title: Development and reliability of retinal arteriolar central light reflex quantification system: a new approach for severity grading.
abstract: OBJECTIVE
  To describe the methodology and assess the reliability of novel computer-based semiautomated software that quantifies retinal arteriolar central light reflex (CR) from digital retinal photographs.
  
  
  METHODS
  A total of 150 optic disc-centered digital color retinal photographs were selected from a population-based cross-sectional study of persons aged 40 to 80 years (the Singapore Malay Eye Study [SiMES]). Computer-assisted software was developed to quantify retinal arteriolar CR by selecting vessel edge points semiautomatically. This software then automatically computes the CR, vessel diameter, and the CR-to-vessel diameter ratio (CRR). Reliability was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman plots. Multiple linear regression analyses were performed to assess the associations between CRR and systemic and ocular factors, to further validate the novel software.
  
  
  RESULTS
  The ICCs for the intergrader and intragrader CRR measurement were 0.76 (95% confidence interval [CI] 0.53-0.89) and 0.86 (95% CI 0.67-0.94), respectively. The ICC for intravisit repeatability was 0.87 (95% CI 0.71-0.95). In the multivariate model, a higher CRR was associated with elevated mean arterial blood pressure (per 10 mm Hg increase) (β = 0.017, P < 0.001).
  
  
  CONCLUSIONS
  Quantitative assessment of retinal arteriolar wall opacification is a reliable method using a new computer-assisted system. This new CRR measurement system is a potentially useful tool to study retinal arteriolar abnormalities with systemic diseases.
authors.affiliation: Commonwealth Scientific and Industrial Research Organisation, Perth, Australia.
authors.forename: Alauddin
authors.initials: A
authors.lastname: Bhuiyan
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Carol Y
authors.initials: CY
authors.lastname: Cheung
authors.affiliation: Commonwealth Scientific and Industrial Research Organisation, Perth, Australia.
authors.forename: Shaun
authors.initials: S
authors.lastname: Frost
authors.affiliation: Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia Singapore Eye Research Institute, Singapore National Eye Centre, Singapore Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Ecosse
authors.initials: E
authors.lastname: Lamoureux
authors.affiliation: Westmead Millennium Institute for Medical Research, University of Sydney, Sydney, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.affiliation: Commonwealth Scientific and Industrial Research Organisation, Perth, Australia.
authors.forename: Yogesan
authors.initials: Y
authors.lastname: Kanagasingam
authors.affiliation: Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia Singapore Eye Research Institute, Singapore National Eye Centre, Singapore Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Tien Y
authors.initials: TY
authors.lastname: Wong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001160:Arterioles / Q000473:pathology; D001794:Blood Pressure / Q000502:physiology; D003430:Cross-Sectional Studies; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D008027:Light; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology; D010781:Photography / Q000379:methods; D012044:Regression Analysis; D015203:Reproducibility of Results; D012161:Retinal Artery / Q000473:pathology*; D012164:Retinal Diseases / Q000175:diagnosis*; D012720:Severity of Illness Index; D012984:Software
keywords: grading; hypertension; image processing; retinal arteriolar central light reflex; retinal color photograph