Fractal Dimension of Peripapillary Vasculature in Primary Open- Angle Glaucoma
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Purpose: To compare the fractal dimensions of the peripapillary microvasculature as obtained by optical coherence tomographyangiography (OCTA) between primary open-angle glaucoma (POAG) and controls. Methods: Optic nerve head and peripapillary area images were taken using the 20° × 20°-scan of Spectralis OCTA (HeidelbergEngineering) in 97 subjects (64 POAG patients, 33 control patients). The optic nerve head microvasculature was evaluatedaccording to predefined slabs: the superficial vascular complex (SVC) and the avascular complex (AVC). The en face image ofeach slab was processed by ImageJ software (National Institutes of Health) in order to calculate the vessel density and thefractal dimension using the box-counting method. For comparison, the peripapillary retinal nerve fiber layer (RNFL) thicknesswas obtained from Spectralis OCT circle scans. The utilities of the parameters for discriminating between the POAG and controlgroups were assessed using areas under the receiver operating characteristic curves (AUCs). Results: The SVC fractal dimension was lower in the POAG than in the control group (p < 0.001), while AVC showed no intergroupdifference (p = 0.563). The fractal dimension showed a good correlation with the vessel density in both SVC and AVC(both p < 0.001). In a multivariable regression analysis, the SVC fractal dimension was negatively correlated with age (p < 0.001)and axial length (p < 0.001) and positively correlated with average RNFL thickness (p < 0.001), while the AVC fractal dimensionwas positively correlated with the Bruch’s membrane opening size (p = 0.013). In terms of diagnostic utility, the AUC was significantlylarger for the average RNFL thickness (AUC, 0.889) than for the SVC fractal dimension (AUC, 0.772; p = 0.008). Conclusions: The fractal dimension of SVC was associated with the average RNFL thickness and was reduced in POAG patients. Fractal dimension analysis could be used in evaluating peripapillary vascularity by OCTA.
Abstract
Purpose: To compare the fractal dimensions of the peripapillary microvasculature as obtained by optical coherence tomographyangiography (OCTA) between primary open-angle glaucoma (POAG) and controls. Methods: Optic nerve head and peripapillary area images were taken using the 20° × 20°-scan of Spectralis OCTA (HeidelbergEngineering) in 97 subjects (64 POAG patients, 33 control patients). The optic nerve head microvasculature was evaluatedaccording to predefined slabs: the superficial vascular complex (SVC) and the avascular complex (AVC). The en face image ofeach slab was processed by ImageJ software (National Institutes of Health) in order to calculate the vessel density and thefractal dimension using the box-counting method. For comparison, the peripapillary retinal nerve fiber layer (RNFL) thicknesswas obtained from Spectralis OCT circle scans. The utilities of the parameters for discriminating between the POAG and controlgroups were assessed using areas under the receiver operating characteristic curves (AUCs). Results: The SVC fractal dimension was lower in the POAG than in the control group (p < 0.001), while AVC showed no intergroupdifference (p = 0.563). The fractal dimension showed a good correlation with the vessel density in both SVC and AVC(both p < 0.001). In a multivariable regression analysis, the SVC fractal dimension was negatively correlated with age (p < 0.001)and axial length (p < 0.001) and positively correlated with average RNFL thickness (p < 0.001), while the AVC fractal dimensionwas positively correlated with the Bruch’s membrane opening size (p = 0.013). In terms of diagnostic utility, the AUC was significantlylarger for the average RNFL thickness (AUC, 0.889) than for the SVC fractal dimension (AUC, 0.772; p = 0.008). Conclusions: The fractal dimension of SVC was associated with the average RNFL thickness and was reduced in POAG patients. Fractal dimension analysis could be used in evaluating peripapillary vascularity by OCTA.
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