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      Deep Ensemble Learning Based Objective Grading of Macular Edema by Extracting Clinically Significant Findings from Fused Retinal Imaging Modalities

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          Abstract

          Macular edema (ME) is a retinal condition in which central vision of a patient is affected. ME leads to accumulation of fluid in the surrounding macular region resulting in a swollen macula. Optical coherence tomography (OCT) and the fundus photography are the two widely used retinal examination techniques that can effectively detect ME. Many researchers have utilized retinal fundus and OCT imaging for detecting ME. However, to the best of our knowledge, no work is found in the literature that fuses the findings from both retinal imaging modalities for the effective and more reliable diagnosis of ME. In this paper, we proposed an automated framework for the classification of ME and healthy eyes using retinal fundus and OCT scans. The proposed framework is based on deep ensemble learning where the input fundus and OCT scans are recognized through the deep convolutional neural network (CNN) and are processed accordingly. The processed scans are further passed to the second layer of the deep CNN model, which extracts the required feature descriptors from both images. The extracted descriptors are then concatenated together and are passed to the supervised hybrid classifier made through the ensemble of the artificial neural networks, support vector machines and naïve Bayes. The proposed framework has been trained on 73,791 retinal scans and is validated on 5100 scans of publicly available Zhang dataset and Rabbani dataset. The proposed framework achieved the accuracy of 94.33% for diagnosing ME and healthy subjects and achieved the mean dice coefficient of 0.9019 ± 0.04 for accurately extracting the retinal fluids, 0.7069 ± 0.11 for accurately extracting hard exudates and 0.8203 ± 0.03 for accurately extracting retinal blood vessels against the clinical markings.

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          A review of optical coherence tomography angiography (OCTA)

          Optical coherence tomography angiography (OCTA) is a new, non-invasive imaging technique that generates volumetric angiography images in a matter of seconds. This is a nascent technology with a potential wide applicability for retinal vascular disease. At present, level 1 evidence of the technology’s clinical applications doesn’t exist. In this paper, we introduce the technology, review the available English language publications regarding OCTA, and compare it with the current angiographic gold standards, fluorescein angiography (FA) and indocyanine green angiography (ICGA). Finally we summarize its potential application to retinal vascular diseases. OCTA is quick and non-invasive, and provides volumetric data with the clinical capability of specifically localizing and delineating pathology along with the ability to show both structural and blood flow information in tandem. Its current limitations include a relatively small field of view, inability to show leakage, and proclivity for image artifact due to patient movement/blinking. Published studies hint at OCTA’s potential efficacy in the evaluation of common ophthalmologic diseases such age related macular degeneration (AMD), diabetic retinopathy, artery and vein occlusions, and glaucoma. OCTA can detect changes in choroidal blood vessel flow and can elucidate the presence of choroidal neovascularization (CNV) in a variety of conditions but especially in AMD. It provides a highly detailed view of the retinal vasculature, which allows for accurate delineation of the foveal avascular zone (FAZ) in diabetic eyes and detection of subtle microvascular abnormalities in diabetic and vascular occlusive eyes. Optic disc perfusion in glaucomatous eyes is notable as well on OCTA. Further studies are needed to more definitively determine OCTA’s utility in the clinical setting and to establish if this technology may offer a non-invasive option of visualizing the retinal vasculature in detail.
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            Optical coherence tomography - principles and applications

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              In vivo retinal imaging by optical coherence tomography.

              We describe what are to our knowledge the first in vivo measurements of human retinal structure with optical coherence tomography. These images represent the highest depth resolution in vivo retinal images to date. The tomographic system, image-processing techniques, and examples of high-resolution tomographs and their clinical relevance are discussed.
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                Author and article information

                Journal
                Sensors (Basel)
                Sensors (Basel)
                sensors
                Sensors (Basel, Switzerland)
                MDPI
                1424-8220
                05 July 2019
                July 2019
                : 19
                : 13
                : 2970
                Affiliations
                [1 ]School of Automation Science and Electrical Engineering, Beihang University (BUAA), Beijing 100191, China
                [2 ]Department of Electrical Engineering, Bahria University (BU), Islamabad 44000, Pakistan
                [3 ]School of Computer Science and Engineering, Beihang University (BUAA), Beijing 100191, China
                [4 ]School of Computer and Communication Engineering, University of Science & Technology Beijing (USTB), Beijing 100083, China
                [5 ]Department of Electrical and Computer Engineering, Sir Syed CASE Institute of Technology (SSCIT), Islamabad 44000, Pakistan
                Author notes
                [* ]Correspondence: libo@ 123456buaa.edu.cn
                [†]

                These authors contributed equally in this research.

                Author information
                https://orcid.org/0000-0003-3672-8100
                https://orcid.org/0000-0002-5896-8677
                https://orcid.org/0000-0002-9337-1921
                Article
                sensors-19-02970
                10.3390/s19132970
                6651513
                31284442
                d38d68b0-8da6-4ed8-9886-0d17d20702b0
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 26 May 2019
                : 26 June 2019
                Categories
                Article

                Biomedical engineering
                biomedical image processing,image analysis,image classification,machine intelligence,machine vision,optical coherence tomography,fundus photography

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