{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T11:44:12Z","timestamp":1794051852377,"version":"4.8.0"},"reference-count":47,"publisher":"Elsevier BV","issue":"11","license":[{"start":{"date-parts":[[2018,11,1]],"date-time":"2018-11-01T00:00:00Z","timestamp":1541030400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2018,11,1]],"date-time":"2018-11-01T00:00:00Z","timestamp":1541030400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2019,10,11]],"date-time":"2019-10-11T00:00:00Z","timestamp":1570752000000},"content-version":"am","delay-in-days":344,"URL":"http:\/\/www.elsevier.com\/open-access\/userlicense\/1.0\/"}],"content-domain":{"domain":["aaojournal.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Ophthalmology"],"published-print":{"date-parts":[[2018,11]]},"DOI":"10.1016\/j.ophtha.2018.04.023","type":"journal-article","created":{"date-parts":[[2018,5,17]],"date-time":"2018-05-17T21:02:10Z","timestamp":1526590930000},"page":"1784-1792","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":49,"title":["The Relationship of Retinal Vessel Geometric Characteristics to the Incidence and Progression of Diabetic Retinopathy"],"prefix":"10.1016","volume":"125","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4428-6237","authenticated-orcid":false,"given":"Ronald","family":"Klein","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristine E.","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorraine","family":"Danforth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Y.","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald E.","family":"Gangnon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacy E.","family":"Meuer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tien Y.","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol Y.","family":"Cheung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara E.K.","family":"Klein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.ophtha.2018.04.023_bib1","series-title":"Diabetes in America","article-title":"Epidemiology of ocular functions and diseases in persons with diabetes","author":"Klein","year":"2017"},{"key":"10.1016\/j.ophtha.2018.04.023_bib2","doi-asserted-by":"crossref","first-page":"16012","DOI":"10.1038\/nrdp.2016.12","article-title":"Diabetic retinopathy","volume":"2","author":"Wong","year":"2016","journal-title":"Nat Rev Dis Primers"},{"key":"10.1016\/j.ophtha.2018.04.023_bib3","series-title":"Diabetes in America","first-page":"221","article-title":"Mortality in insulin-dependent diabetes","author":"Portuese","year":"1995"},{"issue":"9 suppl 1","key":"10.1016\/j.ophtha.2018.04.023_bib4","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1016\/j.amjmed.2013.06.007","article-title":"The early treatment of type 2 diabetes","volume":"126","author":"Pratley","year":"2013","journal-title":"Am J Med"},{"issue":"9","key":"10.1016\/j.ophtha.2018.04.023_bib5","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.2337\/dc15-2171","article-title":"Global estimates on the number of people blind or visually impaired by diabetic retinopathy: a meta-analysis from 1990 to 2010","volume":"39","author":"Leasher","year":"2016","journal-title":"Diabetes Care"},{"issue":"9","key":"10.1016\/j.ophtha.2018.04.023_bib6","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1046\/j.1525-1497.1997.07111.x","article-title":"Screening, prevention, counseling, and treatment for the complications of type II diabetes mellitus. Putting evidence into practice","volume":"12","author":"Vijan","year":"1997","journal-title":"J\u00a0Gen Intern Med"},{"issue":"3","key":"10.1016\/j.ophtha.2018.04.023_bib7","doi-asserted-by":"crossref","first-page":"750","DOI":"10.2337\/dc12-1554","article-title":"Retinal vascular caliber as a biomarker for diabetes microvascular complications","volume":"36","author":"Ikram","year":"2013","journal-title":"Diabetes Care"},{"issue":"7","key":"10.1016\/j.ophtha.2018.04.023_bib8","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.2337\/dc10-2419","article-title":"Retinal vascular geometry predicts incident retinopathy in young people with type 1 diabetes: a prospective cohort study from adolescence","volume":"34","author":"Benitez-Aguirre","year":"2011","journal-title":"Diabetes Care"},{"issue":"9","key":"10.1016\/j.ophtha.2018.04.023_bib9","doi-asserted-by":"crossref","first-page":"1770","DOI":"10.1007\/s00125-017-4333-0","article-title":"Retinal vascular geometry and 6 year incidence and progression of diabetic retinopathy","volume":"60","author":"Cheung","year":"2017","journal-title":"Diabetologia"},{"issue":"4","key":"10.1016\/j.ophtha.2018.04.023_bib10","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.ajo.2012.04.016","article-title":"Retinal vascular fractal dimension and its relationship with cardiovascular and ocular risk factors","volume":"154","author":"Cheung","year":"2012","journal-title":"Am J Ophthalmol"},{"issue":"1","key":"10.1016\/j.ophtha.2018.04.023_bib11","doi-asserted-by":"crossref","first-page":"106","DOI":"10.2337\/dc08-1233","article-title":"Quantitative assessment of early diabetic retinopathy using fractal analysis","volume":"32","author":"Cheung","year":"2009","journal-title":"Diabetes Care"},{"issue":"2","key":"10.1016\/j.ophtha.2018.04.023_bib12","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1159\/000337252","article-title":"Retinal vascular calibre, geometry and progression of diabetic retinopathy in type 2 diabetes mellitus","volume":"228","author":"Crosby-Nwaobi","year":"2012","journal-title":"Ophthalmologica"},{"issue":"5","key":"10.1016\/j.ophtha.2018.04.023_bib13","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.2337\/dc11-1341","article-title":"Early retinal arteriolar changes and peripheral neuropathy in diabetes","volume":"35","author":"Ding","year":"2012","journal-title":"Diabetes Care"},{"issue":"Thesis 1","key":"10.1016\/j.ophtha.2018.04.023_bib14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1755-3768.2010.02105.x","article-title":"Eye complications and markers of morbidity and mortality in long-term type 1 diabetes","volume":"89","author":"Grauslund","year":"2011","journal-title":"Acta Ophthalmol"},{"issue":"7","key":"10.1016\/j.ophtha.2018.04.023_bib15","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1016\/j.ophtha.2009.10.047","article-title":"Retinal vascular fractals and microvascular and macrovascular complications in type 1 diabetes","volume":"117","author":"Grauslund","year":"2010","journal-title":"Ophthalmology"},{"key":"10.1016\/j.ophtha.2018.04.023_bib16","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/1471-2415-14-89","article-title":"The association between retinal vascular geometry changes and diabetic retinopathy and their role in prediction of progression\u2014an exploratory study","volume":"14","author":"Habib","year":"2014","journal-title":"BMC Ophthalmol"},{"issue":"6","key":"10.1016\/j.ophtha.2018.04.023_bib17","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.2337\/dc10-0055","article-title":"Alterations in retinal microvascular geometry in young type 1 diabetes","volume":"33","author":"Sasongko","year":"2010","journal-title":"Diabetes Care"},{"issue":"1","key":"10.1016\/j.ophtha.2018.04.023_bib18","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.ajo.2011.06.005","article-title":"Retinal arteriolar tortuosity is associated with retinopathy and early kidney dysfunction in type 1 diabetes","volume":"153","author":"Sasongko","year":"2012","journal-title":"Am J Ophthalmol"},{"issue":"11","key":"10.1016\/j.ophtha.2018.04.023_bib19","doi-asserted-by":"crossref","first-page":"2081","DOI":"10.2337\/dc09-0719","article-title":"Retinal vascular fractal dimension and risk of early diabetic retinopathy: a prospective study of children and adolescents with type 1 diabetes","volume":"32","author":"Lim","year":"2009","journal-title":"Diabetes Care"},{"issue":"7","key":"10.1016\/j.ophtha.2018.04.023_bib20","doi-asserted-by":"crossref","first-page":"781","DOI":"10.3109\/02713683.2013.779722","article-title":"Multifractal geometry in analysis and processing of digital retinal photographs for early diagnosis of human diabetic macular edema","volume":"38","author":"Talu","year":"2013","journal-title":"Curr Eye Res"},{"issue":"6","key":"10.1016\/j.ophtha.2018.04.023_bib21","doi-asserted-by":"crossref","first-page":"BI0200","DOI":"10.1167\/iovs.17-21699","article-title":"Retinal vessel geometry and the incidence and progression of diabetic retinopathy","volume":"58","author":"Lim","year":"2017","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"5","key":"10.1016\/j.ophtha.2018.04.023_bib22","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1007\/s00125-015-3511-1","article-title":"The clinical implications of recent studies on the structure and function of the retinal microvasculature in diabetes","volume":"58","author":"Cheung","year":"2015","journal-title":"Diabetologia"},{"key":"10.1016\/j.ophtha.2018.04.023_bib23","first-page":"2562759","article-title":"Noninvasive retinal markers in diabetic retinopathy: advancing from bench towards bedside","volume":"2017","author":"Blindbaek","year":"2017","journal-title":"J\u00a0Diabetes Res"},{"issue":"1","key":"10.1016\/j.ophtha.2018.04.023_bib24","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1093\/oxfordjournals.aje.a113725","article-title":"Prevalence of diabetes mellitus in southern Wisconsin","volume":"119","author":"Klein","year":"1984","journal-title":"Am J Epidemiol"},{"issue":"4","key":"10.1016\/j.ophtha.2018.04.023_bib25","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1001\/archopht.1984.01040030398010","article-title":"The Wisconsin Epidemiologic Study of Diabetic Retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years","volume":"102","author":"Klein","year":"1984","journal-title":"Arch Ophthalmol"},{"issue":"4","key":"10.1016\/j.ophtha.2018.04.023_bib26","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1001\/archopht.1984.01040030405011","article-title":"The Wisconsin Epidemiologic Study of Diabetic Retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years","volume":"102","author":"Klein","year":"1984","journal-title":"Arch Ophthalmol"},{"issue":"2","key":"10.1016\/j.ophtha.2018.04.023_bib27","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1001\/archopht.1989.01070010243030","article-title":"The Wisconsin Epidemiologic Study of Diabetic Retinopathy. IX. Four-year incidence and progression of diabetic retinopathy when age at diagnosis is less than 30 years","volume":"107","author":"Klein","year":"1989","journal-title":"Arch Ophthalmol"},{"issue":"9","key":"10.1016\/j.ophtha.2018.04.023_bib28","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1001\/archopht.1994.01090210105023","article-title":"The Wisconsin Epidemiologic Study of Diabetic Retinopathy. XIV. Ten-year incidence and progression of diabetic retinopathy","volume":"112","author":"Klein","year":"1994","journal-title":"Arch Ophthalmol"},{"issue":"10","key":"10.1016\/j.ophtha.2018.04.023_bib29","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1016\/S0161-6420(98)91020-X","article-title":"The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XVII. The 14-year incidence and progression of diabetic retinopathy and associated risk factors in type 1 diabetes","volume":"105","author":"Klein","year":"1998","journal-title":"Ophthalmology"},{"issue":"17","key":"10.1016\/j.ophtha.2018.04.023_bib30","doi-asserted-by":"crossref","first-page":"1917","DOI":"10.1001\/archinte.164.17.1917","article-title":"Cardiovascular disease, mortality, and retinal microvascular characteristics in type 1 diabetes: Wisconsin epidemiologic study of diabetic retinopathy","volume":"164","author":"Klein","year":"2004","journal-title":"Arch Intern Med"},{"issue":"2","key":"10.1016\/j.ophtha.2018.04.023_bib31","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/0091-7435(76)90039-6","article-title":"The hypertension detection and follow-up program: hypertension detection and follow-up program cooperative group","volume":"5","year":"1976","journal-title":"Prev Med"},{"issue":"7","key":"10.1016\/j.ophtha.2018.04.023_bib32","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/0895-4356(88)90116-3","article-title":"Methodologic considerations in measuring glycosylated hemoglobin in epidemiologic studies","volume":"41","author":"Moss","year":"1988","journal-title":"J\u00a0Clin Epidemiol"},{"key":"10.1016\/j.ophtha.2018.04.023_bib33","series-title":"Classification of diabetic retinopathy from stereo color fundus photographs. Early Treatment Diabetic Retinopathy Study (ETDRS) Manual of Operations","first-page":"786","author":"Group","year":"1985"},{"key":"10.1016\/j.ophtha.2018.04.023_bib34","series-title":"Procedures for completing eye examinations. Early Treatment Diabetic Retinopathy Study (ETDRS) Manual of Operations","first-page":"823","author":"Group","year":"1985"},{"issue":"6","key":"10.1016\/j.ophtha.2018.04.023_bib35","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1001\/archophthalmol.2011.2560","article-title":"Changes in retinal vessel diameter and incidence and progression of diabetic retinopathy","volume":"130","author":"Klein","year":"2012","journal-title":"Arch Ophthalmol"},{"issue":"3","key":"10.1016\/j.ophtha.2018.04.023_bib36","doi-asserted-by":"crossref","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach","volume":"44","author":"DeLong","year":"1988","journal-title":"Biometrics"},{"issue":"11","key":"10.1016\/j.ophtha.2018.04.023_bib37","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1016\/S0161-6420(87)33275-0","article-title":"The Wisconsin Epidemiologic Study of Diabetic Retinopathy. VII. Diabetic nonproliferative retinal lesions","volume":"94","author":"Klein","year":"1987","journal-title":"Ophthalmology"},{"issue":"5 suppl","key":"10.1016\/j.ophtha.2018.04.023_bib38","first-page":"823","article-title":"Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12","volume":"98","year":"1991","journal-title":"Ophthalmology"},{"issue":"6","key":"10.1016\/j.ophtha.2018.04.023_bib39","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1085\/jgp.9.6.835","article-title":"The physiological principle of minimum work applied to the angle of branching of arteries","volume":"9","author":"Murray","year":"1926","journal-title":"J\u00a0Gen Physiol"},{"issue":"3","key":"10.1016\/j.ophtha.2018.04.023_bib40","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1073\/pnas.12.3.207","article-title":"The physiological principle of minimum work: I. The vascular system and the cost of blood volume","volume":"12","author":"Murray","year":"1926","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"2","key":"10.1016\/j.ophtha.2018.04.023_bib41","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1177\/1932296816629491","article-title":"Retinal imaging techniques for diabetic retinopathy screening","volume":"10","author":"Goh","year":"2016","journal-title":"J\u00a0Diabetes Sci Technol"},{"issue":"6","key":"10.1016\/j.ophtha.2018.04.023_bib42","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1001\/archophthalmol.2012.727","article-title":"Predicting risk of diabetic retinopathy from retinal vessel analysis: personalized medicine in transition","volume":"130","author":"Cheung","year":"2012","journal-title":"Arch Ophthalmol"},{"issue":"1","key":"10.1016\/j.ophtha.2018.04.023_bib43","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1001\/archophthalmol.2010.347","article-title":"Retinal vessel diameter as a clinical predictor of diabetic retinopathy progression: time to take out the measuring tape","volume":"129","author":"Wong","year":"2011","journal-title":"Arch Ophthalmol"},{"issue":"2","key":"10.1016\/j.ophtha.2018.04.023_bib44","doi-asserted-by":"crossref","DOI":"10.1111\/micc.12327","article-title":"Retinal vascular imaging technology to monitor disease severity and complications in type 1 diabetes mellitus: a systematic review","volume":"24","author":"Kee","year":"2017","journal-title":"Microcirculation"},{"issue":"1","key":"10.1016\/j.ophtha.2018.04.023_bib45","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1001\/archophthalmol.2010.340","article-title":"Retinal venular diameter as an early indicator of progression to proliferative diabetic retinopathy with and without high-risk characteristics in African Americans with type 1 diabetes mellitus","volume":"129","author":"Roy","year":"2011","journal-title":"Arch Ophthalmol"},{"issue":"5","key":"10.1016\/j.ophtha.2018.04.023_bib46","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0127914","article-title":"Suitability of UK biobank retinal images for automatic analysis of morphometric properties of the vasculature","volume":"10","author":"MacGillivray","year":"2015","journal-title":"PLoS One"},{"key":"10.1016\/j.ophtha.2018.04.023_bib47","first-page":"681","article-title":"Development of automatic retinal vessel segmentation method in fundus images via convolutional neural networks","volume":"2017","author":"Joonyoung","year":"2017","journal-title":"Conf Proc IEEE Eng Med Biol Soc"}],"container-title":["Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S016164201830530X?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S016164201830530X?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T14:06:18Z","timestamp":1758981978000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S016164201830530X"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11]]},"references-count":47,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2018,11]]}},"alternative-id":["S016164201830530X"],"URL":"https:\/\/doi.org\/10.1016\/j.ophtha.2018.04.023","relation":{},"ISSN":["0161-6420"],"issn-type":[{"value":"0161-6420","type":"print"}],"subject":[],"published":{"date-parts":[[2018,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"The Relationship of Retinal Vessel Geometric Characteristics to the Incidence and Progression of Diabetic Retinopathy","name":"articletitle","label":"Article Title"},{"value":"Ophthalmology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ophtha.2018.04.023","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2018 by the American Academy of Ophthalmology","name":"copyright","label":"Copyright"}]}}