Diabetic retinopathy (DR) – one of the diabetes complications – is the leading cause of blindness among the age group of 20–74 years old. Fortunately, 90% of these cases (blindness due to DR) could be prevented by early detection and treatment via manual and regular screening by qualified physicians. The screening of DR is tedious, which can be subjective, time-consuming, and sometimes prone to misclassification. In terms of accuracy and time, many automated screening systems based on image processing have been developed to improve diagnostic performance. However, the accuracy and consistency of the developed systems are largely unaddressed, where a manual screening process is still the most preferred option. The main contribution of this paper is to analyse the accuracy and consistency of microaneurysm (MA) detection via image processing by focusing on Otsu’s multi-thresholding as it has been shown to work very well in many applications. The analysis was based on Monte Carlo statistical analysis using synthetic retinal images of retinal images under variation of all stages of DR, retinal, and image parameters – intensity difference between MAs and blood vessels (BVs), MA size, and measurement noise. Then, the conditions – in terms of obtainable retinal and image parameters – that guarantee accurate and consistent MA detection via image processing were extracted. Finally, the validity of the conditions to guarantee accurate and consistent MA detection was verified using real retinal images. The results showed that MA detection via image processing is guaranteed to be accurate and consistent when the intensity difference between MAs and BVs is at least 50% and the sizes of MAs are from 5 to 20 pixels depending on measurement noise values. These conditions are very important as a guideline of MA detection for DR.
