- •Contents
- •1.1. Introduction to the Eye
- •1.2. The Anatomy of the Human Visual System
- •1.3. Neurons
- •1.4. Synapses
- •1.5. Vision — Sensory Transduction
- •1.6. Retinal Processing
- •1.7. Visual Processing in the Brain
- •1.8. Biological Vision and Computer Vision Algorithms
- •References
- •2.1. Introduction to Computational Methods for Feature Detection
- •2.2. Preprocessing Methods for Retinal Images
- •2.2.1. Illumination Effect Reduction
- •2.2.1.1. Non-linear brightness transform
- •2.2.2. Image Normalization and Enhancement
- •2.2.2.1. Color channel transformations
- •2.2.2.3. Local adaptive contrast enhancement
- •2.2.2.4. Histogram transformations
- •2.3. Segmentation Methods for Retinal Anatomy Detection and Localization
- •2.3.1. A Boundary Detection Methods
- •2.3.1.1. First-order difference operators
- •2.3.1.2. Second-order boundary detection
- •2.3.1.3. Canny edge detection
- •2.3.2. Edge Linkage Methods for Boundary Detection
- •2.3.2.1. Local neighborhood gradient thresholding
- •2.3.2.2. Morphological operations for edge link enhancement
- •2.3.2.3. Hough transform for edge linking
- •2.3.3. Thresholding for Image Segmentation
- •2.3.3.1. Segmentation with a single threshold
- •2.3.3.2. Multi-level thresholding
- •2.3.3.3. Windowed thresholding
- •2.3.4. Region-Based Methods for Image Segmentation
- •2.3.4.1. Region growing
- •2.3.4.2. Watershed segmentation
- •2.4.1. Statistical Features
- •2.4.1.1. Geometric descriptors
- •2.4.1.2. Texture features
- •2.4.1.3. Invariant moments
- •2.4.2. Data Transformations
- •2.4.2.1. Fourier descriptors
- •2.4.2.2. Principal component analysis (PCA)
- •2.4.3. Multiscale Features
- •2.4.3.1. Wavelet transform
- •2.4.3.2. Scale-space methods for feature extraction
- •2.5. Summary
- •References
- •3.1.1. EBM Process
- •3.1.2. Evidence-Based Medical Issues
- •3.1.3. Value-Based Evidence
- •3.2.1. Economic Evaluation
- •3.2.2. Decision Analysis Method
- •3.2.3. Advantages of Decision Analysis
- •3.2.4. Perspective in Decision Analysis
- •3.2.5. Decision Tree in Decision Analysis
- •3.3. Use of Information Technologies for Diagnosis in Ophthalmology
- •3.3.1. Data Mining in Ophthalmology
- •3.3.2. Graphical User Interface
- •3.4. Role of Computational System in Curing Disease of an Eye
- •3.4.1. Computational Decision Support System: Diabetic Retinopathy
- •3.4.1.1. Wavelet-based neural network23
- •3.4.1.2. Content-based image retrieval
- •3.4.2. Computational Decision Support System: Cataracts
- •3.4.2.2. K nearest neighbors
- •3.4.2.3. GUI of the system
- •3.4.3. Computational Decision Support System: Glaucoma
- •3.4.3.1. Using fuzzy logic
- •3.4.4. Computational Decision Support System: Blepharitis, Rosacea, Sjögren, and Dry Eyes
- •3.4.4.1. Utility of bleb imaging with anterior segment OCT in clinical decision making
- •3.4.4.2. Computational decision support system: RD
- •3.4.4.3. Role of computational system
- •3.4.5. Computational Decision Support System: Amblyopia
- •3.4.5.1. Role of computational decision support system in amblyopia
- •3.5. Conclusion
- •References
- •4.1. Introduction to Oxygen in the Retina
- •4.1.1. Microelectrode Methods
- •4.1.2. Phosphorescence Dye Method
- •4.1.3. Spectrographic Method
- •4.1.6. HSI Method
- •4.2. Experiment One
- •4.2.1. Methods and Materials
- •4.2.1.1. Animals
- •4.2.1.2. Systemic oxygen saturation
- •4.2.1.3. Intraocular pressure
- •4.2.1.4. Fundus camera
- •4.2.1.5. Hyperspectral imaging
- •4.2.1.6. Extraction of spectral curves
- •4.2.1.7. Mapping relative oxygen saturation
- •4.2.1.8. Relative saturation indices (RSIs)
- •4.2.2. Results
- •4.2.2.1. Spectral signatures
- •4.2.2.2. Oxygen breathing
- •4.2.2.3. Intraocular pressure
- •4.2.2.4. Responses to oxygen breathing
- •4.2.2.5. Responses to high IOP
- •4.2.3. Discussion
- •4.2.3.1. Pure oxygen breathing experiment
- •4.2.3.2. IOP perturbation experiment
- •4.2.3.3. Hyperspectral imaging
- •4.3. Experiment Two
- •4.3.1. Methods and Materials
- •4.3.1.1. Animals, anesthesia, blood pressure, and IOP perturbation
- •4.3.1.3. Spectral determinant of percentage oxygen saturation
- •4.3.1.5. Preparation and calibration of red blood cell suspensions
- •4.3.2. Results
- •4.3.2.2. Oxygen saturation of the ONH
- •4.3.3. Discussion
- •4.3.4. Conclusions
- •4.4. Experiment Three
- •4.4.1. Methods and Materials
- •4.4.1.1. Compliance testing
- •4.4.1.2. Hyperspectral imaging
- •4.4.1.3. Selection of ONH structures
- •4.4.1.4. Statistical methods
- •4.4.2. Results
- •4.4.2.1. Compliance testing
- •4.4.2.2. Blood spectra from ONH structures
- •4.4.2.3. Oxygen saturation of ONH structures
- •4.4.2.4. Oxygen saturation maps
- •4.4.3. Discussion
- •4.5. Experiment Four
- •4.5.1. Methods and Materials
- •4.5.2. Results
- •4.5.3. Discussion
- •4.6. Experiment Five
- •4.6.1. Methods and Materials
- •4.6.1.3. Automatic control point detection
- •4.6.1.4. Fused image optimization
- •4.7. Conclusion
- •References
- •5.1. Introduction to Thermography
- •5.2. Data Acquisition
- •5.3. Methods
- •5.3.1. Snake and GVF
- •5.3.2. Target Tracing Function and Genetic Algorithm
- •5.3.3. Locating Cornea
- •5.4. Results
- •5.5. Discussion
- •5.6. Conclusion
- •References
- •6.1. Introduction to Glaucoma
- •6.1.1. Glaucoma Types
- •6.1.1.1. Primary open-angle glaucoma
- •6.1.1.2. Angle-closure glaucoma
- •6.1.2. Diagnosis of Glaucoma
- •6.2. Materials and Methods
- •6.2.1. c/d Ratio
- •6.2.2. Measuring the Area of Blood Vessels
- •6.2.3. Measuring the ISNT Ratio
- •6.3. Results
- •6.4. Discussion
- •6.5. Conclusion
- •References
- •7.1. Introduction to Temperature Distribution
- •7.3. Mathematical Model
- •7.3.1. The Human Eye
- •7.3.2. The Eye Tumor
- •7.3.3. Governing Equations
- •7.3.4. Boundary Conditions
- •7.4. Material Properties
- •7.5. Numerical Scheme
- •7.5.1. Integro-Differential Equations
- •7.6. Results
- •7.6.1. Numerical Model
- •7.6.2. Case 1
- •7.6.3. Case 2
- •7.6.4. Discussion
- •7.7. Parametric Optimization
- •7.7.1. Analysis of Variance
- •7.7.2. Taguchi Method
- •7.7.3. Discussion
- •7.8. Concluding Remarks
- •References
- •8.1. Introduction to IR Thermography
- •8.2. Infrared Thermography and the Measured OST
- •8.3. The Acquisition of OST
- •8.3.1. Manual Measures
- •8.3.2. Semi-Automated and Fully Automated
- •8.4. Applications to Ocular Studies
- •8.4.1. On Ocular Physiologies
- •8.4.2. On Ocular Diseases and Surgery
- •8.5. Discussion
- •References
- •9.1. Introduction
- •9.1.1. Preprocessing
- •9.1.1.1. Shade correction
- •9.1.1.2. Hough transform
- •9.1.1.3. Top-hat transform
- •9.1.2. Image Segmentation
- •9.1.2.1. The region approach
- •9.1.2.2. The gradient-based method
- •9.1.2.3. Edge detection
- •9.1.2.3.2. The second-order derivative methods
- •9.1.2.3.3. The optimal edge detector
- •9.2. Image Registration
- •9.4. Automated, Integrated Image Analysis Systems
- •9.5. Conclusion
- •References
- •10.1. Introduction to Diabetic Retinopathy
- •10.2. Data Acquisition
- •10.3. Feature Extraction
- •10.3.1. Blood Vessel Detection
- •10.3.2. Exudates Detection
- •10.3.3. Hemorrhages Detection
- •10.3.4. Contrast
- •10.4.1. Backpropagation Algorithm
- •10.5. Results
- •10.6. Discussion
- •10.7. Conclusion
- •References
- •11.1. Related Studies
- •11.2.1. Encryption
- •11.3. Compression Technique
- •11.3.1. Huffman Coding
- •11.4. Error Control Coding
- •11.4.1. Hamming Codes
- •11.4.2. BCH Codes
- •11.4.3. Convolutional Codes
- •11.4.4. RS Codes14
- •11.4.5. Turbo Codes14
- •11.5. Results
- •11.5.1. Using Turbo Codes for Transmission of Retinal Fundus Image
- •11.6. Discussion
- •11.7. Conclusion
- •References
- •12.1. Introduction to Laser-Thermokeratoplasty (LTKP)
- •12.2. Characteristics of LTKP
- •12.3. Pulsed Laser
- •12.4. Continuous-Wave Laser
- •12.5. Mathematical Model
- •12.5.1. Model Description
- •12.5.2. Governing Equations
- •12.5.3. Initial-Boundary Conditions
- •12.6. Numerical Scheme
- •12.6.1. Integro-Differential Equation
- •12.7. Results
- •12.7.1. Pulsed Laser
- •12.7.2. Continuous-Wave Laser
- •12.7.3. Thermal Damage Assessment
- •12.8. Discussion
- •12.9. Concluding Remarks
- •References
- •13.1. Introduction to Optical Eye Modeling
- •13.1.1. Ocular Measurements for Optical Eye Modeling
- •13.1.1.1. Curvature, dimension, thickness, or distance parameters of ocular elements
- •13.1.1.2. Three-dimensional (3D) corneal topography
- •13.1.1.3. Crystalline lens parameters
- •13.1.1.4. Refractive index
- •13.1.1.5. Wavefront aberration
- •13.1.2. Eye Modeling Using Contemporary Optical Design Software
- •13.1.3. Optical Optimization and Merit Function
- •13.2. Personalized and Population-Based Eye Modeling
- •13.2.1. Customized Eye Modeling
- •13.2.1.1. Optimization to the refractive error
- •13.2.1.2. Optimization to the wavefront measurement
- •13.2.1.3. Tolerance analysis
- •13.2.2. Population-Based Eye Modeling
- •13.2.2.1. Accommodative eye modeling
- •13.2.2.2. Ametropic eye modeling
- •13.2.2.3. Modeling with consideration of ocular growth and aging
- •13.2.2.4. Modeling for disease development
- •13.2.3. Validation of Eye Models
- •13.2.3.1. Point spread function and modulation transfer function
- •13.2.3.2. Letter chart simulation
- •13.2.3.3. Night/day vision simulation
- •13.3. Other Modeling Considerations
- •13.3.1. Stiles Crawford Effect (SCE)
- •13.3.1.2. Other retinal properties
- •13.3.1.4. Optical opacity
- •13.4. Examples of Ophthalmic Simulations
- •13.4.1. Simulation of Retinoscopy Measurements with Eye Models
- •13.4.2. Simulation of PR
- •13.5. Conclusion
- •References
- •14.1. Network Infrastructure
- •14.1.1. System Requirements
- •14.1.2. Network Architecture Design
- •14.1.4. GUI Design
- •14.1.5. Performance Evaluation of the Network
- •14.2. Image Analysis
- •14.2.1. Vascular Tree Segmentation
- •14.2.2. Quality Assessment
- •14.2.3. ON Detection
- •14.2.4. Macula Localization
- •14.2.5. Lesion Segmentation
- •14.2.7. Patient Demographics and Statistical Outcomes
- •14.2.8. Disease State Assessment
- •14.2.9. Image QA
- •Acknowledgments
- •References
- •Index
Thomas P. Karnowski et al.
Fig. 14.3. Interfaces between the end-user clinic, the server, and referring physician.
14.1.4. GUI Design
The interface design in the ocular health network is composed of three parts: the client application GUI for the remote clinics, the physician web GUI, and the service GUI, as shown in the workflow chart in Fig. 14.3. In our web-based network, retinal images from diabetic patients are encrypted and transmitted from the fundus cameras at the primary care clinics to the diagnostic server using DICOM protocols. The retinal images are then graded to stratify disease level, recommend a management plan, and generate a report accessible to authorized users.
The client application GUI provides an interface for the regional primary care clinics for monitoring the data transmission and network status. The clinic acquires fundus images of the retina using VisuCam Pro NM (nonmydriatic) camera (Carl Zeiss Meditec). The client application GUI closely monitors the image exportation on the camera. New images are immediately encrypted, exported, and transmitted to the dedicated diagnostic server, along with patient metadata entries from the clinics. At the same time, the client application GUI constantly scans the network status, and reacts in real-time to prompt interactive information when connectivity issues occur.
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Automating the Diagnosis, Stratification, and Management of DR
After the images are submitted to the server, image processing and recognition procedures are triggered on the server to perform automated diagnosis. However, those procedures are transparent to the users. The procedures involved can be briefly described as the following: the submitted images are first subject to a QA to ensure adequacy for further analysis. Images that pass QA are put through the following steps: anatomical structure is analyzed, features are extracted, lesions are segmented, and a diagnosis is assigned according to the posterior probability, P(wi|v), of each defined disease state wi using a content-based image retrieval (CBIR) method that evaluates the retrieval response and stratifies the disease state as described below.
The server web GUI provides an interface for authorized access to the diagnostic result. For an ophthalmologist, the diagnostic result, together with the images and patient metadata are reviewed through the web GUI to confirm digital signature, encrypt sensitive information, and report to the referring physician. For a referring physician, the web GUI provides secure access to the diagnostic result, along with patient information. The server web GUI is accessed through fixed or mobile electronic devices if the GUI has browser access to the web.
The encrypted PDF report (Fig. 14.4) contains patient metadata, the fundus image from both eyes, the diagnosis and recommendation plan, encrypted and electronically signed by a confirming ophthalmologist. The report can be accessed by an authorized user through the web GUI, or as a password-protected e-mail attachment for the referring physician.
14.1.5. Performance Evaluation of the Network
The combination of rapid data transmission and high throughput is one of the key features of the telemedical network. To validate the performance of the designed network infrastructure, the average time from image acquisition to report generation is applied as a metric for performance evaluation. The following system response time is measured by observing 60 sessions of data transmission between a fundus camera in an active clinic and the diagnostic server located in the university server farm. In our implementation of the ocular telehealth diagnostic network, we provide the ophthalmologist with the ability to assign a diagnosis manually before the automatic diagnosis engine is fully incorporated into the system. In the current experiment, we
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