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      Comparison of Common Retinal Vessel Caliber Measurement Software and a Conversion Algorithm

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          Abstract

          Purpose

          To compare three commonly used retinal vessel caliber measurement software systems, and propose an algorithm for conversion between measurement systems.

          Methods

          We used 120 retinal photographs to evaluate the agreement between three commonly used software (Retinal Analysis [RA], Integrative Vessel Analysis [IVAN], and Singapore I Vessel Assessment [SIVA]). Bland-Altman plots were used to evaluate agreement of retinal arteriolar (central retinal artery equivalent, CRAE) and venular (central retinal vein equivalent, CRVE) calibers. Pearson's correlation was used to assess the associations between systemic factors and retinal vessel calibers, and Z-test was used to compare the strength of the correlation coefficients across the three software systems. An algorithm was created to convert measurements, with paired t-test performed to evaluate the differences between SIVA-measured retinal calibers and SIVA-approximates converted from RA- and IVAN-measurements using the algorithm.

          Results

          Differences between SIVA- and RA-measured calibers (CRAE: mean difference [MD] = −21.8 μm, 95% limits of agreement [LOA], −47.3 to 3.7 μm; CRVE: MD = −7.7 μm, 95% LOA, −28.0 to 12.6 μm), SIVA- and IVAN-measured calibers (CRAE: MD = −6.7 μm, 95% LOA, −23.8 to 10.4 μm; CRVE: MD = −18.2 μm 95% LOA, −36.7 to 0.4 μm) were large. However, the strength of correlations between systemic factors with SIVA-measured retinal calibers was not significantly different to that measured using RA and IVAN ( P ≥ 0.332). SIVA-approximates converted from RA and IVAN measurements using the proposed algorithm was not significantly different from SIVA-measured calibers ( P ≥ 0.20).

          Conclusion

          Absolute measurements of retinal vessel calibers vary between three common software systems but associations with systemic factors were similar.

          Translational Relevance

          The proposed algorithm allowed conversions of RA and IVAN measurements to SIVA-approximates. This conversion is important for future data pooling and establishment of normative values for retinal vascular caliber measurements.

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          Most cited references26

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          The Physiological Principle of Minimum Work: I. The Vascular System and the Cost of Blood Volume.

          C. Murray (1926)
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            Comparing methods of measurement: why plotting difference against standard method is misleading.

            When comparing a new method of measurement with a standard method, one of the things we want to know is whether the difference between the measurements by the two methods is related to the magnitude of the measurement. A plot of the difference against the standard measurement is sometimes suggested, but this will always appear to show a relation between difference and magnitude when there is none. A plot of the difference against the average of the standard and new measurements is unlikely to mislead in this way. We show this theoretically and by a practical example.
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              Methods for evaluation of retinal microvascular abnormalities associated with hypertension/sclerosis in the Atherosclerosis Risk in Communities Study.

              To develop protocols to photograph and evaluate retinal vascular abnormalities in the Atherosclerosis Risk in Communities (ARIC) Study; to test reproducibility of the grading system; and to explore the relationship of these microvascular changes with blood pressure. Population-based, cross-sectional study. Among 4 examination centers, 11,114 participants (48-73 years of age) at their third triennial examination, after excluding persons with diabetes from this analysis. One eye of each participant was photographed by technicians with nonmydriatic fundus cameras. Reading center graders evaluated focal arteriolar narrowing, arteriovenous (AV) nicking, and retinopathy by examining slides on a light box and measured diameters of all vessels in a zone surrounding the optic disc on enhanced digitized images. To gauge generalized narrowing, vessel diameters were combined into central arteriolar and venular equivalents with formulas adjusting for branching, and the ratio of equivalents (A/V ratio) was calculated. Retinal vascular abnormalities, mean arteriolar blood pressure (MABP). Among 11,114 participants, photographs were obtained of 99%, with quality sufficient to perform retinal evaluations in 81%. In the 9040 subjects with usable photographs, A/V ratio (lower values indicate generalized arteriolar narrowing) ranged from 0.57 to 1.22 (median = 0.84, interquartile range = 0.10), focal arteriolar narrowing was found in 7%, AV nicking in 6%, and retinopathy in 4%. Because of attrition of subjects and limitation of methods, prevalence of abnormality was likely underestimated. Controlling for gender, race, age, and smoking status, these retinal changes were associated with higher blood pressure. For every 10-mmHg increase in MABP, A/V ratio decreased by 0.02 unit (P < 0.0001), focal arteriolar narrowing had an odds ratio (OR) of 2.00 (95% confidence interval [CI] = 1.87-2.14), AV nicking had an OR of 1.25 (95% CI = 1.16-1.34), and retinopathy had an OR of 1.25 (95% CI = 1.15-1.37). For any degree of generalized narrowing, individuals with focal narrowing had MABP approximately 8 mmHg higher than those without (P < 0.0001). Masked replicate assessment of a sample found the following reproducibility: for A/V ratio, correlation coefficient = 0.79 and median absolute difference = 0.03; for focal arteriolar narrowing, kappa = 0.45; for AV nicking, kappa = 0.61; and for retinopathy, kappa = 0.89. Protocols have been developed for nonmydriatic fundus photography and for evaluation of retinal vascular abnormalities. Several microvascular changes were significantly associated with higher blood pressure; follow-up will show whether these are predictive of later cerebrovascular or cardiovascular disease independently of other known risk factors.
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                Author and article information

                Journal
                Transl Vis Sci Technol
                Transl Vis Sci Technol
                tvst
                tvst
                tvst
                Translational Vision Science & Technology
                The Association for Research in Vision and Ophthalmology
                2164-2591
                12 October 2016
                October 2016
                : 5
                : 5
                : 11
                Affiliations
                [1 ]Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
                [2 ]Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
                [3 ]School of Computing, National University of Singapore, Singapore
                [4 ]University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
                [5 ]Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
                [6 ]Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, National University of Singapore, Singapore
                [7 ]Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
                Author notes
                Correspondence: Wong Tien Yin, Singapore National Eye Center, 11 Third Hospital Avenue, Singapore, 168751. e-mail: wong.tien.yin@ 123456snec.com.sg
                Article
                tvst-05-05-06 TVST-15-0311
                10.1167/tvst.5.5.11
                5063055
                27752402
                50a219d8-34f9-4c67-b112-46f1bb28b0b9

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 16 November 2015
                : 24 April 2016
                Categories
                Articles

                retinal vasculature,retinal vessels,epidemiology
                retinal vasculature, retinal vessels, epidemiology

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