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Jiang Y, Chen Q, Shi D, Miao S, Liu Y, Wang J, Liu L, Chen Y, Wang R. Association of retinal microvascular curve tortuosity and multiple sclerosis: A cross-section analysis from the UK Biobank. Mult Scler Relat Disord 2024; 88:105753. [PMID: 38996710 DOI: 10.1016/j.msard.2024.105753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/03/2024] [Accepted: 06/30/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND There is growing evidence supporting that vascular abnormalities contribute to multiple sclerosis (MS), and retinal microvasculature functions as a visible window to observe vessels. We hypothesized that retinal vascular curve tortuosity is associated with MS, which this study aims to address. METHODS Participants from the UK Biobank with complete clinical records and gradable fundus photos were included in the study. Arteriolar and venular curve tortuosity and vessel area density are quantified automatically using a deep learning system. Individuals with MS were matched to healthy controls using propensity score matching (PSM). Conditional logistic regression was used to investigate the association between retinal vascular characteristics and MS. We also used a receiver operating characteristic (ROC) curve to assess the diagnostic performance of MS. RESULTS Venular curve tortuosity (VCT) was found to be significantly associated with MS. And patients with multiple sclerosis were probable to have lower VCT than the non-MS group (OR = 0.22 [95 % CI, 0.05 to 0.92], P < 0.05). CONCLUSIONS Our study reveals a significant association between vessel curve tortuosity and MS. The lower curve tortuosity of the retinal venular network may indicate a higher risk of incident multiple sclerosis.
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Affiliation(s)
- Yuzhe Jiang
- Department of Ophthalmology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou, China
| | - Qi Chen
- Department of Ophthalmology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Danli Shi
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong; Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong; Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong
| | - Suyu Miao
- First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou, China
| | - Yifeng Liu
- First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou, China
| | - Jinyang Wang
- First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou, China
| | - Lin Liu
- Department of Ophthalmology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yufan Chen
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Ruobing Wang
- Department of Ophthalmology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Marra KV, Chen JS, Robles-Holmes HK, Miller J, Wei G, Aguilar E, Ideguchi Y, Ly KB, Prenner S, Erdogmus D, Ferrara N, Campbell JP, Friedlander M, Nudleman E. Development of a Semi-automated Computer-based Tool for the Quantification of Vascular Tortuosity in the Murine Retina. OPHTHALMOLOGY SCIENCE 2024; 4:100439. [PMID: 38361912 PMCID: PMC10867761 DOI: 10.1016/j.xops.2023.100439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 10/10/2023] [Accepted: 11/27/2023] [Indexed: 02/17/2024]
Abstract
Purpose The murine oxygen-induced retinopathy (OIR) model is one of the most widely used animal models of ischemic retinopathy, mimicking hallmark pathophysiology of initial vaso-obliteration (VO) resulting in ischemia that drives neovascularization (NV). In addition to NV and VO, human ischemic retinopathies, including retinopathy of prematurity (ROP), are characterized by increased vascular tortuosity. Vascular tortuosity is an indicator of disease severity, need to treat, and treatment response in ROP. Current literature investigating novel therapeutics in the OIR model often report their effects on NV and VO, and measurements of vascular tortuosity are less commonly performed. No standardized quantification of vascular tortuosity exists to date despite this metric's relevance to human disease. This proof-of-concept study aimed to apply a previously published semi-automated computer-based image analysis approach (iROP-Assist) to develop a new tool to quantify vascular tortuosity in mouse models. Design Experimental study. Subjects C57BL/6J mice subjected to the OIR model. Methods In a pilot study, vasculature was manually segmented on flat-mount images of OIR and normoxic (NOX) mice retinas and segmentations were analyzed with iROP-Assist to quantify vascular tortuosity metrics. In a large cohort of age-matched (postnatal day 12 [P12], P17, P25) NOX and OIR mice retinas, NV, VO, and vascular tortuosity were quantified and compared. In a third experiment, vascular tortuosity in OIR mice retinas was quantified on P17 following intravitreal injection with anti-VEGF (aflibercept) or Immunoglobulin G isotype control on P12. Main Outcome Measures Vascular tortuosity. Results Cumulative tortuosity index was the best metric produced by iROP-Assist for discriminating between OIR mice and NOX controls. Increased vascular tortuosity correlated with disease activity in OIR. Treatment of OIR mice with aflibercept rescued vascular tortuosity. Conclusions Vascular tortuosity is a quantifiable feature of the OIR model that correlates with disease severity and may be quickly and accurately quantified using the iROP-Assist algorithm. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Kyle V. Marra
- Department of Molecular Medicine, The Scripps Research Institute, San Diego, California
- School of Medicine, University of California San Diego, San Diego, California
| | - Jimmy S. Chen
- Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, San Diego, California
| | - Hailey K. Robles-Holmes
- Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, San Diego, California
| | - Joseph Miller
- Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, San Diego, California
| | - Guoqin Wei
- Department of Molecular Medicine, The Scripps Research Institute, San Diego, California
| | - Edith Aguilar
- Department of Molecular Medicine, The Scripps Research Institute, San Diego, California
| | - Yoichiro Ideguchi
- Department of Molecular Medicine, The Scripps Research Institute, San Diego, California
| | - Kristine B. Ly
- College of Optometry, Pacific University, Forest Grove, Oregon
| | - Sofia Prenner
- Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, San Diego, California
| | - Deniz Erdogmus
- Department of Electrical and Computer Engineering, Northeastern University, Boston, Massachusetts
| | - Napoleone Ferrara
- Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, San Diego, California
| | - J. Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Martin Friedlander
- Department of Molecular Medicine, The Scripps Research Institute, San Diego, California
| | - Eric Nudleman
- Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, San Diego, California
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Hervella ÁS, Ramos L, Rouco J, Novo J, Ortega M. Explainable artificial intelligence for the automated assessment of the retinal vascular tortuosity. Med Biol Eng Comput 2024; 62:865-881. [PMID: 38060101 PMCID: PMC10881731 DOI: 10.1007/s11517-023-02978-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023]
Abstract
Retinal vascular tortuosity is an excessive bending and twisting of the blood vessels in the retina that is associated with numerous health conditions. We propose a novel methodology for the automated assessment of the retinal vascular tortuosity from color fundus images. Our methodology takes into consideration several anatomical factors to weigh the importance of each individual blood vessel. First, we use deep neural networks to produce a robust extraction of the different anatomical structures. Then, the weighting coefficients that are required for the integration of the different anatomical factors are adjusted using evolutionary computation. Finally, the proposed methodology also provides visual representations that explain the contribution of each individual blood vessel to the predicted tortuosity, hence allowing us to understand the decisions of the model. We validate our proposal in a dataset of color fundus images providing a consensus ground truth as well as the annotations of five clinical experts. Our proposal outperforms previous automated methods and offers a performance that is comparable to that of the clinical experts. Therefore, our methodology demonstrates to be a viable alternative for the assessment of the retinal vascular tortuosity. This could facilitate the use of this biomarker in clinical practice and medical research.
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Affiliation(s)
- Álvaro S Hervella
- Centro de Investigación CITIC, Universidade da Coruña, A Coruña, Spain.
- Grupo VARPA, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, A Coruña, Spain.
| | - Lucía Ramos
- Centro de Investigación CITIC, Universidade da Coruña, A Coruña, Spain
- Grupo VARPA, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, A Coruña, Spain
| | - José Rouco
- Centro de Investigación CITIC, Universidade da Coruña, A Coruña, Spain
- Grupo VARPA, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, A Coruña, Spain
| | - Jorge Novo
- Centro de Investigación CITIC, Universidade da Coruña, A Coruña, Spain
- Grupo VARPA, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, A Coruña, Spain
| | - Marcos Ortega
- Centro de Investigación CITIC, Universidade da Coruña, A Coruña, Spain
- Grupo VARPA, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, A Coruña, Spain
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Chen N, Zhu Z, Yang W, Wang Q. Progress in clinical research and applications of retinal vessel quantification technology based on fundus imaging. Front Bioeng Biotechnol 2024; 12:1329263. [PMID: 38456011 PMCID: PMC10917897 DOI: 10.3389/fbioe.2024.1329263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/12/2024] [Indexed: 03/09/2024] Open
Abstract
Retinal blood vessels are the only directly observed blood vessels in the body; changes in them can help effective assess the occurrence and development of ocular and systemic diseases. The specificity and efficiency of retinal vessel quantification technology has improved with the advancement of retinal imaging technologies and artificial intelligence (AI) algorithms; it has garnered attention in clinical research and applications for the diagnosis and treatment of common eye and related systemic diseases. A few articles have reviewed this topic; however, a summary of recent research progress in the field is still needed. This article aimed to provide a comprehensive review of the research and applications of retinal vessel quantification technology in ocular and systemic diseases, which could update clinicians and researchers on the recent progress in this field.
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Affiliation(s)
- Naimei Chen
- Department of Ophthalmology, Huaian Hospital of Huaian City, Huaian, China
| | - Zhentao Zhu
- Department of Ophthalmology, Huaian Hospital of Huaian City, Huaian, China
| | - Weihua Yang
- Department of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China
| | - Qiang Wang
- Department of Ophthalmology, Third Affiliated Hospital, Wenzhou Medical University, Ruian, China
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Raffa L, Abudawd O, Bugshan N, Fageeh S, Ramos L, Novo J, Rouco J, Ortega M. Computer-assisted evaluation of retinal vessel tortuosity in moderate-to-late preterm children. Eur J Ophthalmol 2023; 33:1874-1882. [PMID: 36775924 DOI: 10.1177/11206721231157262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
PURPOSE Since very preterm children often have increased retinal tortuosity that may indicate decisive architectural changes in the systemic microvascular network, we used a new semi-automatic software to measure retinal vessel tortuosity on fundus digital images of moderate-to-late preterm (MLP) children. METHODS In this observational case-control study, the global and local tortuosity parameters of retinal vessels were evaluated on fundus photographs of 36 MLP children and 36 age- and sex-matched controls. The associations between birth parameters and parameters reflecting retinal vessel tortuosity were evaluated using correlation analysis. RESULTS Even after incorporation of anatomical factors, the global and local tortuosity parameters were not significantly different between groups. The MLP group showed a smaller arteriolar caliber (0.53 ± 0.2) than the controls (0.56 ± 0.2; p = 0.013). Other local tortuosity parameters, such as vessel length, distance to fovea, and distance to optic disc, were not significantly different between arteries and veins. Tortuosity in both groups was higher among vessels closer to the fovea (r = -0.077, p < 0.001) and the optic disc (r = -0.0544, p = 0.009). Global tortuosity showed a weakly positive correlation with gestational age and a weakly negative correlation with birth weight in both groups. CONCLUSION MLP patients did not display increased vessel tortuosity in comparison with the controls; however, the arteriolar caliber in the MLP group was smaller than that in children born full-term. Larger studies should confirm this finding and explore associations between cardiovascular and metabolic status and retinal vessel geometry in MLP children.
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Affiliation(s)
- Lina Raffa
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ola Abudawd
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nada Bugshan
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Samiha Fageeh
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Lucia Ramos
- VARPA Research Group, Instituto de Investigacion Biomedica de A Coruna (INIBIC), Universidade da Coruna, A Coruna, Spain
| | - Jorge Novo
- Centro de Investigacion CITIC, Universidade da Coruna, A Coruna, Spain
- VARPA Research Group, Instituto de Investigacion Biomedica de A Coruna (INIBIC), Universidade da Coruna, A Coruna, Spain
| | - Jose Rouco
- Centro de Investigacion CITIC, Universidade da Coruna, A Coruna, Spain
- VARPA Research Group, Instituto de Investigacion Biomedica de A Coruna (INIBIC), Universidade da Coruna, A Coruna, Spain
| | - Marcos Ortega
- Centro de Investigacion CITIC, Universidade da Coruna, A Coruna, Spain
- VARPA Research Group, Instituto de Investigacion Biomedica de A Coruna (INIBIC), Universidade da Coruna, A Coruna, Spain
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Ramírez N, Ralló M, Millan MS. Retinal Vessel Local Tortuosity under a Macula-to-Optic Disc Central-Framing Change. Diagnostics (Basel) 2023; 13:diagnostics13061030. [PMID: 36980338 PMCID: PMC10046985 DOI: 10.3390/diagnostics13061030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023] Open
Abstract
Some ocular and cardiovascular diseases can be detected through the increased tortuosity of retinal blood vessels. Objective tortuosity measures can be obtained from digital image analysis of a retinography. This study tested a set of local tortuosity indices under a change in the frame center (macula, optic disc) of the eye fundus image. We illustrate the effects of such a change on 40 pairs of vessels evaluated with eight tortuosity indices. We show that the frame center change caused significant differences in the mean values of the vast majority of the tortuosity indices analyzed. The index defined as the ratio of the curvature to the arc length of a vessel segment proved to be the most robust in relation to a frame center change. Experimental results obtained from the analysis of clinical images are provided and discussed.
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Dogan C, Gonen B, Dincer MT, Mergen B, Kiykim E, Bakir A, Trabulus S, Yetik H, Seyahi N. Evaluation of the reasons for the microvascular changes in patients with Fabry disease using optic coherence tomography angiography. Eur J Ophthalmol 2020; 31:3231-3237. [PMID: 33225739 DOI: 10.1177/1120672120974288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To investigate the blood flow changes in the choriocapillaris and the superficial and deep capillary plexus of the retina using optic coherence tomography angiography (OCTA) in patients with Fabry disease (FD) and reveal any possible association of these changes with the systemic findings. METHODS This cross-sectional study included 38 patients with FD and age- and gender-matched 40 healthy controls. OCTA images were obtained from all patients. Superficial (sCVD) and deep capillary vascular density (dCVD) in the foveal, parafoveal, and perifoveal zones and the whole image were recorded for each patient. Flow area in the choriocapillaris and central macular thickness (CMT) were also recorded. RESULTS Patients with FD showed a lower whole image (54.45 ± 5.99% vs 57.32 ± 6.71%, p = 0.004), foveal (34.94 ± 7.60% vs 39.65 ± 7.03%, p = 0.003), parafoveal (57.41 ± 4.85% vs 59.19 ± 4.67%, p = 0.043), and perifoveal (55.87 ± 6.43% vs 58.87 ± 7.02%, p = 0.003) dCVD compared to the healthy controls without a significant difference in the sCVD and choriocapillaris blood flow (p > 0.05). A significantly lower whole image and foveal dCVD in the FD patients with renal involvement was observed compared to the healthy controls (p = 0.027 and p = 0.024, respectively) without any significant difference between the FD patients without renal involvement and healthy controls (p = 0.17 and p = 0.13, respectively). CMT was significantly higher in FD patients with renal involvement compared to the ones without renal involvement (252.1 ± 18.5 µm vs 235.5 ± 17.6 µm, p = 0.016). CONCLUSION Patients with FD showed a lower dCVD without any change in sCVD and choriocapillaris compared to the healthy controls. This decrease was associated mostly with the renal involvement and duration of treatment.
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Affiliation(s)
- Cezmi Dogan
- Cerrahpasa Medical Faculty, Department of Ophthalmology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Busenur Gonen
- Cerrahpasa Medical Faculty, Department of Ophthalmology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mevlut Tamer Dincer
- Cerrahpasa Medical Faculty, Department of Nephrology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Burak Mergen
- Basaksehir Cam ve Sakura City Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Ertugrul Kiykim
- Cerrahpasa Medical Faculty, Department of Pediatrics, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Alev Bakir
- Department of Biostatistics, Halic University, Istanbul, Turkey
| | - Sinan Trabulus
- Cerrahpasa Medical Faculty, Department of Nephrology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Huseyin Yetik
- Cerrahpasa Medical Faculty, Department of Ophthalmology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nurhan Seyahi
- Cerrahpasa Medical Faculty, Department of Nephrology, Istanbul University-Cerrahpasa, Istanbul, Turkey
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