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  1. Aliahmad B, Kumar DK, Hao H, Unnikrishnan P, Che Azemin MZ, Kawasaki R, et al.
    ScientificWorldJournal, 2014;2014:467462.
    PMID: 25485298 DOI: 10.1155/2014/467462
    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. Higuchi's 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.
  2. Kumar DK, Aliahmad B, Hao H, Che Azemin MZ, Kawasaki R
    ISRN Ophthalmol, 2013;2013:865834.
    PMID: 24558608 DOI: 10.1155/2013/865834
    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.
  3. Che Azemin MZ, Ab Hamid F, Aminuddin A, Wang JJ, Kawasaki R, Kumar DK
    Exp Eye Res, 2013 Nov;116:355-358.
    PMID: 24512773 DOI: 10.1016/j.exer.2013.10.010
    The fractal dimension is a global measure of complexity and is useful for quantifying anatomical structures, including the retinal vascular network. A previous study found a linear declining trend with aging on the retinal vascular fractal dimension (DF); however, it was limited to the older population (49 years and older). This study aimed to investigate the possible models of the fractal dimension changes from young to old subjects (10-73 years). A total of 215 right-eye retinal samples, including those of 119 (55%) women and 96 (45%) men, were selected. The retinal vessels were segmented using computer-assisted software, and non-vessel fragments were deleted. The fractal dimension was measured based on the log-log plot of the number of grids versus the size. The retinal vascular DF was analyzed to determine changes with increasing age. Finally, the data were fitted to three polynomial models. All three models are statistically significant (Linear: R2 = 0.1270, 213 d.f., p 
  4. Jeganathan VS, Sabanayagam C, Tai ES, Lee J, Sun C, Kawasaki R, et al.
    Hypertens. Res., 2009 Nov;32(11):975-82.
    PMID: 19713968 DOI: 10.1038/hr.2009.130
    Blood pressure has a significant effect on retinal arterioles. There are few data on whether this effect varies by race/ethnicity. We examined the relationship of blood pressure and retinal vascular caliber in a multi-ethnic Asian population. The study is population-based and cross sectional in design. A total of 3749 Chinese, Malay and Indian participants aged > or =24 years residing in Singapore were included in the study. Retinal vascular caliber was measured using a computer program from digital retinal photographs. The associations of retinal vascular caliber with blood pressure and hypertension in each racial/ethnic group were analyzed. The main outcome measures are retinal arteriolar caliber and venular caliber. The results show that retinal arterioles were narrower in persons with uncontrolled/untreated hypertension (140.0 microm) as compared with persons with controlled hypertension (142.1 microm, P=0.0001) and those with no hypertension (146.0 microm, P<0.0001). On controlling for age, gender, body mass index, lipids and smoking, each 10 mm Hg increase in mean arterial blood pressure was associated with a 3.1 microm decrease in arteriolar caliber (P<0.0001), with a similar magnitude seen in all three racial/ethnic groups: 3.1 microm in Chinese, 2.8 microm in Malays and 3.2 microm in Indians (P<0.0001 for all). Each 10 mm Hg increase in mean arterial blood pressure was associated with a 1.8 microm increase in venular caliber (P<0.0001); furthermore, the magnitude of this effect was similar across the three racial/ethnic groups. The effect of blood pressure on the retinal vasculature was similar across three major racial/ethnic groups in Asia.
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