Image enhancement of color fundus photographs for age-related macular degeneration: the Shanghai Changfeng Study
Authors:   Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Center for Evidence-based Medicine, Fudan University, Shanghai 200032, China, Shen Jing-Jing , Wang Li-Long ,   Pingan Technology (Shenzhen) Co., Ltd., Shenzhen 518029, Guangdong Province, China, Lyu Chuan-Feng ,   Pingan Technology (Shenzhen) Co., Ltd., Shenzhen 518029, Guangdong Province, China, Liu Shuo ,   Pingan Technology (Shenzhen) Co., Ltd., Shenzhen 518029, Guangdong Province, China, Xie Guo-Tong ,   Pingan Technology (Shenzhen) Co., Ltd., Shenzhen 518029, Guangdong Province, China, Zeng Hai-Luan ,   Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Fudan Institute for Metabolic Diseases, Shanghai 200032, China, Chen Ling-Yan ,   Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Fudan Institute for Metabolic Diseases, Shanghai 200032, China, Shen Min-Qian ,   Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Center for Evidence-based Medicine, Fudan University, Shanghai 200032, China, Gao Xin ,   Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Fudan Institute for Metabolic Diseases, Shanghai 200032, China, Lin Huan-Dong ,   Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Fudan Institute for Metabolic Diseases, Shanghai 200032, China, Yuan Yuan-Zhi ,   Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Center for Evidence-based Medicine, Fudan University, Shanghai 200032, China
Published: January 2022

AIM: To develop and evaluate a new fundus image optimization software based on red, green, blue channels (RGB) for the evaluation of age-related macular degeneration (AMD) in the Chinese population.
METHODS: Fundus images that were diagnosed as AMD from the Shanghai Changfeng Study database were analyzed to develop a standardized optimization procedure. Image brightness, contrast, and color balance were measured. Differences between central lesion area and normal retinal area under different image brightness, contrast, and color balance were observed. The optimal optimization parameters were determined based on the visual system to avoid image distortion. A paired-sample diagnostic test was used to evaluate the enhancement software. Fundus optical coherence tomography (OCT) was used as the gold standard. Diagnostic performances were compared between original images and optimized images using McNemar's test.
RESULTS: A fundus image optimization procedure was developed using 86 fundus images of 74 subjects diagnosed with AMD. By observing gray-scale images, choroid can be best displayed in red channel and retina in green channel was found. There was limited information in blue channel. Totally 104 participants were included in the paired sample diagnostic test to assess the performance of the optimization software. After the image enhancement, sensitivity increased from 74% to 88% (P=0.008), specificity decreased slightly from 88% to 84% (P=0.500), and Youden index increased by 0.11.
CONCLUSION: The standardized image optimization software increases diagnostic sensitivity and may help ophthalmologists in AMD diagnosis and screening.