A sorting system for hierarchical grading of diabetic fundus images: a preliminary study.

Diabetic retinopathy is a leading cause of blindness in developed countries. Diabetic patients can prevent severe visual loss by attending regular eye examinations and receiving timely treatments. In the United States, standard protocols have been developed and refined for years to provide better screening and evaluation procedures of the fundus images. Due to the emerging number of diabetic retinopathy cases, accurate and efficient evaluations of the fundus images have become a serious burden for the ophthalmologists or care providers. While diabetic retinopathy remains too complicated to call for an automatic diagnosis system, an efficient tool to facilitate the grading process with a limited number of personnel is in great demand. The current study is to develop a sorting system with a user-friendly interface, based upon the standardized early treatment diabetic retinopathy study (ETDRS) protocol, to assist the professional graders. The raw fundus images will be screened and assigned to different graders according to their skill levels and experiences. The developed hierarchical sorting process will greatly support the graders and enhance their efficiency and throughput. The proposed hybrid intelligent system with multilevel knowledge representation is used to construct this sorting system. A preliminary case study is conducted using only the features of the spot lesion group coupled with the ETDRS standard to demonstrate its feasibility and performance. The results obtained from the case study show a promising future.