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Journal of Ophthalmology
Volume 2016 (2016), Article ID 6259047, 13 pages
Research Article

Reliability of Using Retinal Vascular Fractal Dimension as a Biomarker in the Diabetic Retinopathy Detection

1Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
2University Eye Clinic Maastricht, Maastricht, Netherlands
3Department of Biomedical and Information Engineering, Northeastern University, Shenyang, China

Received 27 November 2015; Accepted 17 August 2016

Academic Editor: Ana Raquel Santiago

Copyright © 2016 Fan Huang et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The retinal fractal dimension (FD) is a measure of vasculature branching pattern complexity. FD has been considered as a potential biomarker for the detection of several diseases like diabetes and hypertension. However, conflicting findings were found in the reported literature regarding the association between this biomarker and diseases. In this paper, we examine the stability of the FD measurement with respect to (1) different vessel annotations obtained from human observers, (2) automatic segmentation methods, (3) various regions of interest, (4) accuracy of vessel segmentation methods, and (5) different imaging modalities. Our results demonstrate that the relative errors for the measurement of FD are significant and FD varies considerably according to the image quality, modality, and the technique used for measuring it. Automated and semiautomated methods for the measurement of FD are not stable enough, which makes FD a deceptive biomarker in quantitative clinical applications.