Retinal Vascular Geometry in Asian Persons with Diabetes and Retinopathy

Cheung, Carol Y.; Lamoureux, Ecosse L.; Ikram, Mohammad Kamran; Sasongko, Muhammad Bayu; Ding, Jie; Zheng, Yingfeng; Mitchell, Paul; Wang, Jie Jin; Wong, Tien Yin

doi:10.1177/193229681200600315

Cited by 70 publications

(76 citation statements)

References 51 publications

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“…One study conducted by Sasongko et al found the retinal vascular tortuosity is positively associated with having diabetes [5], while Cheung et al showed a negative relationship [8]. This contradiction may be from the population difference including race, age, duration of diabetes and HbA1c.…”

Section: Previous Researchmentioning

confidence: 89%

Retinal Vascular Tortuosity in Hospitalized Patients with Type 2 Diabetes and Diabetic Retinopathy in China

Zhu¹,

Triest²,

Tong³

et al. 2016

JBiSE

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Context: Diabetic patients are at high risk for microvascular complications of disease such as diabetic retinopathy (DR) and diabetic neuropathy. Imaging the retinal microvasculature offers a chance to measure quantitatively the microvascular changes in diabetic patients' onset and progression. However, the relation between retinal biomarkers and diabetic risk factors is unclear in Chinese hospitalized type 2 diabetic patients. Aims: To examine the associations of retinal vascular tortuosity with risk factors of type 2 diabetes and diabetic retinopathy in Chinese hospitalized patients. Patients and Methods: Our cross-sectional study includes 504 participants with type 2 diabetes hospitalized in the department of endocrinology in Shengjing hospital, Shenyang, China. Patients' socio-demographic, clinical and biological information was retrieved from their ID card, the interview, and the local hospital information system. Retinal photographs were taken by laser-scanning ophthalmoscopy of both eyes and checked if gradable for analysis. The weighted mean and standard deviation of tortuosity were calculated from the retinal photographs using a novel robust and fully automatic quantitative method. DR was assessed from the retinal photographs by the ophthalmologist according to the modified Airlie House classification into No DR and Any DR in our current study. Data were analyzed by SPSS Version 22 with Student's t test, Mann-Whitney U test, Chi-square test, and linear regression. Results:For the total participants (504) in this study, the weighted mean and standard deviation (SD) of tortuosity was 12.05 × 10 −3 (SD: 1.66 × 10 −3 ) and 24.31 × 10 −3 (SD: 3.69 × 10 −3 ), respectively. 386 (76.6%) patients were diagnosed with DR who had older age, long duration of diabetes, higher brachial ankle pulse wave velocity (baPWV), higher systolic blood pressure (SBP), higher diastolic blood pressure (DBP), and higher reHow to cite this paper: Zhu, S., van Triest, M., Tong, M., Lamers, T., Han, P., Qian, W. 144tinal vascular tortuosity values. In univariable linear regression analyses, older age, longer duration, higher baPWV, higher urine microalbuminuria, higher urine albumin/creatinine ratio, diagnosed with high blood pressure, thrombosis or Any DR, were significantly associated with both higher tortuosity measures (all P values < 0.05). In multivariable-adjusted linear regression analyses, age and diabetes duration (all P values < 0.05) were independently and positively associated with both tortuosity measures, after adjustment for low-density lipoprotein (LDL), high-density lipoprotein (HDL) and high blood pressure. Furthermore, after adding some kidney failure factors, the urine albumin/creatinine ratio was also an independent risk factor of vascular tortuosity. These associations remained even after including or excluding the factor of DR. Conclusions: Retinal vascular tortuosity is independently associated with older age, longer duration, and higher urine albumin/creatinine ratio in Chinese hospitalized type 2 di...

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Section: Previous Researchmentioning

confidence: 89%

Retinal Vascular Tortuosity in Hospitalized Patients with Type 2 Diabetes and Diabetic Retinopathy in China

Zhu¹,

Triest²,

Tong³

et al. 2016

JBiSE

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“…This is not the case for vessel tortuosity, which makes it still a very relevant topic of research. E.g., in [3] a positive, and in [4] a negative association of vessel tortuosity with progression towards diabetic retinopathy (DR) is found. In this work, we present a novel robust and fully automated method for the extraction of tortuosity measures, and show strong positive associations of the measures with diabetes and progressive stages of DR.…”

Section: Introductionmentioning

confidence: 99%

“…One of the most relevant geometrical features of the microvasculature is vessel tortuosity [2][3][4][5]. While for some geometrical features (such as vessel calibre) there is a general consensus [1] on how they are associated to several diseases.…”

Section: Introductionmentioning

confidence: 99%

“…Vessel tortuosity descriptors are typically computed via an extensive pipeline (including manual interventions) of image pre-processing, segmentation, thinning and splitting of the vascular network, after which tortuosity values are computed from the extracted vessel centerlines [2,3,5,6]. In such pipelines, errors introduced in each processing step may accumulate, and information might get lost along the way.…”

Section: Introductionmentioning

confidence: 99%

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Curvature Based Biomarkers for Diabetic Retinopathy via Exponential Curve Fits in SE(2)

Bekkers

Zhang

Duits

et al. 2015

Proceedings of the Ophthalmic Medical Image Analysis Second International Workshop

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Abstract. We propose a robust and fully automatic method for the analysis of vessel tortuosity. Our method does not rely on pre-segmentation of vessels, but instead acts directly on retinal image data. The method is based on theory of best-fit exponential curves in the roto-translation group SE(2). We lift 2D images to 3D functions called orientation scores by including an orientation dimension in the domain. In the extended domain of positions and orientations (identified with SE(2)) we study exponential curves, whose spatial projections have constant curvature. By locally fitting such curves to data in orientation scores, via our new iterative stabilizing refinement method, we are able to assign to each location a curvature and confidence value. These values are then used to define global tortuosity measures. The method is validated on synthetic and retinal images. We show that the tortuosity measures can serve as effective biomarkers for diabetes and different stages of diabetic retinopathy.

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“…Measurements of vessel calibres in retinal photos could potentially deliver such biomarkers [3][4][5][6][7], but more global variables are available, for example retinal vascular fractal dimensions. The fractal dimension summarises the complexity and density of branching structures characterised by selfsimilarity and a similar level of complexity despite changes in magnification (for example snowflakes, tree branches, lightning).…”

Section: Introductionmentioning

confidence: 99%

Retinal vascular fractals predict long-term microvascular complications in type 1 diabetes mellitus: the Danish Cohort of Pediatric Diabetes 1987 (DCPD1987)

et al. 2014

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Aims/hypothesis Fractal analysis of the retinal vasculature provides a global measure of the complexity and density of retinal vessels summarised as a single variable: the fractal dimension. We investigated fractal dimensions as long-term predictors of microvasculopathy in type 1 diabetes. Methods We included 180 patients with type 1 diabetes in a 16 year follow-up study. In baseline retinal photographs (from 1995), all vessels in a zone 0.5-2.0 disc diameters from the disc margin were traced using Singapore Institute Vessel Assessment-Fractal image analysis software. Artefacts were removed by a certified grader, and fractal dimensions were calculated using the box-counting method. At follow-up (in 2011), diabetic neuropathy, nephropathy and proliferative retinopathy were assessed and related to baseline fractal dimensions in multiple regressions adjusted for sex and baseline age, diabetes duration, HbA 1c , BP, BMI, vibration perception threshold, albuminuria, retinopathy and vessel diameters. Results Mean baseline age and diabetes duration were 21.0 and 13.4 years, respectively, and of patients 50.0% were males. The mean fractal dimension was 1.3817. The 16 year incidences of neuropathy, nephropathy and proliferative retinopathy were 10.8%, 8.0% and 27.9%, respectively. Multiple regression analyses showed a lower fractal dimension to significantly predict incident neuropathy (OR 1.17 per 0.01 fractal dimension decrease [95% CI 1.01, 1.36]), nephropathy (OR 1.40 per 0.01 fractal dimension decrease [95% CI 1.10, 1.79]) and proliferative retinopathy (OR 1.22 per 0.01 fractal dimension decrease [95% CI 1.09, 1.37]). Conclusions/interpretation The retinal vascular fractal dimension is a shared biomarker of diabetic microvasculopathy, thus indicating a possible common pathogenic pathway. Retinal fractal analysis therefore is a potential tool for risk stratification in type 1 diabetes.

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Retinal Vascular Geometry in Asian Persons with Diabetes and Retinopathy

Cited by 70 publications

References 51 publications

Retinal Vascular Tortuosity in Hospitalized Patients with Type 2 Diabetes and Diabetic Retinopathy in China

Retinal Vascular Tortuosity in Hospitalized Patients with Type 2 Diabetes and Diabetic Retinopathy in China

Curvature Based Biomarkers for Diabetic Retinopathy via Exponential Curve Fits in SE(2)

Retinal vascular fractals predict long-term microvascular complications in type 1 diabetes mellitus: the Danish Cohort of Pediatric Diabetes 1987 (DCPD1987)

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