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. 2022 Nov;47(11):1547-1552.
doi: 10.1080/02713683.2022.2126860. Epub 2022 Oct 2.

Enhanced Detection of Reticular Pseudodrusen on Color Fundus Photos by Image Embossing

Shin Kadomoto  1   2 , Onisa Nanegrungsunk  1   2 , Muneeswar Gupta Nittala  1   2 , Ayesha Karamat  1   2 , SriniVas R Sadda  1   2
Affiliations

Enhanced Detection of Reticular Pseudodrusen on Color Fundus Photos by Image Embossing

Shin Kadomoto et al. Curr Eye Res. 2022 Nov.

Erratum in

  • Correction.
    [No authors listed] [No authors listed] Curr Eye Res. 2023 May;48(5):I. doi: 10.1080/02713683.2023.2200072. Epub 2023 Apr 11. Curr Eye Res. 2023. PMID: 37017369 No abstract available.

Abstract

Purpose: To evaluate whether processing a color fundus photo (CFP) using an image embossing technique can improve the detection of reticular pseudodrusen (RPD).

Methods: This post-hoc analysis included the eyes of subjects enrolled in the Amish Eye Study with early or intermediate age-related macular degeneration and evidence of RPD. All patients underwent CFP, near-infrared reflectance (NIR), and fundus autofluorescence (FAF) imaging. The ground-truth presence of RPD was established with a combination of NIR and FAF imaging. An embossing processed (EP) image was created by replacing each pixel of the CFP image with a highlight or a shadow representing light and dark boundaries in the original CFP image. The presence of RPD in CFP and EP images was assessed by two graders in a masked fashion and the sensitivity of CFP and EP for detection of RPD was evaluated. Cohen's kappa (k) was used to test inter-grader agreement for CFP and EP.

Results: A total of 106 eyes from 62 patients with RPDs were analyzed. The sensitivity for detection of RPD on CFP and EP was 63.2% (95%CI: 52.0%-74.4%) and 91.5% (95%CI: 85.0%-98.0%), respectively. The inter-rater reliabilities of CFP and EP for RPD detection were 0.81 and 0.84, respectively.

Conclusions: Embossing of CFP can improve the sensitivity for detection of RPD. The embossing technique can be a useful tool for better assessment of the true frequency of RPD in datasets where only CFP images are available.

Keywords: Age-related macular degeneration; embossing; image processing; reticular pseudodrusen.

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Figures

Figure 1.
Figure 1.. Embossing image processing.
A: Original RGB color image. B: 8-bit grayscale image. C: Reversed image. D: The reversed image (C) was translated by 0.3% of the total number of pixels in the horizontal and vertical directions. E: The embossing processed image is created combining image B and D. F: Normal color fundus photo. G: Embossing processed color fundus photo.
Figure 2.
Figure 2.. Multimodal imaging of reticular pseudodrusen (RPD).
A: Color fundus photo shows RPD as yellowish round or interlacing oval-shaped lesions. B: Embossing processed (EP) image shows RPD as three-dimensional relief-like round appearance. C: Near-infrared reflectance shows RPD as target configurations surrounded by a hyporeflective annulus or an ill-defined hyporeflective inter-connected network. D: Fundus autofluorescence shows RPD as hypo-autofluorescent lesions.
Figure 3.
Figure 3.. Reticular pseudodrusen (RPD) that were not detected on color fundus photo.
A: Color fundus photo (CFP). B: Embossing processed (EP) image. C: Near-infrared reflectance (NIR) image. D: Fundus autofluorescence (FAF) image. On CFP, RPD were not detected. In contrast, the EP image revealed multiple RPD (arrows) that were also visualized on NIR and FAF images.
Figure 4.
Figure 4.. High contrast imaging with embossing process.
A: Color fundus photo (CFP). B: Embossing processed (EP) image. C: Near-infrared reflectance (NIR) image. D: Fundus autofluorescence (FAF) image. On the EP image, reticular pseudodrusen (RPD) were delineated with good contrast compared to NIR and FAF images. Note that some of the RPD (arrow) which were not detected on CFP were well-delineated.
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