood vessel. The following glaucomatous. As discussed earlier, Glaucoma detection is a
algorithm IV is used to find out the threshold value major research area where several methods have already been
which is used to extract the necessary pixels, which formulated using different techniques. In this study we were
are brighter pixels than others. able to find a new approach for Glaucoma detection by
checking more images and using simple algorithm with better
i = averageGreyLevel performance.
while i < 256 do
while pixels density < 10000 do The process of the system starts when the user uploads the
j=i image. The user of the system can be a doctor, lab assistant or
while j < nonZeroDensityGreyLevel do a patient who can handle the application and a computer.
if no. of pixels at i < no. of pixels at i-1 then There should be a scanner connected to the machine or a soft
thresholdGreyLevelValue = i copy could be used to upload the image.
end if
j = j+1 We have used 50 images when identifying the algorithm
end while and 50 images for testing. When the testing number of images
end while is increasing, a constant cannot be used as a threshold value to
i = i +1 extract needed features from different images. So we have
end while implemented a method to identify a variable for threshold
value for different images using the histogram features. The
Algorithm. IV. Finding threshold value cup to disc ratio calculation is used as the main glaucoma
identification technique and blood vessel orientation
f) Extract blood vessel and display. If grey level is identification is used to identify the stage of the disease. The
above the threshold value, then the value will be images were evaluated using these two techniques.
taken as it is. If grey level value is less than the
threshold value, then that value will be changed to According to our experiment we have proved that if the
255. Through that only the relevant feature could be CDR value is between 0.0 and 0.3, then image is normal and if
extracted. The extracted blood vessels are shown in it is greater than 0.3, then it is glaucomatous. Blood vessel
Fig. 5. orientation is identified by the distribution of the extracted
blood vessels in four equal quarter circles. If most of the blood
vessels are belonged to only one or two quarter circles then it

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 This full-text paper was peer-reviewed and accepted to be presented at the IEEE WiSPNET 2016 conference.

is advanced glaucomatous and if the blood vessels spread into
three or all four quarter circles, then it is early glaucomatous
or normal.
The following are considered in evaluating the system,
True Positive (TP): The image is glaucomatous and it is
detected as glaucomatous.
True Negative (TN): The image is normal and the system
detects it as normal.
Even diagnosis of this kind of eye disease by a doctor is
unreliable. Even though some researches were done earlier in
Sri Lanka, until now manual procedures are in practice. Many
people in underdeveloped areas lose their vision due to the
lack of eye specialists. The aforementioned issues could be
overcome by introducing automatic diagnosing system. The
proposed system can detect glaucoma by calculating CDR.
The system shows a higher level of precision and recall values
while maintaining F-score value about 96%. However, it is
necessary to further evaluate this method against variety of
retina images with different image qualities.

False Positive (FP): Normal image is detected as ACKNOWLEDGEMENT

glaucomatous image. We would like to thank all the lecturers in the Faculty of
Information Technology for their immense support. We are
False Negative (FN): The image is glaucomatous but the grateful to our colleagues who have volunteered for the testing
system detects it as normal image. of the system. We are thankful to Vision Care for providing
the images to test our system.
Precision: Proportion of glaucomatous images detected as
glaucomatous images from the cases that normal images and REFERENCES
glaucomatous images that are detected as glaucomatous [1] A.K.Nandi, W.Al.Nuaimy and S.Sekhar, “Automated Localisation Of
images. An Optical Disk And Fovea In Retinal Images,” 16th European Signal
Processing Conference (EUSIPCO 2008), Lausanne, Switzerland,
August 25-29, 2008.
The results of 50 images according to the above scenario are [2] J Arulmozhivarman Pachiyappan, Tatavarti VSP Murthy, Rao Tatavarti
given in Table 1. The original image data set we have used for and Undurti N Das, “Automated diagnosis of diabetic retinopathy and
testing contains 39 glaucomatous and 11 normal images. glaucoma using fundus and OCT images”.
[3] Karthikeyan Sakthivel and Rengarajan Narajanan, “An automated
detection of glaucoma using histogram features”.
Precision = TP/ (TP+FP) [4] K.Kavitha and M.Malathi, “Optic Disc and Optic Cup Segmentation for
Specificity = TN/ (TN+FP) Glaucoma Classification,” International Journal of Advanced Research
Sensitivity (Recall) = TP/ (TP+FN) in Computer Science & Technology (IJARCST 2014), Vol. 2, Issue
F-score = 2*[(Precision* Recall)/ (Precision+ Recall)] Special 1, Jan-March 2014.
[5] S.Letishia Mary, “Segmenting Optic Disk Cup in Retinal Fundus
Images,” International Journal of Computer Applications (0975 –
TABLE I. RESULTS OF 50 IMAGES
8887), International Seminar on Computer Vision (ISCV-2013).
[6] S.Karthikeyan and V.Mahalakshmi, “Clustering Based Optic Disc and
TP 38 Optic Cup Segmentation for Glaucoma Detection,” International
Journal of Innovative Research in Computer and Communication
TN 9 Engineering, Vol. 2, Issue 4, April 2014.
FP 2 [7] Arun Kumar Patel, Prashant Choukikar and Ravi Shankar Mishra,
FN 1 “Segmenting the Optic Disc in Retinal Images Using Bi-Histogram
Equalization and Thresholding the Connected Regions,” International
Precision 0.95 Journal of Emerging Technology and Advanced Engineering, ISSN
Specificity 0.82 2250-2459, ISO 9001:2008 Certified Journal, Volume 4, Issue 6, June
2014.
Sensitivity (Recall) 0.97
[8] T.Chandra Shekar Rao and Kilaru Anusha, “Super Pixel Classification
F-score 0.96 Based Optic Disc and Optic Cup Segmentation for Glaucoma
Screening,” International Journal of Advanced Technology and
V. CONCLUSION Innovative Research, ISSN 2348–2370, Vol.06, Issue.05, August-2014,
Pages:367-375.
“Automatic Glaucoma Detection” will provide better solution
[9] S. Chandrika and K. Nirmala, “Diagnosis Analysis of Cdr Detection For
for the difficulties and drawbacks of current manual procedure Glaucoma,” International Journal of Engineering Research and
of detecting glaucoma with naked human eyes, which is more Applications, ISSN: 2248-9622, National Conference on Advanced
time consuming, requires more effort and more human ommunication & Computing Techniques, 19 March 2013.
resources with an expert level knowledge and experience.

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