Segmentation of Diabetic Retinopathy Lesions: The Common Fallacy and Evaluation of Real Segmenters

In the context of automated analysis of eye fundus images, it is an important common fallacy that prior works achieve very high scores in segmentation of lesions, and that fallacy is fueled by some reviews reporting very high scores, and perhaps some confusion with terms. A simple analysis of the detail of the few prior works that really do segmentation reveals scores between 7% and 70% in sensitivity for 1 FPI. That is clearly sub-par with medical doctors trained to detect signs of Diabetic Retinopathy, since they can distinguish well the contours of lesions in Eye Fundus Images (EFI). Still, a full segmentation of lesions could be an important step for both visualization and further automated analysis using rigorous quantification or areas and numbers of lesions to better diagnose. I discuss what prior work really does, using evidence-based analysis, and confront with segmentation networks, comparing on the terms used by prior work to show that the best performing segmentation network outperforms those prior works. I also compare architectures to understand how the network architecture influences the results. I conclude that, with the correct architecture and tuning, the semantic segmentation network improves up to 20 percentage points over prior work in the real task of segmentation of lesions. I also conclude that the network architecture and optimizations are important factors and that there are still important limitations in current work.