Fractal Dimension and Retinal Pathology: A Meta-Analysis

Due to the fractal nature of retinal blood vessels, the retinal fractal dimension is a natural parameter for researchers to explore and has garnered interest as a potential diagnostic tool. This review aims to summarize the current scientific evidence regarding the relationship between fractal dimension and retinal pathology and thus assess the clinical value of retinal fractal dimension. Following the PRISMA guidelines, a literature search for research articles was conducted in several internet databases (EMBASE, MEDLINE, Web of Science, Scopus). This led to a result of 28 studies included in the final review, which were analyzed via meta-analysis to determine whether the fractal dimension changes significantly in retinal disease versus normal individuals. From the meta-analysis, summary effect sizes and 95% confidence intervals were derived for each disease category. The results for diabetic retinopathy and myopia suggest decreased retinal fractal dimension for those pathologies with the association for other diseases such as diabetes mellitus, hypertension, and glaucoma remaining uncertain. Due to heterogeneity in imaging/fractal analysis setups used between studies, it is recommended that standardized retinal fractal analysis procedures be implemented in order to facilitate future meta-analyses.