Objective:

To compare the vessel geometry characteristics of color fundus photographs in normal control and diabetes mellitus (DM) patients and to find potential biomarkers for early diabetic retinopathy (DR) based on a neural network vessel segmentation system and automated vascular geometry parameter analysis software.

Methods:

A total of 102 consecutive patients with type 2 DM (T2DM) and 132 healthy controls were recruited. All participants underwent general ophthalmic examinations, and retinal fundus photographs were taken with a digital fundus camera without mydriasis. Color fundus photographs were input into a dense-block generative adversarial network (D-GAN)-assisted retinal vascular segmentation system (http://www.gdcerc.cn:8081/#/login) to obtain binary images. These images were then analyzed by customized software (ocular microvascular analysis system V2.9.1) for automatic processing of vessel geometry parameters, including the monofractal dimension (D_box), multifractal dimension (D₀), vessel area ratio (R), max vessel diameter (d_max), average vessel diameter (d_ave), arc–chord ratio (A/C), and tortuosity (τ_n). Geometric differences between the healthy subjects and DM patients were analyzed. Then, regression analysis and receiver operating characteristic (ROC) curve analysis were performed to evaluate the diagnostic efficiency of the vascular geometry parameters.

Results:

No significant differences were observed between the baseline characteristics of each group. DM patients had lower D_box and D₀ values (1.330 ± 0.041; 1.347 ± 0.038) than healthy subjects (1.343 ± 0.048, p < 0.05; 1.362 ± 0.042, p < 0.05) and showed increasing values of d_max, d_ave, A/C, and τ_n compared with normal controls, although only the differences in d_ave and τ_n between the groups were statistically significant. In the regression analysis, d_ave and τ_n showed a good correlation with diabetes (d_ave, OR 1.765, 95% CI 1.319–2.362, p < 0.001; τ_n, OR 9.323, 95% CI 1.492–58.262, p < 0.05).

Conclusions:

We demonstrated the relationship between retinal vascular geometry and the process in DM patients, showing that D_box, D₀, d_ave, and τ_n may be indicators of morphological changes in retinal vessels in DM patients and can be early biomarkers of DR.