Enhanced glaucoma classification through advanced segmentation by integrating cup-to-disc ratio and neuro-retinal rim features

Glaucoma is a progressive eye condition caused by high intraocular fluid pressure, damaging the optic nerve, leading to gradual, irreversible vision loss, often without noticeable symptoms. Subtle signs like mild eye redness, slightly blurred vision, and eye pain may go unnoticed, earning it the nickname “silent thief of sight.” Its prevalence is rising with an aging population, driven by increased life expectancy. Most computer-aided diagnosis (CAD) systems rely on the cup-to-disc ratio (CDR) for glaucoma diagnosis. This study introduces a novel approach by integrating CDR with the neuro-retinal rim ratio (NRR), which quantifies rim thickness within the optic disc (OD). NRR enhances diagnostic accuracy by capturing additional optic nerve head changes, such as rim thinning and tissue loss, which were overlooked using CDR alone. A modified ResUNet architecture for OD and optic cup (OC) segmentation, combining residual learning and U-Net to capture spatial context for semantic segmentation. For OC segmentation, the model achieved Dice Coefficient (DC) scores of 0.942 and 0.872 and Intersection over Union (IoU) values of 0.891 and 0.773 for DRISHTI-GS and RIM-ONE, respectively. For OD segmentation, the model achieved DC of 0.972 and 0.950 and IoU values of 0.945 and 0.940 for DRISHTI-GS and RIM-ONE, respectively. External evaluation on ORIGA and REFUGE confirmed the model's robustness and generalizability. CDR and NRR were calculated from segmentation masks and used to train an SVM with a radial basis function, classifying the eyes as healthy or glaucomatous. The model achieved accuracies of 0.969 on DRISHTI-GS and 0.977 on RIM-ONE.