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Open Access Highly Accessed Research article

The association between retinal vascular geometry changes and diabetic retinopathy and their role in prediction of progression – an exploratory study

Maged S Habib1*, Bashir Al-Diri2, Andrew Hunter2 and David HW Steel3

Author Affiliations

1 Sunderland Eye Infirmary – Queen Alexandra Road, Sunderland SR2 9HP, UK

2 Department of Computing and Informatics, Lincoln University, Brayford Pool, Lincoln LN6 7TS, UK

3 Institute of Genetic Medicine, University of Newcastle Upon Tyne, Central parkway, Newcastle NE1 3BZ, UK

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BMC Ophthalmology 2014, 14:89  doi:10.1186/1471-2415-14-89

Published: 7 July 2014



The study describes the relationship of retinal vascular geometry (RVG) to severity of diabetic retinopathy (DR), and its predictive role for subsequent development of proliferative diabetic retinopathy (PDR).


The research project comprises of two stages. Firstly, a comparative study of diabetic patients with different grades of DR. (No DR: Minimal non-proliferative DR: Severe non-proliferative DR: PDR) (10:10: 12: 19). Analysed RVG features including vascular widths and branching angles were compared between patient cohorts. A preliminary statistical model for determination of the retinopathy grade of patients, using these features, is presented. Secondly, in a longitudinal predictive study, RVG features were analysed for diabetic patients with progressive DR over 7 years. RVG at baseline was examined to determine risk for subsequent PDR development.


In the comparative study, increased DR severity was associated with gradual vascular dilatation (p = 0.000), and widening of the bifurcating angle (p = 0.000) with increase in smaller-child-vessel branching angle (p = 0.027). Type 2 diabetes and increased diabetes duration were associated with increased vascular width (p = <0.05 In the predictive study, at baseline, reduced small-child vascular width (OR = 0.73 (95% CI 0.58-0.92)), was predictive of future progression to PDR.


The study findings suggest that RVG alterations can act as novel markers indicative of progression of DR severity and establishment of PDR. RVG may also have a potential predictive role in determining the risk of future retinopathy progression.

Diabetic retinopathy; Retinal vascular geometry; Retinal vascular analysis; Retinal bifurcations