The role of haemorrhage and exudate detection in automated grading of diabetic retinopathy

Alan D Fleming, Keith A Goatman, Sam Philip, Graeme J Williams, Gordon J Prescott, Graham S Scotland, Paul McNamee, Graham P Leese, William N Wykes, Peter F Sharp, John A Olson, Scottish Diabetic Retinopathy Clinical Research Network

Research output: Contribution to journalArticlepeer-review

74 Citations (Scopus)


Background/aims: Automated grading has the potential to improve the efficiency of diabetic retinopathy screening services. While disease/no disease grading can be performed using only microaneurysm detection and image-quality assessment, automated recognition of other types of lesions may be advantageous. This study investigated whether inclusion of automated recognition of exudates and haemorrhages improves the detection of observable/referable diabetic retinopathy.

Methods: Images from 1253 patients with observable/referable retinopathy and 6333 patients with non-referable retinopathy were obtained from three grading centres. All images were reference-graded, and automated disease/no disease assessments were made based on microaneurysm detection and combined microaneurysm, exudate and haemorrhage detection.

Results: Introduction of algorithms for exudates and haemorrhages resulted in a statistically significant increase in the sensitivity for detection of observable/referable retinopathy from 94.9% (95% CI 93.5 to 96.0) to 96.6% (95.4 to 97.4) without affecting manual grading workload.

Conclusion: Automated detection of exudates and haemorrhages improved the detection of observable/referable retinopathy.

Original languageEnglish
Pages (from-to)706-711
Number of pages6
JournalBritish Journal of Ophthalmology
Issue number6
Early online date5 Aug 2009
Publication statusPublished - Jun 2010


  • algorithms
  • diabetic retinopathy
  • diagnosis, computer-assisted
  • diagnostic techniques, ophthalmological
  • exudates and transudates
  • humans
  • image interpretation, computer-assisted
  • mass screening
  • reference standards
  • retinal hemorrhage
  • severity of illness index


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