Hardware Implementation of Detection of Glaucoma from

Color Fundus Images

R. Manjula Sri a,*, M. Raghupathi Reddy b, K.M.M.Raoc

a,b
Department of EIE, VNR Vignana Jyothi IET, Hyderabad, India.
c
Department of EEE, BITS-Pilani-Hyd. campus, Hyderabad, India

Abstract

Glaucoma is one of the most commonly observed retinal disease in India that leads to blindness if not diagnosed and treated at early
stage. There are no specific symptoms for this disease, it is observed by loss of side vision. Glaucoma is a slow progressive degeneration of
retinal ganglion cells (RGC) and their axons, resulting in a distinct appearance to the optic nerve head (ONH), often called cupping. Due to
cupping the cup area increases and causes loss of side vision. Usually specially trained clinicians manually grade the fundus images in a
time-consuming manner. The authors have developed a novel algorithm for automatic detection of AMD using image processing
techniques and implementation on hardware. Glaucoma is assessed by estimating the cup to disc ratio (CDR). The proposed algorithm
employed morphological and histogram techniques to identify cup and disc on fundus images and to measure the radius and area of cup
and disc of the retina. Intel’s Open CV Library is used to implement the algorithm. The hardware is a Texas Instruments (TI) DM3730
based system on chip (SOC) low cost, low power single board computer system. The software developed is embedded on the hardware to
test retinal images for the detection of AMD. The algorithm has been tested with 55 normal and 45 glaucomatous images and has yielded
an accuracy of 94%.

Keywords : Glaucoma, Cup to Disc Ratio (CDR), Image processing, open CV.

1. Introduction One of the glaucomatous changes observed in the

Glaucoma is a group of progressive optic neuropathies
that have in common a slow progressive degeneration of
retinal ganglion cells (RGC) and their axons, resulting in a
distinct appearance to the optic nerve head (ONH), often
called ‘cupping’. Glaucoma is the second leading cause of
blindness. Central vision is often preserved until late in the
disease despite disabling loss of peripheral vision. This
damage is often linked with elevated intraocular pressure.
This damage to the ONH causes partial to full loss of the
visual field, which is the portion of space in which objects
are simultaneously visible inzthe steadily fixating eye.
Damage to the visual field is irreversible; however, the loss
can be transitory in the early stages of glaucoma. If the
condition is untreated the damage to the affected visual
field usually worsens and spreads eventually until complete
loss of vision may occur.
retinal fundus images of affected individuals is enlargement
of depression, called cupping, of optic disc and/or local rim
thinning. Although the ratio of the diameters of the cup and
Disc (CD Ratio) is a widely accepted index for the
assessment of cupping; its determination is often subjective
and may include considerable intra- and inter-reader
variations. The cup and disk areas play a vital role in
detection of the disease. For normal eye the cup to disc
ratio is bellow 0.3, and for Glaucoma eye Cup to Disk ratio
is greater than 0.3. For normal eye the rim to disc ratio is
greater than 0.7, whereas for the Glaucoma eye it is less
than 0.7. Based on this a quantitative analysis of
glaucomatous eye images are done. Retinal images are
captured by using special devices called ophthalmoscopes
also known as fundus scope. Each pixel in the fundus
image consists of three values namely red, green and blue,
each value being quantized to 256 levels. The retinal
images are cropped to cup and disk regions by ROI. After

*
Corresponding author. E-mail: rmanjulasri@gmail.com

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that image processing techniques are employed for image
enhancement and analysis.
Numbers of researcher have proposed different
techniques to identify cup and disc and to estimate Cup to
Disc ratio (CDR). G.C. Sekhar et al. expressed that optical
disc (OD) size in Ocular Hypertension(OHT) patients is
smaller compared to Primary Open angle
Glaucoma(POAG) patients and normals. The horizontal
and the vertical diameters were measured [1]. S.Sekhar et
al. used Hough transform to detect OD. To find the
contours of OD, a region of interest (ROI) is found from
the binary image obtained after pre-processing.
Morphological operations are used to calculate the
magnitude gradient for edge detection[2]. Mahdad Esmaeili
et al. efficient OD localization and segmentation are
important tasks in automated retinal screening. In this
digital curvelet transform (DCUT) of the enhanced retinal
image is taken and its coefficients are modified based on
the sparsity of curvelet coefficients to get probable location
of OD[3]. Rudiger Bock et al. proposed a novel automated
glaucoma detection system in which, Glaucoma Risk Index
calculation consists of three steps: pre-processing to
eliminate the disease independent variations from the input
image, Feature Extraction by Principle Component
Analysis (PCA) to transform the pre-processed input data
to characteristic and compact representation, and a two-
stage probabilistic SVM classifier to generate the
Glaucoma Risk Index[4]. R. Chrastek et al. Author in this
paper presented a method for optic nerve head
segmentation and its validation. The method is based on
morphological operations, Hough transform, and an
anchored active contour model[5]. Gopal Dat Joshi et al. In
this paper author described Glaucoma detection by
calculating cup to disc ratio (CDR). Morphological
operations and Hough transform are applied to detect the
OD[6]. Meindert Niemeijer et.al, implemented a fast
method to detect the position of the optic disc and the fovea
in retinal images [7]. Jaeyoung Kim et.al, implemented
real-time image processing program using OpenCV library
for Apple’s iPhone4, smart mobile phone [8]. Sopharak
et.al, implemented detection of OD based on entropy filter
[9]. Rashid Jalal Qureshi et.al, implemented a combination
of the different algorithms for the detection of OD and
Macula [10]. Aby P.K et.al, implemented image processing
algorithms on DM3730 for face detection applications [11].
Shifeng Hu, proposed a driver fatigue eye features
detection algorithm based on OpenCV, Hiroki Sugano in
his paper, proposed a parallel implementation of
morphological processing optimized for Cell Broadband
Engine [12]. sIvan Culjak et al, in their paper described
many computer vision algorithms to make a reader familiar
with OpenCV and presented many basic and popular
Computer Vision algorithms, along with many key
references for an interested reader to pursue further
details[14].
Slavomir Matuska et al, in their paper presented basic
algorithm for image processing, focusing for their CPU
time consumption in Matlab and OpenCV. Results showed
that OpenCV is faster than Matlab in some algorithm from
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4 to 30 times and in case of Erosion algorithm up to 100
times. On the other hand, Matlab environment is relative
simply and friendly to use, and provides various sort of
function and algorithm. It isn’t necessary to care about
memory allocation and memory leak in Matlab, but it is
very important task in OpenCV. This allocation and
releasing memory inserts lines into the code. Matlab needs
for smoothing algorithm 2 lines, but OpenCv needs 5 lines
to write source code with the same functionality[15]. Raida
Hentati and Mohamed Abid focused on iris recognition
algorithm. First, the OSIRIS system in order to have a new
algorithm independent to the OpenCV library, and added
the pre-processing module to improve the performance of
the OSIRIS system. Then implemented OSIRIS (Open
Source for IRIS) system. For this a development board with
a Cyclone II FPGA device is used. The experimental
results show that, the segmentation module and the feature
extraction module require more time. The proposal to
achieve a mixed implementation of the system in order to
increase the performances implement the step which has
the greater time execution in hardware using VHDL
language while the other parts in C++. The authors also
proposed to use co-design approach to implement the entire
algorithm. Jaeyoung Kim, Heesung Jun implemented real-
time image processing program using OpenCV library for
Apple’s iPhone4 smart mobile phone. The entire image
processing program can do various operations such as
thresholding, adaptive thresholding, edge detection and
contour detection. Convenient user interface was developed
using Objective-C and also implemented augmented reality
program on iPhone4. Shifeng Hu et al proposed a driver
fatigue eye features detection algorithm based on OpenCV
image processing and computer vision development
platform. These algorithms localize eye-area and detect its
state based on rough to accurate thought, and can localize
eye pupils in eye-open state accurately. Hiroki Sugano
Ryusuke Miyamoto described a parallel implementation of
morphological processing optimized for Cell Broadband
Engine. Authors applied several optimization techniques
suitable for Cell Architecture such as multiple SPEs
(Synergistic Processor Element), SIMD (Single Instruction
Multiple Data) operation, doubles buffering, and loop
unrolling. By this implementation, 3.2 GHz Cell using two
3.6 GHz SPEs can erode a 1024x768 pixel Image by a 5x5
pixel rectangle kernel in 0.601 milliseconds. Shen Khang
Teoh et al presented in their paper presented work on
implementing a human tracking system on both Intel based
PC platform and embedded systems to optimize the
algorithms for high performance. The algorithms are
benchmarked on the Intel platform processor and
BeagleBoard xM based on low-power Texas Intruments
(TI) DM3730 ARM processor. Functions and library in
OpenCV which developed by Intel Corporation was
utilized for building the human tracking algorithms.
2. Methodology
The proposed algorithm by the authors for the detection of
glaucoma localizes the optical disc and cup and estimates
the areas of cup and disc. The cup to disc ratio (CDR) is
used for the assessment of glaucoma. The algorithm is
initially implemented on LabVIEW platform [13] to enable
the algorithms on hardware the LabVIEW program is
converted to C. Then these C programs are replaced with
Open CV programs as the single board computer system
operates on open source Linux platform.
2. 1. Software Development
Figure1 shows the flowchart for the proposed algorithm
for detection of Glaucoma. Retinal images captured by
fundus scopes are considered as source images for the
proposed investigations. First the original image is pre-
processed. Pre-processing operations are employed for
improving the image quality (data) by suppressing
unwanted distortions and enhancing the image features
important for further processing. Pre-processing operations
include brightness transformations, geometric
transformations, local pre-processing gradient operation
and image restoration. Brightness transformations modify
pixel intensity. Geometric transforms permit the
elimination of geometric distortions that are introduced
during the process of image capture. Local pre-processing
(Smoothing) suppresses noise and other small intensity
fluctuations in the image; equivalent to the suppression of
high frequencies in the frequency domain. Gradient
operators suppress low frequencies in the frequency
domain.
Original Glaucoma Retinal Image
Preprocessing (Selecting the Region of
Interest, Re-sampling)
Pre-processing
(Green plane extraction,
Histogram equalization)
Elimination of blood vessels
(Dilation)
Identification of Cup and Disc and estimation of
their areas (Thresholding, Histogram)
Evaluation of CDR from the estimated areas
of Cup and Disc
Figure 1: Flowchart for the proposed algorithm
Local image smoothing effectively eliminates impulsive
noise or degradations appearing as thin stripes. Image
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restoration suppresses image degradation with proper
knowledge about its nature. Most image restoration
methods are based on convolution applied globally to the
whole image.
The proposed algorithm for the detection of glaucoma
employs localization of the optical disc and cup
automatically and measurement of the areas of cup and
disc. The cup to disc ratio (CDR) is estimated for the
assessment of glaucoma.
First, the retinal images are cropped at ONH (optical
nerve head) or cup and disc region of retina and re-sampled
to a standard resolution 256*256. Then histogram
equalization is applied to the cropped image, it redistributes
the pixel values of an image to linearize the accumulated
histogram. Next dilation is applied for elimination of blood
vessels from retinal image. Finally thresholding with
average intensity of Disc and Cup regions is applied to
identify Disc and Cup regions respectively. Application of
histogram calculation provides the areas of Disc and Cup.
Cropping refers to the removal of the outer parts of an
image to improve framing, accentuate subject matter or
change aspect ratio. The image is cropped for given number
(pixels) of right to left and top to bottom. The image
resolution depends on the original image resolution. The
cropped image size is 3 to 4 Kbytes.
Re-sampling is the mathematical technique used to
create a new version of the image with a different width
and/or height in pixels. Re-sampling in Picture Window is
performed by the Resize transformation. The Resize dialog
boxes displays the input image width, height and dpi
setting and specify the output image width, height, dpi
setting and re-sampling method. Changing the dpi setting
(resolution) does not affect the image data in any way, it is
simply a suggested scale factor that is associated with the
image to expedite printing or document the size of the
original subject. The nearest neighbour re-sampling is a
simple method that computes new pixels as the value of the
nearest pixel in the original image.
Histogram equalization is a common technique for
enhancing the appearance of images. An image which is
predominantly dark has its histogram skewed towards the
lower end of the grey scale and all the image detail is
compressed into the dark end of the histogram. If the grey
levels at the dark end are `stretch out' to produce a more
uniformly distributed histogram, then the image would
become much clearer. Histogram equalization involves
finding a grey scale transformation function that creates an
output image with a uniform histogram. Histogram
equalization is a method in image processing for contrast
adjustment using the image's histogram.
Histogram equalization accomplishes this by effectively
spreading out the most frequent intensity values.
Histogram equalization is useful in images with
backgrounds and foregrounds that are both bright or both
dark. A key advantage of this technique is that it is a fairly
straightforward and an invertible operator.
Dilation is one of the two basic operators in the area of
mathematical morphology, the other being erosion. It is
typically applied to binary images, but there are versions
that work on grayscale images. The basic effect of the
operator on a binary image is to gradually enlarge the
boundaries of regions of foreground pixels (i.e. white
pixels, typically). Thus areas of foreground pixels grow in
size while holes within those regions become smaller.
The dilation operator takes two pieces of data as inputs.
The first is the image which is to be dilated. The second is a
(usually small) set of coordinate points known as a
structuring element (also known as a kernel). It is this
structuring element that determines the precise effect of the
dilation on the input image. To compute the dilation of a
binary input image by this structuring element, for each
background pixel, the structuring element is superimposed
on top of the input image so that the origin of the
structuring element coincides with the input pixel position.
If atleast one pixel in the structuring element coincides with
a foreground pixel in the image underneath, then the input
pixel is set to the foreground value. If all the corresponding
pixels in the image are background, however, the input
pixel is left at the background value.
For our example 3×3 structuring element, the effect of
this operation is to set to the foreground color any
background pixels that have a neighboring foreground
pixel. Such pixels must lie at the edges of white regions,
and so the practical upshot is that foreground regions grow
(and holes inside a region shrink). Dilation is the dual of
erosion i.e. dilating foreground pixels is equivalent to
eroding the background pixels.
Thresholding is the simplest method of
image segmentation. From a gray scale image, thresholding
can be used to create binary images. Thresholding an image
means transforming all pixels into two intensity values
only. This is the special type of quantization comparing the
pixel values with a given threshold value. Thresholding
makes output image with only two values that is 0 and 255
for 8bit gray level image.
0, if I(r) <=T
J(r) =
255, if I(r) > T
I(r) is the color level for the input pixel (r) and J(r) is the
color level for the output pixel(r) and 0 ≤ T ≤ 255.
Localization of cup and disc is done by applying
threshold technique.To locate the cup, average intensity
(bright) in the cup region is chosen as the threshold
intensity. All the pixels above the threshold intensity are
converted to dark (0 intensity).The pixels with intensity
below threshold intensity are converted to bright pixels
(255 intensity) and are identified as Cup region.
Application of histogram gives the area of the
cup.Similarly for identification of the Disc, average
intensity in the disc region is chosen as threshold. All the
pixels below this threshold intensity are converted to bright
pixels, when threshold is applied.This region is identified
as disc and histogram provides the area of the disc.
The areas of cup and disc are measured and their ratios
(CDR) are estimated. The magnitude of CDR gives an
assessment of the severity of Glaucoma.
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2.2. Hardware
The hardware is DM3730 SOC based low cost low
power single board computer system .The block diagram of
the hardware is presented in figure2. DM3730 is a multi
core processor that consists of ARM cortex A8 and a
TMS320DMC64X+ Digital Signal Processor (DSP). The
single board system (Beagle board) has many extensible
interfaces for the implementation of detection of retinal
diseases. An LCD of 4.7 inch in size with 800x400
resolution. Micro SD of 4GB and the high speed USB hub
are used for display, data storage and for external input-
output devices. The source images are acquired from
fundus scope interfaced to one of the USB port. The
database as well as the application programs resides in SD
card memory.
Figure 2: Block diagram of the hardware
3. Implementation
3.1. Embedded software
The single board computer system operates on open
source Linux platform .Hence the algorithms developed are
implemented with open Cv libraries.The OpenCV libraries
and functions used to develop the algorithm are descibed
bellow:
cvLoadimage is used to load an image from a file.
cvEqualizeHist is normalizes brightness and increases
contrast of the image. cvCalcHist is used to Calculate and
Plot the equalized histogram of an image. cvDilate is used
to Dilate (enlargement or expansion) the source image using
the specified structuring element that determines the shape
of a pixel neighborhood over which the maximum is taken
The function supports the in-place mode. Dilation can be
applied several (iterations) times. cvFloodFill is used to fill
a connected component with the same intensity. cv
ShowImage is used to display the image in specified
window. cvSaveImage is used to Saves an image to a
specified file.
3.2. Hardware implementation Normal Image Glaucoma image
The implementation of the proposed algorithm employ
three steps cropping of an original image, pre-processing of (a)
cropped image and identification of cup and disc and their
areas. Detection of cup and disc are presented in figure 3,
figure 4 and figure 5 during the execution of the program.
Histogram calculation of the selected region (cup and Disc)
provides the area in terms of pixels.

(b)

(c)

(a) (b)

Figure3: (a)original and (b)cropped images

(d)

(a) (b)
(e)
Figure 4: (a) Histogram equalization, (b) Morphological Dilation

(f)

Figure 5: Disc and Cup identification

Figure 7: (a)original image, (b) cropped image, (c) histogram
equalization, (d) Morphology(dilation), (e) thresholding with Disc
intensity (f) thresholding with cup intensity

4. Results
The algorithm has been applied to retinal images of 45
glaucomatous and 55 normal eyes from open source
DRIVE data base as well as data base from local Hospitals.
The algorithm has yielded an accuracy of 94%. The
statistical results of few cases are shown in Table1.The
results are compared with results of circle fit techniques
employed in the earlier research. The resultant images after
every step of the algorithm for all these cases are shown in
the figure 7.
5. Conclusion
The algorithm has been tested with DRIVE data set and
clinical images. 94% of the images tested matched with the
ophthalmologist’s reports. The objective of developing this
simple embedded system is to provide screening system for
identifying retinal diseases at low cost. More over this
system can be duplicated for number of villages with
network connectivity; any trained technician can
communicate with expert for advice.

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