Retinal Vascular Fractals Correlate With Early Neurodegeneration in Patients With Type 2 Diabetes Mellitus

Ulrik Frydkjaer-Olsen, Rasmus Soegaard Hansen, Knud Pedersen, Tunde Peto, Jakob Grauslund

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)


PURPOSE: To investigate the correlation between the retinal vascular fractal dimension (Fd) and neurodegenerative changes in patients with no or mild diabetic retinopathy (DR).

METHODS: In this cross-sectional study we examined 103 patients with type 2 diabetes mellitus (T2DM) with no or mild DR. In a randomly selected eye of each patient, Fd was calculated using SIVA-Fractal, a specialized semiautomatic software. Retinal neurodegeneration was evaluated by Topcon 3D OCT-2000 spectral-domain optical coherence tomography (OCT) and by a RETI-scan multifocal ERG (mf-ERG) system in rings one to six. Level of DR was determined by a single trained grader in seven-field fundus photos according to the Early Treatment Diabetic Retinopathy Study (ETDRS) scale.

RESULTS: Mean age and duration of T2DM were 62.3 and 11.6 years, respectively; 46.6% were men. Mean Fd was 1.413 (range, 1.278-1.509) and ETDRS levels were 10 (42.7%), 20 (35.0%), and 35 (22.3%), respectively. Fd correlated inversely with mf-ERG implicit time of ring one (r = -0.25, P = 0.01) and present diabetic neuropathy (P = 0.02), and positively with OCT ganglion cell layer (GCL) thickness (r = 0.20, P = 0.04). In a multivariable linear regression model, Fd was associated with mf-ERG implicit time of ring one (coefficient -0.0021/ms, P = 0.040) and the presence of diabetic neuropathy (coefficient -0.0209 for neuropathy present versus absent, P = 0.041).

CONCLUSIONS: In patients with T2DM and no or minimal DR, independent correlations were found between early vascular and neurogenic changes. Thus, retinal vascular fractal analysis might be considered as a tool to identify patients with early neurodegenerative retinal changes.

Original languageEnglish
Pages (from-to)7438-43
JournalInvestigative ophthalmology & visual science
Issue number12
Publication statusPublished - Nov 2015
Externally publishedYes


  • Adult
  • Aged
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2
  • Diabetic Retinopathy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retinal Degeneration
  • Retinal Vessels
  • Retrospective Studies
  • Time Factors
  • Tomography, Optical Coherence
  • Journal Article
  • Research Support, Non-U.S. Gov't

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