Characterisation of the neovascularisation process in diabetic retinopathy by means of fractal geometry: diagnostic implications

The neovascularisation formation and regression process of the peripheral retina in diabetic retinopathy was studied by means of fractal analysis. The fractal dimension of the local retinal vessel pattern was calculated to be significantly lower before formation of relevant neovascularisations than 2.5 years later, after formation of strong preretinal neovascularisations. Another year later the new vessels had regressed partially and the fractal dimension was again significantly reduced. This behaviour is almost independent of the representation of the vessel thickness during calculation. Since the retinal vasculature is a fractal, the fractal dimension appears as the "natural" measure of proliferative retinal vessel changes. It is demonstrated that the fractal dimension can be applied to characterise proliferative diabetic retinopathy. These features offer the possibility for computer-driven ("automated") quantitative characterisation of the treatment effect in proliferative diabetic retinopathy and possibly automated detection of proliferative diabetic retinopathy in the future. The limitations of the method are discussed.