A local adaptive method is proposed for automatic detection of microaneurysms in a digital ocular fundus image. Multiple subregions of the image are automatically analyzed and adapted to local intensity variation and properties. A priori region and location information about structural features such as vessels, optic disk and hard exudates are incorporated to further improve the detection accuracy. The method effectively improves the specificity of microaneurysms detection, without sacrificing sensitivity. The method may be used in automatic level-one grading of diabetic retinopathy screening.