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Title: Quantitative Assessment of Early Diabetic Retinopathy Using Fractal Analysis
Authors: Cheung, N.
Donaghue, K.C.
Liew, G.
Rogers, S.L.
Wang, J.J.
Lim, S.-W.
Jenkins, A.J.
Hsu, W. 
Lee, M.L. 
Wong, T.Y. 
Issue Date: 2009
Citation: Cheung, N., Donaghue, K.C., Liew, G., Rogers, S.L., Wang, J.J., Lim, S.-W., Jenkins, A.J., Hsu, W., Lee, M.L., Wong, T.Y. (2009). Quantitative Assessment of Early Diabetic Retinopathy Using Fractal Analysis. Diabetes Care 32 (1) : 106-110. ScholarBank@NUS Repository.
Abstract: Objective - Fractal analysis can quantify the geometric complexity of the retinal vascular branching pattern and may therefore offer a new method to quantify early diabetic microvascular damage. In this study, we examined the relationship between retinal fractal dimension and retinopathy in young individuals with type 1 diabetes. Research design and methods - We conducted a cross-sectional study of 729 patients with type 1 diabetes (aged 12-20 years) who had seven-field stereoscopic retinal photographs taken of both eyes. From these photographs, retinopathy was graded according to the modified Airlie House classification, and fractal dimension was quantified using a computer-based program following a standardized protocol. Results - In this study, 137 patients (18.8%) had diabetic retinopathy signs; of these, 105 had mild retinopathy. Median (interquartile range) retinal fractal dimension was 1.46214 (1.45023-1.47217). After adjustment for age, sex, diabetes duration, A1C, blood pressure, and total cholesterol, increasing retinal vascular fractal dimension was significantly associated with increasing odds of retinopathy (odds ratio 3.92 [95% CI 2.02-7.61] for fourth versus first quartile of fractal dimension). In multivariate analysis, each 0.01 increase in retinal vascular fractal dimension was associated with a nearly 40% increased odds of retinopathy (1.37 [1.21- 1.56]). This association remained after additional adjustment for retinal vascular caliber. Conclusions - Greater retinal fractal dimension, representing increased geometric complexity of the retinal vasculature, is independently associated with early diabetic retinopathy signs in type 1 diabetes. Fractal analysis of fundus photographs may allow quantitative measurement of early diabetic microvascular damage. © 2009 by the American Diabetes Association.
Source Title: Diabetes Care
ISSN: 01495992
DOI: 10.2337/dc08-1233
Appears in Collections:Staff Publications

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