Mohd Zulfaezal Che Azemin

Age-related rarefaction in the fractal dimension of retinal vessel

Previous work suggests a general reduction in complexity with aging, referred to as the aging-complexity theory. Fractal dimension (FD) of the vessels in the retina is a global measure of the complexity of the vasculature. However, earlier works did not find any correlation between aging and FD of the retinal vasculature, in contrast to the findings of reduced complexity in other parts of the body. The authors tested the hypothesis that reduced complexity develops with advancing age in the structure of the retinal vasculature. To overcome the limitations of earlier works, a three-dimensional representation of the vasculature, together with Fourier fractal dimension (FFD) techniques, was used. Based on the analysis of 748 retinal images taken of persons aged 49-89 years, we observed a significant decrease in the FFD with aging (p < 0.0001). These data provide evidence supporting rarefaction (i.e. reduction) of the retinal vasculature with aging, consistent with observations from other human organ systems.

Robust Methodology for Fractal Analysis of the Retinal Vasculature

We have developed a robust method to perform retinal vascular fractal analysis from digital retina images. The technique preprocesses the green channel retina images with Gabor wavelet transforms to enhance the retinal images. Fourier Fractal dimension is computed on these preprocessed images and does not require any segmentation of the vessels. This novel technique requires human input only at a single step; the allocation of the optic disk center. We have tested this technique on 380 retina images from healthy individuals aged 50+ years, randomly selected from the Blue Mountains Eye Study population. To assess its reliability in assessing retinal vascular fractals from different allocation of optic center, we performed pair-wise Pearson correlation between the fractal dimension estimates with 100 simulated region of interest for each of the 380 images. There was Gaussian distribution variation in the optic center allocation in each simulation. The resulting mean correlation coefficient (standard deviation) was 0.93 (0.005). The repeatability of this method was found to be better than the earlier box-counting method. Using this method to assess retinal vascular fractals, we have also confirmed a reduction in the retinal vasculature complexity with aging, consistent with observations from other human organ systems.

Does Retinal Vascular Geometry Vary with Cardiac Cycle

PURPOSE Changes in retinal vascular parameters have been shown to be associated with systemic vascular diseases. In this study, we assessed the physiologic variations in retinal vascular measurements during the cardiac cycle. METHODS Fundus images were taken using electrocardiogram-synchronized retinal camera at nine distinct cardiac points from 15 healthy volunteers (135 images). Analyses of retinal vessel geometric measures, including retinal vessel caliber (individual and summary), tortuosity, branching angle, length-diameter ratio (LDR), and optimality deviation, were performed using semiautomated computer software. Repeated-measures ANOVAs were used to obtain the means and to estimate the variation of each cardiac point compared with cardiac point 1. RESULTS There was a significant variation of the caliber of the individual arteriolar and venular vessels. However, there was no significant variation found for vessel caliber summary, represented by the central retinal arteriolar equivalent (CRAE) and the central retinal venular equivalent (CRVE). There was also no significant variation found for tortuosity and branching angle, and LDR showed none or very little variations at different cardiac points: variations in caliber ranges between 0 and 4.1%, tortuosity 0 and 1.5%, branching angle 0 and 3.5%, and LDR 0 and 2%; all values for variations, P > 0.1; linear trend, P > 0.5; and nonlinear trend, P > 0.8. CONCLUSIONS This study showed that there were minimal variations in the CRAE, CRVE, tortuosity, and branching angle that are clinically used for two-dimensional measures of retinal vascular geometry during cardiac cycles. However, there was significant variation in the caliber of the individual vessels over the cardiac cycle.

Influence of Refractive Condition on Retinal Vasculature Complexity in Younger Subjects

Objective. The aim of this study was to compare the retinal vasculature complexity between emmetropia, and myopia in younger subjects. Methods. A total of 82 patients (24.12 ± 1.25 years) with two types of refractive conditions, myopia and emmetropia were enrolled in this study. Refraction data were converted to spherical equivalent refraction. These retinal images (right eyes) were obtained from NAVIS Lite Image Filing System and the vasculature complexity was measured by fractal dimension (D f), quantified using a computer software following a standardized protocol. Results. There was a significant difference (P < 0.05) in the value of D f between emmetropic (1.5666 ± 0.0160) and myopic (1.5588 ± 0.0142) groups. A positive correlation (rho = 0.260, P < 0.05) between the D f and the spherical equivalent refraction was detected in this study. Using a linear model, it was estimated that 6.7% of the variation in D f could be explained by spherical equivalent refraction. Conclusions. This study provides valuable findings about the effect of moderate to high myopia on the fractal dimension of the retinal vasculature network. These results show that myopic refraction in younger subjects was associated with a decrease in D f, suggesting a loss of retinal vessel density with moderate to high myopia.

Zone Specific Fractal Dimension of Retinal Images as Predictor of Stroke Incidence

Fractal dimensions (FDs) are frequently used for summarizing the complexity of retinal vascular. However, previous techniques on this topic were not zone specific. A new methodology to measure FD of a specific zone in retinal images has been developed and tested as a marker for stroke prediction. Higuchis fractal dimension was measured in circumferential direction (FDC) with respect to optic disk (OD), in three concentric regions between OD boundary and 1.5 OD diameter from its margin. The significance of its association with future episode of stroke event was tested using the Blue Mountain Eye Study (BMES) database and compared against spectrum fractal dimension (SFD) and box-counting (BC) dimension. Kruskal-Wallis analysis revealed FDC as a better predictor of stroke (H = 5.80, P = 0.016, α = 0.05) compared with SFD (H = 0.51, P = 0.475, α = 0.05) and BC (H = 0.41, P = 0.520, α = 0.05) with overall lower median value for the cases compared to the control group. This work has shown that there is a significant association between zone specific FDC of eye fundus images with future episode of stroke while this difference is not significant when other FD methods are employed.

A method for visualization of fine retinal vascular pulsation using nonmydriatic fundus camera synchronized with electrocardiogram.

Pulsatile changes in retinal vascular geometry over the cardiac cycle have clinical implication for diagnosis of ocular and systemic vascular diseases. In this study, we report a Vesselness Mapping of Retinal Image Sequence (VMRS) methodology to visualize the vessel pulsation and quantify the pulsatile motions in the cardiac cycle. Retinal images were recorded in an image sequence corresponding to 8 segments of the cardiac cycle using a nonmydriatic fundus camera (Canon CR45, Canon Inc., Japan) modified with ECG-synchronization. Individual cross-sectional vessel diameters were measured separately and the significance of the variations was tested statistically by repeated measures analysis of variance (ANOVA). The graders observed an improved quality of vessel pulsation on a wide region around the optic disk using the VMRS. Individual cross- sectional vessel diameter measurement after visualization of pulsatile motions resulted in the detection of more significant diameter change for both arterioles (3.3 μm, P = 0.001) and venules (6.6 μm, P < 0.001) compared to individual measurement without visualization of the pulsatile motions (all P values > 0.05), showing an increase of 2.1 μm and 4.7 μm for arterioles and venules, respectively.

Retinal vessel diameter measurement using multi-step regression method

Study of retinal blood vessel features, especially the caliber, has been widely used for risk level assessment of certain disease conditions. In this work a vessel diameter measurement technique based on Gaussian modeling has been proposed. This method adaptively combines a series of second and higher order Gaussians to model the vessel profile and uses the sigma parameter of the best fitted Generalized Gaussians to the boundaries, to measure the vessel caliber. One advantage of this technique is that, unlike other methods, it does not assume the vessel profile as a symmetrical Gaussian-like shape with similar blurriness levels at the edges. The technique has been tested on 580 cross-sections from normal and pathological public datasets with mixed quality fundus images. Comparison was made against two gold standard techniques and a ground truth obtained manually by three experts to sub-pixel accuracy.

Supervised retinal biometrics in different lighting conditions

Retinal image has been considered for number of health and biometrics applications. However, the reliability of these has not been investigated thoroughly. The variation observed in retina scans taken at different times is attributable to differences in illumination and positioning of the camera. It causes some missing bifurcations and crossovers from the retinal vessels. Exhaustive selection of optimal parameters is needed to construct the best similarity metrics equation to overcome the incomplete landmarks. In this paper, we extracted multiple features from the retina scans and employs supervised classification to overcome the shortcomings of the current techniques. The experimental results of 60 retina scans with different lightning conditions demonstrate the efficacy of this technique. The results were compared with the existing methods.

Automatic retinal vessel profiling using multi-step regression method

Caliber of the retinal blood vessel is widely used for risk assessment of cardiovascular diseases. Accurate and automatic caliber measurement requires a precise model to be made for the vessel profile. In this paper, we present a new approach for retinal vessel profiling in which the background noise, uneven illuminations and specular reflections have all been considered. In this method, regression analysis is performed with a series of second-order Gaussians to filter and up-sample the original vessel profile. This is then segmented to identify and represent the vessel edges by two Generalized Gaussian functions. The technique has been applied to retinal images and the results have been verified and compared with the state of the art automatic techniques.

Improved retinal photography method and visualization of multiple retinal images

The current instantaneous retinal photography method has large variations in the retinal vessel diameter measurement due to retinal vessel pulsation which has been reported associated to the cardiac cycle. The previous limited studies show limitation on their methodologies. To better understand and analyze the variation in the cardiac cycle, we developed an Electrocardiogram (ECG) synchronized retinal photography method which overcomes the previous limitations. Our method is able to detect ECG signal and calculate R-R interval in real time. The retinal camera can be triggered electronically and automatically at the designated time delays based on the real-time calculated R-R interval. Our results demonstrate this method is able to provide the visualization of the retinal vessel pulsations. It will be helpful for studying the relation of ophthalmology and cardiology. It also provides a possible solution to eliminate the cardiac cycle related photography variation in the retinal images analysis.