Automatic detection of glaucoma via fundus imaging and artificial intelligence: A review

Glaucoma is a leading cause of irreversible vision impairment globally and cases are continuously rising worldwide. Early detection is crucial, allowing timely intervention which can prevent further visual field loss. To detect glaucoma, examination of the optic nerve head via fundus imaging can be performed, at the centre of which is the assessment of the optic cup and disc boundaries. Fundus imaging is non-invasive and low-cost; however, the image examination relies on subjective, time-consuming, and costly expert assessments. A timely question to ask is can artificial intelligence mimic glaucoma assessments made by experts. Namely, can artificial intelligence automatically find the boundaries of the optic cup and disc (providing a so-called segmented fundus image) and then use the segmented image to identify glaucoma with high accuracy. We conducted a comprehensive review on artificial intelligence-enabled glaucoma detection frameworks that produce and use segmented fundus images. We found 28 papers and identified two main approaches: 1) logical rule-based frameworks, based on a set of simplistic decision rules; and 2) machine learning/statistical modelling based frameworks. We summarise the state-of-art of the two approaches and highlight the key hurdles to overcome for artificial intelligence-enabled glaucoma detection frameworks to be translated into clinical practice.