Deep Learning Network with Illuminant Augmentation for Diabetic Retinopathy Segmentation Using Comprehensive Anatomical Context Integration

<b>Background/Objectives:</b> Diabetic retinopathy (DR) segmentation faces critical challenges from domain shift and false positives caused by heterogeneous retinal backgrounds. Recent transformer-based studies have shown that existing approaches do not comprehensively integrate the anatomical context, particularly training datasets combining blood vessels with DR lesions. <b>Methods:</b> These limitations were addressed by deploying a DeepLabV3+ framework enhanced with more comprehensive anatomical contexts, rather than more complex architectures. The approach produced the first training dataset that systematically integrates DR lesions with complete retinal anatomical structures (optic disc, fovea, blood vessels, retinal boundaries) as contextual background classes. An innovative illumination-based data augmentation simulated diverse camera characteristics using color constancy principles. Two-stage training (cross-entropy and Tversky loss) managed class imbalance effectively. <b>Results:</b> An extensive evaluation of the IDRiD, DDR, and TJDR datasets demonstrated significant improvements. The model achieved competitive performances (AUC-PR: 0.7715, IoU: 0.6651, F1: 0.7930) compared with state-of-the-art methods, including transformer approaches, while showing promising generalization on some unseen datasets, though performance varied across different domains. False-positive returns were reduced through anatomical context awareness. <b>Conclusions:</b> The framework demonstrates that comprehensive anatomical context integration is more critical than architectural complexity for DR segmentation. By combining systematic anatomical annotation with effective data augmentation, conventional network performances can be improved while maintaining computational efficiency and clinical interpretability, establishing a new paradigm for medical image segmentation.