Microaneurysm detection with radon transform-based classification on retina images.

The creation of an automatic diabetic retinopathy screening system using retina cameras is currently receiving considerable interest in the medical imaging community. The detection of microaneurysms is a key element in this effort. In this work, we propose a new microaneurysms segmentation technique based on a novel application of the radon transform, which is able to identify these lesions without any previous knowledge of the retina morphological features and with minimal image preprocessing. The algorithm has been evaluated on the Retinopathy Online Challenge public dataset, and its performance compares with the best current techniques. The performance is particularly good at low false positive ratios, which makes it an ideal candidate for diabetic retinopathy screening systems.

Automatic detection of retina disease: robustness to image quality and localization of anatomy structure.

The automated detection of diabetic retinopathy and other eye diseases in images of the retina has great promise as a low-cost method for broad-based screening. Many systems in the literature which perform automated detection include a quality estimation step and physiological feature detection, including the vascular tree and the optic nerve / macula location. In this work, we study the robustness of an automated disease detection method with respect to the accuracy of the optic nerve location and the quality of the images obtained as judged by a quality estimation algorithm. The detection algorithm features microaneurysm and exudate detection followed by feature extraction on the detected population to describe the overall retina image. Labeled images of retinas ground-truthed to disease states are used to train a supervised learning algorithm to identify the disease state of the retina image and exam set. Under the restrictions of high confidence optic nerve detections and good quality imagery, the system achieves a sensitivity and specificity of 94.8% and 78.7% with area-under-curve of 95.3%. Analysis of the effect of constraining quality and the distinction between mild non-proliferative diabetic retinopathy, normal retina images, and more severe disease states is included.

Statistical characterization and segmentation of drusen in fundus images.

Age related Macular Degeneration (AMD) is a disease of the retina associated with aging. AMD progression in patients is characterized by drusen, pigmentation changes, and geographic atrophy, which can be seen using fundus imagery. The level of AMD is characterized by standard scaling methods, which can be somewhat subjective in practice. In this work we propose a statistical image processing approach to segment drusen with the ultimate goal of characterizing the AMD progression in a data set of longitudinal images. The method characterizes retinal structures with a statistical model of the colors in the retina image. When comparing the segmentation results of the method between longitudinal images with known AMD progression and those without, the method detects progression in our longitudinal data set with an area under the receiver operating characteristics curve of 0.99.

Geographic atrophy segmentation in infrared and autofluorescent retina images using supervised learning.

Geographic Atrophy (GA) of the retinal pigment epithelium (RPE) is an advanced form of atrophic age-related macular degeneration (AMD) and is responsible for about 20% of AMD-related legal blindness in the United States. Two different imaging modalities for retinas, infrared imaging and autofluorescence imaging, serve as interesting complimentary technologies for highlighting GA. In this work we explore the use of neural network classifiers in performing segmentation of GA in registered infrared (IR) and autofluorescence (AF) images. Our segmentation achieved a performance level of 82.5% sensitivity and 92.9% specificity on a per-pixel basis using hold-one-out validation testing. The algorithm, feature extraction, data set and experimental results are discussed and shown.

Practical considerations for optic nerve location in telemedicine.

The projected increase in diabetes in the United States and worldwide has created a need for broad-based, inexpensive screening for diabetic retinopathy (DR), an eye disease which can lead to vision impairment. A telemedicine network with retina cameras and automated quality control, physiological feature location, and lesion / anomaly detection is a low-cost way of achieving broad-based screening. In this work we report on the effect of quality estimation on an optic nerve (ON) detection method with a confidence metric. We report on an improvement of the method using a data set from an ophthalmologist practice then show the results of the method as a function of image quality on a set of images from an on-line telemedicine network collected in Spring 2009 and another broad-based screening program. We show that the fusion method, combined with quality estimation processing, can improve detection performance and also provide a method for utilizing a physician-in-the-loop for images that may exceed the capabilities of automated processing.

Elliptical local vessel density: a fast and robust quality metric for retinal images.

A great effort of the research community is geared towards the creation of an automatic screening system able to promptly detect diabetic retinopathy with the use of fundus cameras. In addition, there are some documented approaches for automatically judging the image quality. We propose a new set of features independent of field of view or resolution to describe the morphology of the patient's vessels. Our initial results suggest that these features can be used to estimate the image quality in a time one order of magnitude shorter than previous techniques.

Comparative analysis of the uptake and expression of plasmid vectors in human ciliary and retinal pigment epithelial cells in vitro.

The retinal pigment epithelium is uniquely suited to gene therapy that uses lipid-mediated DNA transfer due to its high phagocytic activity in situ. We compared the relative efficacy of phagocytosis on the uptake of labeled plasmid vectors by retinal pigment epithelial and ciliary epithelial cells in vitro. Relative levels of endocytosis were then compared with the efficiency of marker transgene expression in these cells. Human retinal pigment epithelial and ciliary epithelial cells from a single donor were isolated and expanded in vitro. Polyplex-mediated transfections were performed using a rhodamine-labeled expression vector for green fluorescent protein. Rhodamine-labeled endosomes were examined by fluorescence microscopy at different time points. Rhodamine labeling and green fluorescent protein expression were analyzed by flow cytometry 48 h after transfection. These gene transfer studies showed that expression of transgenes does occur in both human retinal pigment epithelial and ciliary epithelial cells in vitro. Endocytosis of labeled plasmid vectors occurs at a significantly higher number and density in retinal pigment epithelial cells than in ciliary epithelial cells (P < 0.04). However, the efficiency of marker transgene expression is similar in the two cell types. These studies demonstrate that the higher intrinsic phagocytic activity does not enhance the efficacy of transgene expression in retinal pigment epithelial cells in vitro. Both human retinal pigment epithelial and ciliary epithelial cells are competent recipients for lipid-mediated gene transfer, and transgene expression occurs at similar levels in both cell types.

Nerve fiber bundle visual field defect resulting from a giant peripapillary cotton-wool spot.

Cotton-wool spots are the clinical manifestation of focal infarcts of the retinal nerve fiber layer. They rarely cause significant visual field loss. A large idiopathic cotton-wool spot in a 34-year-old healthy woman caused a nerve fiber bundle visual field defect and an afferent pupillary defect that remained after the cotton-wool spot had disappeared and the retina and optic nerve appeared normal.

Polyplex-mediated gene transfer into human retinal pigment epithelial cells in vitro.

The human retinal pigment epithelium (RPE) is a potential target tissue for directed transfer of candidate genes to treat age-related macular degeneration (AMD). The RPE is uniquely suited to gene therapy protocols that use liposome-mediated DNA transfer because of its high intrinsic phagocytic function in vivo. In these studies, we examined the efficacy of human RPE cell uptake and expression of the green fluorescent protein (GFP) and neomycin resistance marker genes by polyplex-mediated gene transfer in vitro. The effects of varying DNA and polyplex concentration and ratios on GFP transgene expression were examined. A narrow range of experimental conditions were found to maximize transgene expression; most important were the DNA concentration and the DNA:polyplex ratio. The transfection efficiency for human RPE cells was reproducibly 20% in vitro by this method and reached a maximum level of expression after 48 h. There was a rapid decline in gene expression over 2 weeks following polyplex-mediated gene transfer, but stable integration does occur at low frequencies with and without selection.

Molecular and cytologic analysis of DNA amplification in retinoblastoma.

Amplification of two distinct genomic DNA segments is observed in homogeneously staining regions in two sets of retinoblastoma cell lines derived from two different patients. One DNA segment was known to have sequence homology to the c-myc oncogene, and both DNA segments had previously been shown to be amplified in neuroblastoma cells. The absolute degree of amplification differed in all cytogenetically distinct retinoblastoma cell lines tested. Also, the relative amplification of these two DNA segments was unequal within a given cell line. Minimal amplification of both DNA segments was also detected in DNA directly isolated from one primary retinoblastoma. Based on these and previous results, it is concluded that assembly of amplifiable, relocatable units in many human retinoblastoma and neuroblastoma cells may involve a complex process of differential recruitment of separate DNA segments that are located on human chromosome #2.

Bleomycin-induced chromosome breakage in G2 lymphocytes of retinoblastoma patients.

Retinoblastoma (Rb) cells may be more sensitive to X-irradiation than normal cells when assayed for clonogenic survival, suggesting that such sensitivity can be used as a trait for detecting RB1 gene carriers. We studied induction of chromosome damage in lymphocytes from patients with Rb by the radiomimetic antineoplastic antibiotic, bleomycin (BL). Lymphocytes were treated in G2 for 4 h at four concentrations of the drug (0.0, 0.3, 0.9, and 2.7 micrograms/ml), and chromosome damage was evaluated. No difference in levels of spontaneous or induced damage was detected among hereditary Rb, non-hereditary Rb, and normal lymphocytes. The role of X-ray treatment in the induction of second tumors in Rb patients is discussed.

Cytogenetic analysis of retinoblastoma: evidence for multifocal origin and in vivo gene amplification.

Retinoblastoma (Rb) is an uncommon childhood tumor of the neural retina with a significant genetic component in its etiology. A small proportion of patients have a deletion in chromosome 13 encompassing band 13q14, an observation which permitted the assignment of the RB1 locus to this region. About 20% of Rb tumors exhibit microscopic deletions of band 13q14 or monosomy 13. Trisomy 1q and i(6p) have also been reported in a high percentage of tumors. We analyzed the chromosome complements from direct preparations of 10 Rb tumors derived from seven patients. Modal chromosome numbers ranged from 45 to 48, and occasional duplications of the genomes were noted. In general, the tumors were chromosomally stable, although karyotypic evolution and random chromosome loss were encountered. Consistent abnormalities included trisomy 1q, i(6p), 6q-, and del(13)(q12----14). One patient with bilateral Rb had three tumor clones (two in one eye and one in the other) with chromosome abnormalities unrelated in origin. A second patient with unilateral Rb had two tumor clones with chromosome abnormalities again unrelated in origin. These two patients provide some of the first cytogenetic evidence for the multifocal origin of primary Rb. In the untreated tumor of a third patient, a homogeneously staining region (HSR) was detected in 1p32, indicating gene amplication in vivo; previously, an HSR at this site has been reported in the established Rb cell line Y79.