Eminent identification and classification of Diabetic Retinopathy
in clinical fundus images using Probabilistic Neural Network
Vishnuvarthanan Govindaraj
Associate professor & Head
Department of Biomedical Engineering
Kalasalingam Academy of Research and Education
Krishnankoil, India.
gvvarthanan@gmail.com
Thamimul Ansari Mohideen
Department of Biomedical Engineering
Kalasalingam Academy of Research and Education
Krishnankoil, India.
ansarimohideen786@hotmail.com
Abstract— Diabetic retinopathy occurs due to increased
risk at the eye via swelling and occurrence of abnormalities
in blood vessels. Years ago, several methods have been
implemented to detect the Diabetic Retinopathy (DR), but
there is a lack of efficiency over the traditional methods that
utilize unsupervised algorithms. Recently, neural networks
play a prominent role in several technological applications
such as image recognition and semantic analysis, which have
also been utilized for portraying the DR. In our proposed
methodology, an innovative framework has been
implemented to overcome the issues of traditional
methodology in identifying the DR. Initially, an input image
is acquired from the dataset. Then the preprocessing is
performed where the image resizing and the double
conversion is carried out and next to this, image
segmentation processes such as morphology and
thresholding-based operations are performed. The GLCM -
an effective feature is chosen for extracting the features with
the co-occurrence matrix and Probabilistic Neural Network
is chosen for classification purpose it’s an effective classifier
comparing to other neural network. This helps to identify
the diabetic retinopathy and its severity level. It is
concluded that this novel vessel segmentation framework
acquired better accuracy, sensitivity, F-measures,
specificity and precision for the fundus-based DR images.
Index Terms— Image Processing, Diabetic Retinopathy,
Morphological Operation, Thresholding, Grey Level Co-
occurrence Matrix, Probabilistic Neural Network.
I. INTRODUCTION
A recent survey shows that a huge number of people
are affected by the diabetic retinopathy which is the main reason
for carrying out several research in this field to find the
precaution measures. Why people are not bothering about their
diabetes? Sometimes people are not taking much care even they
are conscious about their diabetes which leads to death. Since
many years, diabetes is treated as a common disease in the view
of people those who are not having much awareness about
diabetes. So, the government decided to possess several camps
in remote areas to take safety measures to those people affected
by diabetes.
Mirthula Balaji
Department of Biomedical Engineering
Kalasalingam Academy of Research and Education
Krishnankoil, India.
mirthulamirthu1996@gmail.com
Syed Ali Fathima Jamal Mohideen
Department of Biomedical Engineering
Kalasalingam Academy of Research and Education
Krishnankoil, India.
syedalifathima663@gmail.com
Diabetes affected patients are sometimes in a higher risk that
may cause diabetic retinopathy and other severe health related
diseases. Earlier detection of diabetic retinopathy is useful for
doctors to start the treatment as earlier in preventing visual loss.
In the year 2030, 552 million persons will be affected by
diabetes [1] all over the world. In that partial number of people
will be affected by diabetic retinopathy and it will be impossible
to provide eye care to them. The author in this study examined
the telemedicine programs and found that it has the ability to
take eye care anywhere and also addresses the lack of access to
ophthalmic services.
Diabetic retinopathy occurs due to the changes in retinal
blood vessels such as irregular new blood vessels occurrence or
leakage of the blood vessels. Diabetic retinopathy eye disease is
harmful, which leads to stress in the eye nerve fiber.
Consequently, it is vital to identify it at earlier stages. The eye is
a furthermost significant organ for human being; it aids them to
intellect the color, shape, and state of physical substances. But
eye contaminations alike Fungous Keratitis, fungus Aspergillus
in the corneal deposits is some of the foremost reasons for
impaired vision.
The digital images are detected and identified by using
the image recognition process. The diabetic eye diseases are
referred to as diabetic retinopathy (DR) and it leads to
blindness. A Computer Aided Diagnosis (CAD) is one of the
computerized frameworks that ensembles computer vision and
machine learning approaches to diagnose the DR. There may be
modifications over the changes of image intensities, tissues, and
abnormalities during the reading process of images.
Henceforth, the ophthalmologist’s burdens are pointedly
reduced with the use of CAD. Early detection of DR through
identification and classification of microaneurysms by using an
effective three-stage system is receiving most welcome as of
now. Diagnosing the DR using CAD facilitates an
ophthalmologist to automatically detect the presence of
exudates of retinal images. Exudates are diagnosed by using
back propagation algorithm with an efficient neural network
approach.
 Currently, a greater number of programs reliant on
particularly skilled retinal image graders a short supply resource
in wide-reaching. Above f e a t u r e s required an automation
process over image grading for increasing the speed of retinal
image evaluation during the maintenance of accuracy and cost-
effectiveness. Telemedicine has been widely developed and it
has been commercially available through designing a number
of automatic retinal image analysis systems. Thus, with this
system, there is an improvement in the way of delivering
diabetes eye care through providing an automatic actual
assessment to accelerate analysis and recommendation is
essential. Moreover, incorporation with electronic medical
records permit a more accurate prediction of separate patients
and provide a predictive representative of medical risk factors.
The remaining sections of this research paper are
organized as follows: section II gives a detailed review about
the traditional works that are related to the identification of
diabetic retinopathy in an automated manner. Section III
describes the working procedure of the proposed approach
elaborately. Section IV evaluates the performance of the
proposed approach and compared with the existing approaches.
Finally, this research work is concluded in section V.
II. RELATED WORKS
In this subdivision, various traditional approaches that
are related to the detection of diabetic retinopathy using deep
learning in image preprocessing is surveyed and presented
with their merits and demerits. [3] In order to avoid blindness,
a pre-screening MCA approach was utilized to evaluate
whether the superiority of retinal images is acceptable or not.
If the quality of a retinal image is not acceptable, then the
patient must concern the ophthalmologist and recollected
again whenever it is required. If not, the quality of the retinal
image causes detection. The experimental result of proposed
system uses Messidor dataset to calculate sensitivity and
specificity of retinal image achieves better results than the
existing system of diabetic retinopathy. [1] suggested an
analysis of the automated retinal image for diabetic
retinopathy in telemedicine programs to allocate the quality of
eye care at any location effectively and report the deficiency of
ophthalmic services. According to the status of the population,
some of the individuals in diabetic retinopathy had been
created that causes a severe problem in diabetes eye care that
needs to be provided and rectified at a certain period of time.
An automatic retinal image analysis system utilizes
integration along with electronic medical records to provide
more accurate prognostication of particular patient which
depends on broad population data. [4] proposed the
progression as well as evaluation of a deep learning system for
diabetic retinopathy and diseases that were related to the eye by
utilizing images from multiethnic populations with diabetes to
evaluate the performance of deep learning system for
detecting various retinal diseases. [5] elucidated a deep
learning approach for the detection of diabetic retinopathy in
retinal fundus images to relate referable diabetic retinopathy
technique for the identification of diabetic macular edema as
well as diabetic retinopathy in retinal fundus photographs
depending upon the several references of ophthalmologist
decision panel. It further helped to determine feasibility
settings of ophthalmologic clinic assessment in deep learning
methods [6].
proposed an automated diabetic retinopathy screening and
monitoring using retinal fundus image analysis to evaluate the
color retinal fundus image of ophthalmology patients. Diabetic
retinopathy introduces microaneurysm method to arrange retinal
images in sequential order for several types of diabetic patients
under both type 1 and type2 that need to be detected and
rectified.[7] proposed an automated screening for diabetic
retinopathy using deep learning network to prevent and screen
the blindness of retinal fundus eye image for the diabetic patient.
A squeeze Net- based deep learning network was proposed
mainly by the clinician to hold and access diabetic retinopathy
records for certain patients by using deep learning methods.
Diabetic retinopathy is defined as a chronic condition through
which several people in the world gets suffered that causes eye
blindness of a retinal patient [8]. Proposed the feature selection for
the identification of DR by using a hybrid approach. Initially, the
input image preprocessed by using a median filter and the green
channel extraction. [9] proposed the computer-aided automatic
screening scheme for Diabetic Retinopathy (DR). It was
diagnosed by detecting the hemorrhages in the retinal images and
considering the relationship with the fovea region. The retinal
image classification system was enhanced by using the multi-
resolution Gabor transform, directional local histogram
equalization, feature extraction, and Support Vector Machine
(SVM) Classifier. It was used to classify the retinal fundus
images towards the normal or the abnormal retinal images for the
DR diagnosis system. In the fovea and hemorrhages detection,
the fovea referred to as the middle of the macula, which was
analyzed the DR severity. The hemorrhages in the retinal images
were detected and segmented by the following stages, initially,
each retinal image was pre-processed with the parting of RGB
channel. The pixel with maximum intensity value was selected
and each pixel of the image was subtracted from that value to
found the original retinal image. The adaptive histogram
equalization was used to the original image to acquiring an
equalized image. At the final stage, the morphological operations
were performed on the histogram equalized image with disc
structuring element. The DR severity was divided into mild,
moderate and severe. Moderate DR was the reason for starting of
blindness and the severe DR was led to blindness. The high true
positive rate was attained by using the retinal fundus image
classification system on both normal and abnormal retinal
images. The high sensitivity and specificity also attained by the
proposed system for hemorrhages detection. The proposed
system was used to detect the hemorrhages and analyzed the
severity of DR. It was designed to prevent the vision loss for
diabetic patients at an earlier stage. [10] described a novel
automated detection of the Proliferative DR based on the dual
classification and modified line operator. The major advantage
of the proposed method in the retinal image analysis that the
detection of new vessels, while reducing false responses from the
retinal features. The local contrast was enhanced by Contrast
Limited Adaptive Histogram Equalization (CLAHE) [11]. The
accuracy of the automated detection of the PDR based on the dual
classification and modified line operator were improved.
Several existing types of research utilized an
unsupervised methods category, in that leading algorithms are
vessel tracking, matched filtering and model-based algorithms
morphological transformations.
 A matched filtering-based method, a 2-D linear
structuring element is utilized for extracting a Gaussian
intensity outline of the retinal blood vessels[2], via for vessel
enhancement, Gaussians and their derivatives. In existing
research work, the structuring element is revolved 8–12 times to
fitting the vessels in different outlines for extracting the vessel
boundaries. There are several drawbacks in existing
methodologies that are specified as time consumption on
segmentation, less reliability, inefficient accuracy. And also,
high time complexity as an ending measure is assessed for each
end pixel. This traditional method agonizes from over detection (a) (b)
of blood vessel pixels because of the huge number of false
edges. (a) Input Image (b) Enhanced Image
In order to overcome all those aforementioned Fig. 1 Preprocessed Images.
drawbacks, the new retinal vessel segmentation approach B. Segmentation
related to a modest version of a 2nd-order locally adaptive
derivative has been proposed. Whilst comparing this to the The segmentation of blood vessels in the retinal image plays a
existing method, our proposed method performed well and it significant role in diagnosing eye diseases. In this work, the
evades a full Laplacian computation in vessel enhancements process of segmentation is carried out using Morphological and
(geometric diffusions) give the impression. In this approach, thresholding-based segmentation approach.
three major things are involved at first the image is undergone
for the process of preprocessing, then the binary conversion is
carried out by the effective morphological operation.
The main objectives of this research work are:
• To remove the noise efficiently, preprocessing uses
image resizing and double conversion.
• Effective Image segmentation is carried out where the
morphological and thresholding operation is involved
to segment an image in an effective manner.
• The feature extraction takes place with the use of
GLCM to extracting the features.
• To enhance the classification accuracy, PNN classifier
is utilizer which yields better classification output for
detecting diabetic retinopathy.

III. PROPOSED WORK

In this section, the working procedure of the proposed
methodology is discussed. The diagrammatic representation of
this proposed approach is shown in fig. 1. In this proposed
methodology, the input fundus image is initially taken from the
dataset [15]. The input image is then resized and converted into
a double in the preprocessing step. Then the preprocessed image
is segmented using morphological and thresholding-based
segmentation approach. From the segmented image, the
features are extracted and classified using Probabilistic Neural
Network. This helps to identify the diabetic retinopathy and its
severity level.
A. Preprocessing
The initial step of any vision system is the image acquisition
which is the digitization and storage of an image. The input
retinal image is taken from the dataset and is preprocessed to
obtain an enhanced image. For this purpose, the process of
resizing and double conversion is carried out in this step. Here
the process of scaling is referred to as resizing of the input
image. The exaggeration of digital material is termed as
resolution enhancement or upscaling.
Fig. 2 proposed methodology
 Edges are pixels wherever intensity fluctuates sharply. There
are several edge detectors like Prewitt, Sobel, Robert, Canny
etc. In this work detection of an edge is performed by means of
morphological attitude. Modest morphological operators are
utilized for the purpose of segmentation. Standard logic
operation utilized in image processing are AND, OR and NOT.
NOT is the admiring process. Logic processes like AND, OR
are accomplished on a pixel by pixel source among equivalent
pixels of two or more images. NOR operation is achieved on
the pixel of a single image. A Complimentary process adapts
the obscure pixel into white and the white pixel to black.
Initially, the complementary image of the pre-processed image
is engaged. The morphological operations consist of these steps
such as structuring the element, erosion, dilation, closing,
opening, edge detection, morphological reconstruction.
Threshold-based image segmentation is relatively modest
however the segmenting images with the influential method is
based on image- space region i.e. features of the image. The
images consuming light objects on the darker background is
taken into account for this method. Thresholding algorithm is
used to select the appropriate threshold value T for dividing the
image’s pixels into numerous classes and individual objects
from the background.
(a) Extracted Blood vessel (b) Optimized Image
(c) Masked OD (d) Region of Interest
Fig. 3 Extracted Outputs
C. Feature Extraction
The segmented images are then utilized for extracting
the features which help to identify the diabetic retinopathy.
Generally, the texture features can be modeled as a 2D array of
gray level variation for feature extraction. The image texture
pattern is found by employing a pattern matrix which is referred
to as the Gray Level Co-occurrence Matrix (GLCM) [12].
GLCM is a classic method in texture analysis. In this approach,
the
statistical patterns are extracted for the gray values. For this
reason, GLCM is utilized in our work for extracting the texture
features of the affected region. The grey level co-occurrence
matrix comprises the pixel position information which is taking
the same values of the grey level matrix. It is a two- dimensional
array at which the column and row depict the set of probable
values of that image. This process is realistic to mine the color
and surface features of the image. The extraction of 12 different
statistical features is performed from the obtained co-occurrence
matrix. The texture features like autocorrelation, inverse
different moment, Entropy, Energy, Homogeneity, the sum of
squares, Dissimilarity, cluster prominence, correlation, cluster
prominence, Maximum probability, Inverse different moment,
and Contrast are extracted.
(a) Optic Disk (b) Exudates Disk
(c) Hemorrhages
Fig. 4 Segmented Outputs
D. Classification
From the extracted features, the process of classifying
the image as normal or abnormal is taking place. For this
purpose, the Probabilistic Neural Network (PNN) is utilized in
this work. PNN classifier is an extension of the neural network
which is capable of approximating the Bayes classifier and
convergence to Bayes-optimal decision surface. It also
estimates the similar probability density function for each class
based on their training samples. PNN includes four layers and
each layer is performing a particular function. Here, the input
pattern or feature vectors are present in the input layer and the
pattern layer which includes the vectors of the training set.
Moreover, the summation layer done with all approaches and
each possible classes is represented in the output layer. Also, it
classifies the data which comes from the summation layer.
IV. PERFORMANCE ANALYSIS
This section demonstrates the performance of the
proposed methodology. Here the performance is analyzed and
compared with various traditional approaches. Also, several
metrics are
 utilized for analyzing the performance of the proposed proposed PNN classifier offers better results in case of
approach. sensitivity and specificity.
120
A. Performance Measures

Performance values
100
The metrics such as sensitivity, specificity, precision,
80
recall, accuracy, and F-measures are utilized for analyzing the
performance of the proposed approach. They are described as 60
follows. 40
20
Sensitivity, Specificity, and Accuracy 0
Sensitivity is the proportion of true positives that are SVM LR DT KNN EB PNN
correctly identified by the classification technique. Similarly, Methods
specificity is the proportion of true negatives that are correctly
identified. Accuracy is measured by identifying the
Precision F measure
correctness of the classified results [13,14].

TP Fig. 6 Precision and Recall

Sensitivity  100% Fig. 6 illustrates the performance analysis of the proposed
TP  FN
 approach. Several existing techniques such as SVM, LR, DT,
TN
Specificity  100% KNN, and EB are used for comparing the performance of the
TN  FP
 TP  TN
proposed PNN classifier. From the graph, it is observed that the
Accuracy  *100%
proposed PNN classifier offers better results in case of precision

TP  FN  TN  FP
A. Precision, Recall and F-Score 100
The accuracy of the measure is further validated using 95
parameters like precision, recall, and F-score. Especially in a
Accuracy

statistical analysis of binary classification, F- measure is a test 90

accuracy. Moreover, the F-score is interpreted as a weighted
average of precision and recall. 85
TP 80
Precision (TP  FP)
 75


TP SVM LR DT KNN EB PNN

Recall 
Methods
(TP  FN)
precision.recall
F Score  2 * Fig. 7 Accuracy
precisionrecall Fig. 7 describes the accuracy obtained for the proposed
approach. Several existing techniques such as SVM, LR, DT,
B. Performance Analysis KNN and EB are used for comparing the performance of the
The performance of the proposed approach is analyzed proposed PNN classifier. From the graph, it is observed that the
and compared with the existing techniques. proposed PNN classifier offers the highest of 98% classification
120
accuracy. It reveals that the proposed approach has the greatest
capability to identify diabetic retinopathy in an accurate
Performance values

100
manner.
80
60 V. CONCLUSION
40 In this research methodology, the input fundus image is
20 initially taken from the dataset. The input image is then resized
0 and converted into a double in the preprocessing step. Then the
SVM LR DT KNN EB PNN preprocessed image is segmented using morphological and
Methods thresholding-based segmentation approach. From the
segmented image, the features are extracted and classified using
Sensitivity Specificity
Probabilistic Neural Network. This helps to identify the diabetic
retinopathy and its severity level. Finally, the performance of the
Fig. 5 Sensitivity and Specificity proposed approach is evaluated and compared with the
Fig. 5 depicts the comparative analysis of the proposed traditional approaches. This proposed approach better results
approach. Several existing techniques such as SVM, LR, DT, compared to the other techniques with an increased
KNN, and EB are used for comparing the performance of the classification accuracy of 98%. From the results, it is concluded
proposed PNN classifier. From the graph, it is observed that the that the proposed approach identifies the diabetic retinopathy
in the retinal images in an accurate manner
 [11]
than conventional techniques.
VI. FUTURE WORK
Future analysis in detection of diabetic retinopathy [12]
using deep learning method can reduce the medication
and the method is easy for the physician to diagnose. The
future work also develops the smart phone based diabetic [13]
retinopathy detection system. The alternate algorithms
are used in deep neural network method to increase the
efficiency of the output. Artificial intelligence method
can also have developed in detection of diabetic
retinopathy. The future work and development in [14]
diabetic retinopathy detection helps to reduce the risk
factor and also the time consumption.
ACKNOWLEDGMENT [15]
We would like to thank our institution and our
Department of Biomedical Engineering for giving this
valuable chance to gain knowledge and special thanks to our
professors and colleagues for supporting throughout this
paper. We also thank the Department of Electrical and
Electronics Engineering for providing the workspace for the
successful completion of this paper.
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Prasath, T. Unsupervised learning‐based clustering approach for smart
identification of pathologies and segmentation of tissues in brain magnetic
resonance imaging. International Journal of Imaging Systems and
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Kauppi, T., & Kalesnykiene, V. DIARETDB0-standard diabetic
retinopathy database, calibration level 0. IMAGERET project 2007.

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