Digital image analysis in retinopathy of prematurity: A comparison of vessel selection methods

Purpose To evaluate vessel selection methods to distinguish between eyes with and without retinopathy of prematurity (ROP) and between different stages of ROP when quantifying the associated vessel changes in width and tortuosity semiautomatically from digital retinal images. Methods Color digital images from 75 infants screened for ROP were cropped to a standardized diameter of 240 pixels and evaluated by semiautomated vessel analysis software, Computer-Aided Image Analysis of the Retina (CAIAR), to measure retinal vessel width and tortuosity. Two methods of vessel selection were used: (1) clinical observer selecting the most prominent arteriole or venule in each retinal quadrant (4-vessel analysis) and then separately the 4 most prominent arterioles and venules from each quadrant (8-vessel analysis); (2) CAIAR selecting, regardless of retinal quadrant, the 4 widest or most tortuous arterioles or venules. Selected vessels were measured by CAIAR for tortuosity and width. Results When comparing ROP stages, whether observer or CAIAR selected and whether 4 or 8 vessels were analyzed, we found that arteriolar tortuosity was significantly greater with advancing ROP stage for stage 0 versus stage 2; stage 0 or 1 versus stage 3; stages 1+2 combined versus stage 3; and stage 0 versus 1+2+3 combined ( P < 0.01). Venular tortuosity was significantly greater with advancing ROP stage for stage 0 versus stage 3 and stage 0 versus stages 1 and 2+3 combined ( P < 0.01). Width parameters did not help us to distinguish between stages. Conclusions Distinguishing between arterioles and venules is not necessary to differentiate stage 0 ROP from stage 2 or 3 ROP when one is using CAIAR. Tortuosity shows more promise than width at providing a reliable vessel parameter for distinguishing between eyes without and with ROP.