The Retinal Vasculature as a Fractal: Methodology, Reliability, and Relationship to Blood Pressure

Liew, Gerald; Wang, Jie Jin; Cheung, Ning; Zhang, Yong Ping; Hsu, Wynne; Lee, Mong Li; Mitchell, Paul; Tikellis, Gabriella; Taylor, Barry R.; Wong, Tien Yin

doi:10.1016/j.ophtha.2008.05.029

Cited by 197 publications

(236 citation statements)

References 34 publications

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“…The program then calculates the D f from the refined line tracing using the box-counting approach. Grading time for each photograph is approximately 5 min [4]. Reproducibility of measurements was very high, with intra-and intergrader intraclass correlation coefficients ranging from 0.93 to 0.95 [4].…”

Section: Methodsmentioning

confidence: 93%

“…Two trained graders, masked to patients' clinical diagnoses, graded the disc-centred fundus photographs using a validated semi-automated computer program described previously [4,6]. In brief, the program automatically traces all retinal vessels within a predefined circular region, 3.5 optic disc radii, centred on the optic disc.…”

Section: Methodsmentioning

confidence: 99%

“…Grading time for each photograph is approximately 5 min [4]. Reproducibility of measurements was very high, with intra-and intergrader intraclass correlation coefficients ranging from 0.93 to 0.95 [4]. We additionally graded for retinopathy signs according to the simplified Wisconsin grading system [9].…”

Section: Methodsmentioning

confidence: 99%

“…Fractal analysis has been applied to characterise self-similar structures in various organs and tissues, such as the bronchial tree and the vascular system of the myocardium and kidney. The D f of the retinal vasculature can now be measured from digital fundus photographs using computer programs [4]. Recent studies show that changes in retinal D f are associated with diabetic retinopathy [5,6] and hypertension [4], with a suggestion from a small study of an association with diabetes [7].…”

Section: Introductionmentioning

confidence: 99%

“…The D f of the retinal vasculature can now be measured from digital fundus photographs using computer programs [4]. Recent studies show that changes in retinal D f are associated with diabetic retinopathy [5,6] and hypertension [4], with a suggestion from a small study of an association with diabetes [7]. Few studies have examined the possible association of retinal D f in people with impaired glucose metabolism.…”

Section: Introductionmentioning

confidence: 99%

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Retinal fractal dimension is increased in persons with diabetes but not impaired glucose metabolism: the Australian Diabetes, Obesity and Lifestyle (AusDiab) study

et al. 2010

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Aims/hypothesis The fractal dimension (D f ) of the retinal vasculature is a global measure of its branching pattern complexity. We examined the relationship of retinal D f with diabetes. Methods We conducted a cross-sectional study of 1,577 participants with diabetes and impaired glucose metabolism and normal controls from the population-based Australian Diabetes, Obesity and Lifestyle (AusDiab) study. Retinal D f was quantified from fundus photographs using a computerbased programme and diabetes status was determined by oral glucose tolerance test based on the WHO criteria. Results After adjustment for age, sex and vascular risk factors, persons with higher retinal D f were more likely to have diabetes (OR 1.56; 95% CI 1.14-2.14, highest vs lowest fractal tertile). This relationship remained with further adjustment for retinal arteriolar calibre and presence of retinopathy (OR 1.64; 95% CI 1.19-2.27), and after excluding participants with retinopathy (OR 1.60; 95% CI 1.16-2.21). Retinal D f was not related to impaired glucose tolerance or impaired fasting glucose (OR 1.19; 95% CI 0.85-1.67). Conclusions/interpretation Individuals with diabetes, but not with impaired glucose metabolism, have greater retinal D f , reflecting greater complexity of the retinal vasculature. Our findings suggest the presence of early microvascular changes in the retinal vasculature of persons with diabetes, even in the absence of overt retinopathy.

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Section: Methodsmentioning

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Retinal fractal dimension is increased in persons with diabetes but not impaired glucose metabolism: the Australian Diabetes, Obesity and Lifestyle (AusDiab) study

et al. 2010

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Association of fractal dimension and other retinal vascular network parameters with cognitive performance and neuroimaging biomarkers: The Multi‐Ethnic Study of Atherosclerosis (MESA)

Ong,

Peavey,

Hiatt

et al. 2023

Alzheimer's & Dementia

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INTRODUCTIONRetinal vascular network changes may reflect the integrity of the cerebral microcirculation, and may be associated with cognitive impairment.METHODSAssociations of retinal vascular measures with cognitive function and MRI biomarkers were examined amongst Multi‐Ethnic Study of Atherosclerosis (MESA) participants in North Carolina who had gradable retinal photographs at Exams 2 (2002 to 2004, n = 313) and 5 (2010 to 2012, n = 306), and detailed cognitive testing and MRI at Exam 6 (2016 to 2018).RESULTSAfter adjustment for covariates and multiple comparisons, greater arteriolar fractal dimension (FD) at Exam 2 was associated with less isotropic free water of gray matter regions (β = −0.0005, SE = 0.0024, p = 0.01) at Exam 6, while greater arteriolar FD at Exam 5 was associated with greater gray matter cortical volume (in mm3, β = 5458, SE = 20.17, p = 0.04) at Exam 6.CONCLUSIONGreater arteriolar FD, reflecting greater complexity of the branching pattern of the retinal arteries, is associated with MRI biomarkers indicative of less neuroinflammation and neurodegeneration.

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Retinal fractals and acute lacunar stroke

Cheung

Liew

Lindley

et al. 2010

Annals of Neurology

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105

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This study aimed to determine whether retinal fractal dimension, a quantitative measure of microvascular branching complexity and density, is associated with lacunar stroke. A total of 392 patients presenting with acute ischemic stroke had retinal fractal dimension measured from digital photographs, and lacunar infarct ascertained from brain imaging. After adjusting for age, gender, and vascular risk factors, higher retinal fractal dimension (highest vs lowest quartile and per standard deviation increase) was independently and positively associated with lacunar stroke (odds ratio [OR], 4.27; 95% confidence interval [CI], 1.49-12.17 and OR, 1.85; 95% CI, 1.20-2.84, respectively). Increased retinal microvascular complexity and density is associated with lacunar stroke.

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The Retinal Vasculature as a Fractal: Methodology, Reliability, and Relationship to Blood Pressure

Cited by 197 publications

References 34 publications

Retinal fractal dimension is increased in persons with diabetes but not impaired glucose metabolism: the Australian Diabetes, Obesity and Lifestyle (AusDiab) study

Retinal fractal dimension is increased in persons with diabetes but not impaired glucose metabolism: the Australian Diabetes, Obesity and Lifestyle (AusDiab) study

Association of fractal dimension and other retinal vascular network parameters with cognitive performance and neuroimaging biomarkers: The Multi‐Ethnic Study of Atherosclerosis (MESA)

Retinal fractals and acute lacunar stroke

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