title: Fractal Dimensional Analysis of Optical Coherence Tomography Angiography in Eyes With Diabetic Retinopathy.
abstract: OBJECTIVE
  We used fractal dimensional analysis to analyze retinal vascular disease burden in eyes with diabetic retinopathy using spectral-domain optical coherence tomography angiography (OCTA).
  
  
  METHODS
  A retrospective study was performed of 13 eyes with diabetic retinopathy without diabetic macular edema and 56 control eyes. Optical coherence tomography angiography images were acquired using the RTVue XR Avanti. Automated segmentation was obtained through the superficial and deep capillary plexuses for each eye. Grayscale OCTA images were standardized and binarized using ImageJ. Fractal box-counting analyses were performed using Fractalyse. Fractal dimensions (FD) as well as software-generated vascular density analyses of the superficial and deep capillary plexuses were compared between diabetic and control eyes using 2-tailed t-tests and 1-way multivariate ANOVA (MANOVA) analyses.
  
  
  RESULTS
  The superficial and deep plexuses from diabetic and control eyes were analyzed. The average FD for diabetic eyes was significantly lower than control eyes for the superficial (P = 4.513 × 10-3) and deep (P = 2.653 × 10-3) capillary plexuses. In diabetic eyes, the vascular density also was significantly reduced in the superficial (P = 8.068 × 10-5) and deep (P = 3.120 × 10-6) capillary plexuses. One-way MANOVA showed a significant difference between diabetic and control eyes.
  
  
  CONCLUSIONS
  The OCTA FD is significantly reduced in the superficial and deep capillary plexuses in eyes with diabetic retinopathy. Applying fractal analysis to OCTA imaging holds the potential to establish quantitative parameters for microvascular pathology.
authors.affiliation: Department of Ophthalmology, New York University Langone Medical Center, New York, New York, United States.
authors.forename: Sarwar
authors.initials: S
authors.lastname: Zahid
authors.affiliation: Vitreous Retina Macula Consultants of New York, New York, New York, United States 3LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York, United States.
authors.forename: Rosa
authors.initials: R
authors.lastname: Dolz-Marco
authors.affiliation: Department of Ophthalmology, New York University Langone Medical Center, New York, New York, United States 2Vitreous Retina Macula Consultants of New York, New York, New York, United States 3LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York, United States 4Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York, United States.
authors.forename: K Bailey
authors.initials: KB
authors.lastname: Freund
authors.affiliation: Department of Ophthalmology, New York University Langone Medical Center, New York, New York, United States 2Vitreous Retina Macula Consultants of New York, New York, New York, United States 3LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York, United States 5Department of Physiology and Pharmacology, Lions Eye Institute, University of Western Australia, Perth, Australia.
authors.forename: Chandrakumar
authors.initials: C
authors.lastname: Balaratnasingam
authors.affiliation: Vitreous Retina Macula Consultants of New York, New York, New York, United States 3LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York, United States 6Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, United States.
authors.forename: Kunal
authors.initials: K
authors.lastname: Dansingani
authors.affiliation: Vitreous Retina Macula Consultants of New York, New York, New York, United States 3LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York, United States.
authors.forename: Fatimah
authors.initials: F
authors.lastname: Gilani
authors.affiliation: Department of Ophthalmology, New York University Langone Medical Center, New York, New York, United States.
authors.forename: Nitish
authors.initials: N
authors.lastname: Mehta
authors.affiliation: Department of Ophthalmology, New York University Langone Medical Center, New York, New York, United States.
authors.forename: Emma
authors.initials: E
authors.lastname: Young
authors.affiliation: Department of Ophthalmology, New York University Langone Medical Center, New York, New York, United States.
authors.forename: Meredith R
authors.initials: MR
authors.lastname: Klifto
authors.affiliation: Department of Ophthalmology, New York University Langone Medical Center, New York, New York, United States.
authors.forename: Bora
authors.initials: B
authors.lastname: Chae
authors.affiliation: Department of Ophthalmology, New York University Langone Medical Center, New York, New York, United States 2Vitreous Retina Macula Consultants of New York, New York, New York, United States 3LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York, United States 4Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York, United States.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Yannuzzi
authors.affiliation: Department of Ophthalmology, New York University Langone Medical Center, New York, New York, United States.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Young