Diabetic Retinopathy (DR) is one of the major causes of blindness. Many DR detection systems were developed to segment and determine the type and number of lesions that appeared on retinal images and used to classify DR and its severity level. Even though several researchers have already proposed many automated diagnosis systems with different image segmentation algorithms, their accuracy and reliability are generally unexplored. The accuracy of an automated diagnosis system usually depends on the segmentation techniques. The accuracy of this system is heavily dependent upon the retinal and image parameters, which have intensity level difference between background (BG)-blood vessels (BV), BV-bright lesions, BV-dark lesions, and noise levels. In this work, the automated diagnosis system accuracy has been analysed to successfully detect DR and its severity levels. The focus is on fundus image modalities segmentation based on fuzzy entropy multi-level thresholding. The analysis aimed to develop conditions to guarantee accurate DR detection and its severity level. Firstly, a retinal image model was developed that represents the retina under the variation of all retinal and image parameters. Overall, 45,000 images were developed using the retinal model. Secondly, feasibility and consistency analysis were performed based on a specific design Monte Carlo statistical method to quantify the successful detection of DR and its severity levels. The conditions to guarantee accurate DR detections are: BG to BV > 30% and BV to the dark lesions (MAs) >15% for mild DR, BG to BV > 40% and BV to the dark lesions (MAs and HEM) > 20% for moderate DR, and BG to BV > 30% and BV to the dark lesions (MAs and HEM) > 15%, and BV to the bright lesions (EX) > 55% for severe DR. Finally, the validity of these conditions was verified by comparing their accuracy against real retinal images from publicly available datasets. The verification results demonstrated that the condition for the analysis could be used to predict the success of DR detection.
