Automatic vessel tortuosity measures are crucial for many applications related to retinal diseases such as those due to retinopathy of prematurity (ROP), hypertension, stroke, diabetes and cardiovascular diseases. An automatic evaluation and quantification of retinal vascular tortuosity would help in the early detection of such retinopathies and other systemic diseases. In this paper, we propose a novel tortuosity index based on principal component analysis. The index is compared with three existant indices using simulated curves and real retinal images to demonstrate that it is a valid indicator of tortuosity. The proposed index satisfies all the tortuosity properties such as invariance to translation, rotation and scaling and also the modulation properties. It is capable of differentiating the tortuosity of structures that visually appear to be different in tortuosity and shapes. The proposed index can automatically classify the image as tortuous or non tortuous. For an optimal set of training parameters, the prediction accuracy is as high as 82.94% and 86.6% on 45 retinal images at segment level and image level, respectively. The test results are verified against the judgement of two expert Ophthalmologists. The proposed index is marked by its inherent simplicity and computational attractiveness, and produces the expected estimate, irrespective of the segmentation approach. Examples and experimental results demonstrate the fitness and effectiveness of the proposed technique for both simulated curves and retinal images.

Retinopathy of Prematurity (ROP) is an infant disease characterized by increased dilation and tortuosity of the retinal blood vessels. Automatic tortuosity evaluation from retinal digital images is very useful to facilitate an ophthalmologist in the ROP screening and to prevent childhood blindness. This paper proposes a method to automatically classify the image into tortuous and non-tortuous. The process imitates expert ophthalmologists' screening by searching for clearly tortuous vessel segments. First, a skeleton of the retinal blood vessels is extracted from the original infant retinal image using a series of morphological operators. Next, we propose to partition the blood vessels recursively using an adaptive linear interpolation scheme. Finally, the tortuosity is calculated based on the curvature of the resulting vessel segments. The retinal images are then classified into two classes using segments characterized by the highest tortuosity. For an optimal set of training parameters the prediction is as high as 100%.

To prevent blindness from diabetic retinopathy, periodic screening and early diagnosis are neccessary. Due to lack of expert ophthalmologists in rural area, automated early exudate (one of visible sign of diabetic retinopathy) detection could help to reduce the number of blindness in diabetic patients. Traditional automatic exudate detection methods are based on specific parameter configuration, while the machine learning approaches which seems more flexible may be computationally high cost. A comparative analysis of traditional and machine learning of exudates detection, namely, mathematical morphology, fuzzy c-means clustering, naive Bayesian classifier, Support Vector Machine and Nearest Neighbor classifier are presented. Detected exudates are validated with expert ophthalmologists' hand-drawn ground-truths. The sensitivity, specificity, precision, accuracy and time complexity of each method are also compared.