Automatic Algorithm-Aided Segmentation of Retinal Nerve Fibers Using Fundus Photographs.

This work presents an image processing algorithm for the segmentation of the personalized mapping of retinal nerve fiber layer (RNFL) bundle trajectories in the human retina. To segment RNFL bundles, preprocessing steps were used for noise reduction and illumination correction. Blood vessels were removed. The image was fed to a maximum-minimum modulation algorithm to isolate retinal nerve fiber (RNF) segments. A modified Garway-Heath map categorizes RNF orientation, assuming designated sets of orientation angles for aligning RNFs direction. Bezier curves fit RNFs from the center of the optic disk (OD) to their corresponding end. Fundus images from five different databases ( = 300) were tested, with 277 healthy normal subjects and 33 classified as diabetic without any sign of diabetic retinopathy. The algorithm successfully traced fiber trajectories per fundus across all regions identified by the Garway-Heath map. The resulting trace images were compared to the Jansonius map, reaching an average efficiency of 97.44% and working well with those of low resolution. The average mean difference in orientation angles of the included images was 11.01 ± 1.25 and the average RMSE was 13.82 ± 1.55. A 24-2 visual field (VF) grid pattern was overlaid onto the fundus to relate the VF test points to the intersection of RNFL bundles and their entry angles into the OD. The mean standard deviation (95% limit) obtained 13.5° (median 14.01°), ranging from less than 1° to 28.4° for 50 out of 52 VF locations. The influence of optic parameters was explored using multiple linear regression. Average angle trajectories in the papillomacular region were significantly influenced ( < 0.00001) by the latitudinal optic disk position and disk-fovea angle. Given the basic biometric ground truth data (only fovea and OD centers) that is publicly accessible, the algorithm can be customized to individual eyes and distinguish fibers with accuracy by considering unique anatomical features.