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Fractal analysis of the macular region in healthy eyes using swept-source optical coherence tomography angiography

  • Retinal Disorders
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Abstract

Purpose

This cross-sectional observational study evaluated the relationship between retinal vascular fractal dimension (FD) and age, as well as other vascular parameters in healthy eyes using swept-source optical coherence tomography angiography (SS-OCTA).

Methods

The study cohort consisted of 222 eyes of 116 healthy participants with no ocular or systemic disease. SS-OCTA images were captured and analyzed using the Plex Elite 9000 and software tools available in the advanced retinal imaging (ARI) network hub. The retinal vascular layers were defined by the instrument's automatic retinal layer segmentation. The fractal analysis was performed on the superficial capillary plexus (SCP), deep capillary plexus (DCP), and the whole retina. Grayscale OCTA images were standardized and binarized using ImageJ and fractal box-counting analyses were performed using Fractalyse software. Pearson’s correlation was used to analyze the correlation between FD and retinal vascular parameters.

Results

The results showed that FD values were significantly higher in the 6 mm ring and the whole 6 × 6 scan region when compared to the 1 mm ETDRS central subfield. The correlation between age and FD was weak with a significant positive correlation between age and FD of the SCP in the 6 mm ring and between age and FD of the DCP in the 1 mm ring. Overall, differences in FD values in these healthy eyes were extremely small regardless of age or macular location.

Conclusion

FD values in normal eyes show little variation with age and are relatively stable across the macula. This suggests that FD values may not need adjustment for age or location when evaluated in the context of retinal disease.

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Author information

Author notes

  1. Kowsigan Magesan and Ramya Gnanaraj are contributed equally to this manuscript and should be considered the first authors.

Authors and Affiliations

  1. Elite School of Optometry, Unit of Medical Research Foundation, Chennai, Tamil Nadu, India

    Kowsigan Magesan, T Amose & Maanasi Mahalingam

  2. Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu, India

    Kowsigan Magesan, Ramya Gnanaraj, T Amose, Maanasi Mahalingam, Parveen Sen & Aditya Verma

  3. Doheny Eye Institute, Pasadena, CA, USA

    Ramya Gnanaraj, Jasaman Tojjar, Aditya Verma & SriniVas R. Sadda

  4. Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, 150 N, Orange Grove Blvd, Pasadena, CA, 91103, USA

    Jasaman Tojjar & SriniVas R. Sadda

  5. Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt

    Ahmed Roshdy Alagorie

  6. Department of Ophthalmology and Visual Sciences, University of Louisville, Kentucky, USA

    Aditya Verma

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  1. Kowsigan Magesan
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Correspondence to SriniVas R. Sadda.

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Vas Sadda- although the co-author is an editor of the journal, there was no involvement with the peer review process for this article.

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KM, RG, JT, AT, ARA, MM, PS, AV: None; SRS: 4DMT Consultant/Advisor; Alexion Consultant/Advisor; Allergan, Inc. Consultant/Advisor; Alnylam Pharmaceuticals Consultant/Advisor; Amgen Inc Consultant/Advisor; Apellis Pharmaceuticals, Inc. Consultant/Advisor; Astellas Consultant/Advisor; Bayer Healthcare Pharmaceuticals Consultant/Advisor; Carl Zeiss Meditec Consultant/Advisor, Lecture Fees/Speakers Bureau, Grant Support; Catalyst Pharmaceuticals Inc Consultant/Advisor; Centervue, Inc. Consultant/Advisor; GENENTECH Consultant/Advisor; Gyroscope Therapeutics Consultant/Advisor; Heidelberg Engineering Consultant/Advisor, Lecture Fees/Speakers Bureau, Grant Support; Iveric Bio Consultant/Advisor; Janssen Pharmaceuticals, Inc. Consultant/Advisor; Merck & Co., Inc. Consultant/Advisor; Nanoscope Consultant/Advisor; Nidek Incorporated Lecture Fees/Speakers Bureau; Novartis Pharma AG Consultant/Advisor, Lecture Fees/Speakers Bureau; Optos, Inc. Consultant/Advisor; Oxurion/ Thrombogenics Consultant/Advisor; Pfizer, Inc. Consultant/Advisor; Regeneron Pharmaceuticals, Inc. Consultant/Advisor; Samsung Bioepis Consultant/Advisor; Topcon Medical Systems Inc. Lecture Fees/Speakers Bureau; Vertex Pharmaceuticals Incorporated Consultant/Advisor.

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The manuscript was presented at the Association for Research in Vision and Ophthalmology, 2023 at New Orleans, LA, USA.

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Magesan, K., Gnanaraj, R., Tojjar, J. et al. Fractal analysis of the macular region in healthy eyes using swept-source optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 261, 2787–2794 (2023). https://doi.org/10.1007/s00417-023-06117-x

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