Optic Disc Segmentation in Fundus Images: From Classical Image Processing and Deformable Models to Modern AI

Accurate localization and segmentation of the optic disc (OD) are important for retinal image analysis and glaucoma assessment, yet remain challenging due to variations in illumination, pathology, vascular interference, and poorly defined boundaries. This structured methodological review examines the evolution of OD segmentation from classical image-processing and deformable models to contemporary artificial intelligence (AI)-based approaches. A structured literature search and study-selection process was used to identify representative studies spanning major methodological developments. The review first summarizes commonly used fundus-image datasets, then organizes classical methods by principal mechanisms, including intensity and thresholding, histogram and entropy analysis, morphology, geometric and Hough-transform methods, filtering and feature operators, texture- and region-based approaches, and active-contour and level-set models. This paper pays particular attention to the assumptions, strengths, limitations, and complementary roles of these methods in OD localization and boundary delineation. Representative AI approaches are subsequently examined to illustrate the transition from handcrafted features and explicitly defined priors to learned representations, Transformer-based segmentation, boundary- and shape-aware learning, promptable segmentation, and retinal foundation models. Across these methodological generations, several core segmentation principles persist, including region-of-interest localization, multiscale representation, geometric and anatomical constraints, and boundary regularization, although their implementation has shifted from predefined operators to learned modules, losses, prompts, and pretrained representations. The review further identifies boundary ambiguity, anatomical variability, domain shift, and cross-dataset generalization as continuing challenges.