April 2011
Volume 52, Issue 14
ARVO Annual Meeting Abstract  |   April 2011
Plus Disease Diagnosis in Retinopathy of Prematurity by Fractal Analysis
Author Affiliations & Notes
  • Rony Gelman
    Ophthalmology, Columbia University, New York, New York
  • M. Elena Martinez-Perez
    Computer Science, National Autonomous University of Mexico, Mexico City, Mexico
  • Michael F. Chiang
    Departments of Ophthalmology & Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
  • Footnotes
    Commercial Relationships  Rony Gelman, None; M. Elena Martinez-Perez, None; Michael F. Chiang, MFC is an unpaid member of the Scientific Advisory Board for Clarity Medicine (C)
  • Footnotes
    Support  Supported by grant EY19474 from the National Institutes of Health. MFC is an unpaid member of the Scientific Advisory Board for Clarity Medical Systems.
Investigative Ophthalmology & Visual Science April 2011, Vol.52, 3163. doi:
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      Rony Gelman, M. Elena Martinez-Perez, Michael F. Chiang; Plus Disease Diagnosis in Retinopathy of Prematurity by Fractal Analysis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3163.

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      © ARVO (1962-2015); The Authors (2016-present)

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To examine the accuracy of fractal analysis for plus diseasediagnosis in retinopathy of prematurity (ROP).


34 retinal images were diagnosed as "plus" or "not plus" byconsensus of 22 experts. These images were segmented by a computer-basedimage analysis system (see sample RetCam and segmented images).Fractal dimension, Df, was computed with the box-counting methodusing Matlab (Natick, MA). Images were separated into retinalartery and vein subsets for analysis, and fractal dimensionswere computed for all subsets. The Mann-Whitney test was usedto compare "plus" vs. "not plus" groups. Receiver operatingcharacteristic areas under the curve (AUC) for plus diseasediagnosis by artery and vein fractal dimensions were calculated,and compared to a reference standard of expert diagnosis.


Among the 34 images, 21 were identified as "not plus" and 13as "plus" by expert consensus. Mean (SD) retinal artery Df was1.1874 (0.0974) in the "not plus" group and 1.2404 (0.08682)in the "plus" group (no statistically significant differencebetween the groups [p=0.151]). Mean (SD) retinal vein Df was1.2691 (0.04677) in the "not plus" group and 1.3011 (0.04626)in the "plus group" (statistically significant difference betweenthe groups [p=0.045]). AUC (SD; p-value) for retinal arteryDf was 0.650 (0.099; 0.151) and for retinal vein Df was 0.707(0.096; 0.045).


Fractal dimension of retinal veins from ROP retinal images maydiagnose plus disease with high accuracy.  


Keywords: retinopathy of prematurity • image processing • imaging/image analysis: clinical 

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