The Retinal Vasculature as a Fractal: Methodology, Reliability, and Relationship to Blood Pressure

Objective: Fractals represent a type of derived geometric pattern that permits the characterization of the branching pattern of retinal vessels. We examined a new semiautomated method to measure retinal vessel fractals. Design: Methodology study. Participants: Three hundred randomly selected participants from the population-based Blue Mountains Eye Study. Methods: We developed a semiautomated computer program to measure the fractal dimension (Df) of the retinal vessels from digitized images of disk-centered retinal photographs. Two trained graders masked to participant characteristics measured Df of right eye images of participants. Reliability was determined by repeat grading of the images from 60 participants, and association with systolic and diastolic blood pressure was examined in all 300 participants. Main Outcome Measure: Df of the retinal vessels. Results: Mean Df was 1.437 with a standard deviation of 0.025. Intragrader and intergrader reliability estimates were high with intraclass correlation ranging from 0.93 to 0.95. Df was inversely correlated with age (r = -0.42, P = 0.001) and systolic blood pressure (r = -0.29, P