Effects of myopia-related parameters on retinal vessel calibers measurement results on AI fundus photographs

Effects of myopia-related parameters on retinal vessel calibers measurement results on AI fundus photographs | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of myopia-related parameters on retinal vessel calibers measurement results on AI fundus photographs Rui Zhang, Ying Zhou, Ya Huang, Wenji Ni, Dandan Li, Tao Jin, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6316298/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background： There has been a paucity of information on the efects of myopia-related parameters factors on the retinal vessel caliber (RVC). Information on this relationship should be useful in studying possible roles of refractive status in the development and progression of ocular circulation. Methods： Subjects were from the Health Medicine Department of Jinling Hospital, Afliated Hospital of Medical School, Nanjing University in China aged 20 to 60 years. All participants underwent fundus photography examination. Parameters assessed were central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), Arteriovenous ratio (AVR), cup/disc ratio, optic disc size, cup area,cup/disc ratio, arc spot to optic disc area ratio, and average density of leopard print spots. Normal subjects and eyes were defined according to standardized systemic and ocular examinations. The central retinal artery and vein equivalents (CRAE, CRVE, Arc spot to optic disc area ratio, Average density of leopard print spots and other indicators) were determined on fundus photographs by correcting the magnifcation using the refractive error, corneal curvature, and axial length (AL) of an individual eye and paraxial ray tracing. Results： In a total of 4252 right eyes (4252 normal subjects), aged 37.27±7.29 (standard deviation) years with gradable photographs and planimetric results, CRAE averaged 0.02±0.01μm and CRVE 0.03±0.01 μm. After adjustment for the efects of confounding factors in multivariate analysis, the horizontal cup area ( P ＜0.0001), vertical cup area( P ＜0.0001), vertical cup/disc ratio ( P ＝0.036) and arc spot to optic disc area ratio ( P ＜0.0001) positively with CRAE and the Age ( P ＜0.0001), mean blood pressure ( P ＝0.011 ), body mass index ( P ＝0.003 ), horizontal optic disc size ( P ＝0.005 ), horizontal cup area ( P ＜0.0001 ) and average density of leopard print spots ( P ＜0.0001 ) correlated negatively with CRAE; the horizontal cup area ( P ＝0.001), vertical cup area( P ＜0.0001), vertical cup/disc ratio ( P ＝0.009) and arc spot to optic disc area ratio ( P ＜0.0001) positively with CRVE and the age ( P ＜0.0001), horizontal optic disc size ( P ＝0.021 ), and average density of leopard print spots ( P ＜0.0001 ) correlated negatively with CRVE. There were differences in CRAE, CRVE, AVR based on the quartile of the ratio of arc point to optic disc area (all P ＜0.0001), and there were also differences in CRAE, CRVE, AVR based on the quartile of the average density of leopard point ( P ＝0.035, P ＝0.030, P ＜0.0001). Conclusions： The current study showed signifcant efects of arc spot to optic disc area ratio, average density of leopard print spots on the photographs on the RVC measurement results. Further, it showed a necessity to incorporate the myopia related parameters as co-variables to correctly estimate the efects of various factors on the RVC. Central Retinal Artery Equivalent (CRAE) Central retinal vein equivalent (CRVE) Arteriovenous ratio (AVR) Optic Nerve Head-Related Structures Fundus Photographs Figures Figure 1 Introduction Retinal vessel caliber (RVC) is a simple and clinical useful index refexing cardiovascular disorders and a variety of demographic and life-style factors and systemic medical conditions. RVC also is afected by a variety of ocular disorders. The ratio of arc point to optic disc area and the average density of leopard print are important indicators for evaluating the retinal health of patients with retinal lesions and high myopia, which can help detect and intervene in retinal lesions early. This study explores the influence of myopia related parameters on the measurement results of retinal vessel diameter in artificial intelligence fundus photographs. Methods Study design The survey targets 4252 medical examination personnel aged 20–60 years old from the department of health medicine, Jinling hospital, Afliated hospital of medical school, Nanjing university. The research plan has been approved by the Key Project of Cadre Health Care in Jiangsu Province (Approval Number: BJ2407). All participants provided written informed consent before being included in the study. Study subjects Collect basic information such as age, height, weight, BMI, waist circumference, systolic blood pressure, and diastolic blood pressure of the research subjects. Experienced professional ophthalmologists conducted international standard visual acuity testing and slit lamp examination on all research subjects. Excluded from the group due to one or more of the following conditions, the medical examination data is severely incomplete and cannot be analyzed; Opacity of refractive media leads to the inability to obtain clear fundus photographs; Having fundus diseases, such as retinal detachment, retinal vein occlusion, diabetes retinopathy; Has mental cognitive behavioral disorders. Measurement of RVC The Japanese Topcon TRC-NW400 fully automatic non mydriatic fundus camera was used in the darkroom to capture binocular fundus images of patients. Use Eagle Eye Airdoc automatic analysis software to measure retinal blood vessels. Measure the diameters of four retinal arteries (superior temporal artery, inferior temporal artery, superior nasal artery, inferior nasal artery) and retinal veins (superior temporal vein, inferior temporal vein, superior nasal vein, inferior nasal vein) in zone B (within 1/2 to 1 diameter of the optic disc edge), as shown in Fig. 1. Based on the measured pixel diameters of blood vessels, the actual diameters of four retinal arteries and veins were obtained. Then, using the corrected Parr Hubbard formula [ 1 ], the central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), retinal artery vein ratio (AVR), cup horizontal diameter (µm), cup vertical diameter (µm), disc horizontal diameter (µm), disc vertical diameter (µm), horizontal cup to disc ratio, vertical cup to disc ratio, arc spot to disc area ratio, leopard spot average density. i is the width of the lower rim; s is the width of the upper edge of the disc; n is the width of the nasal side disc edge; t is the width of the temporal disc edge; A is the diameter of the horizontal viewing cup; B is the diameter of the vertical viewing cup; Dh/Dv is the ratio of horizontal disc diameter to vertical disc diameter; C/D is the cup to plate ratio. Intelligent segmentation of retinal arteries and veins, with red blood vessels representing retinal arteries and blue blood vessels representing retinal veins. The area between the first and second dashed lines near the optic nerve is designated as Zone B. Data analysis Multiple regression analysis was adopted where the dependent variable was CRAE, CRVE and AVR and explanatory variables were whole body and eye related indicators. Kruskal Wallis H test was adopted to compare the differences between multiple groups. Measurement data that conform to normal distribution are expressed as mean ± standard deviation (‾x ± s), while measurement data that do not conform to normal distribution are described as M ( Q 1, Q 3). P < 0.05 was considered statistically signifcant. Results Baseline characteristics Table 1 Subject Characteristics No. right eyes (subjects) 4252/4252 Male/female 3746/506 Age (years) 37.27 ± 7.29 Height (cm) 172.54 ± 6.33 Body weight (kg) 72.34 ± 10.43 Body mass index (kg/m 2 ) 24.23 ± 2.69 Waist (cm) 83.98 ± 8.41 Systolic blood pressure (mmHg) 118.50 ± 12.47 Diastolic blood pressure (mmHg) 72.94 ± 9.84 Mean blood pressure (mmHg) 88.13 ± 9.96 Central retinal artery equivalent (um) 0.02 ± 0.01 Central retinal vein equivalent (um) 0.03 ± 0.01 Arteriovenous ratio 0.73 ± 0.08 Horizontal optic disc size (mm 2 ) 438.51 ± 125.99 Horizontal cup area (mm 2 ) 1366.35 ± 139.99 Horizontal cup/disc ratio 0.32 ± 0.09 Vertical optic disc size (mm 2 ) 496.82 ± 139.55 Vertical cup area (mm 2 ) 1198.16 ± 134.84 Vertical cup/disc ratio 0.41 ± 0.10 Arc spot to optic disc area ratio 0.27 ± 0.31 Average density of leopard print spots 0.09 ± 0.10 Figures are mean ± standard deviation. Effects on central retinal artery equivalent Table 2 Effects on central retinal artery equivalent. results of multiple regression analysis including arc spot to optic disc area ratio and average density of leopard print spots as explanatory variables Factors Partial Regression Coefcient Standard Error P Value Sex <0.0001 <0.0001 0.216 LnAge (years) -0.002 <0.0001 <0.0001 LnMean blood pressure (mmHg) -0.002 0.001 0.011 LnWaist (cm) 0.001 0.001 0.240 LnBody mass index (kg/m 2 ) -0.003 0.001 0.003 LnHorizontal optic disc size (mm 2 ) -0.006 0.002 0.005 LnHorizontal cup area (mm 2 ) 0.012 0.003 <0.0001 Horizontal cup/disc ratio 0.007 0.008 0.336 LnVertical optic disc size (mm 2 ) -0.003 0.002 0.194 LnVertical cup area (mm 2 ) 0.006 0.002 <0.0001 Vertical cup/disc ratio 0.017 0.008 0.036 Arc spot to optic disc area ratio 0.003 <0.0001 <0.0001 Average density of leopard print spots -0.003 0.001 <0.0001 Effects on central retinal vein equivalent. Table 3 Effects on central retinal vein equivalent. results of multiple regression analysis including arc spot to optic disc area ratio and average density of leopard print spots as explanatory variables、 Factors Partial Regression Coefcient Standard Error P Value Sex <0.0001 <0.0001 0.899 LnAge (years) -0.003 <0.0001 <0.0001 LnMean blood pressure (mmHg) <0.0001 0.001 0.556 LnWaist (cm) 0.002 0.001 0.131 LnBody mass index (kg/m 2 ) -0.002 0.001 0.190 LnHorizontal optic disc size (mm 2 ) -0.007 0.0030 0.021 LnHorizontal cup area (mm 2 ) 0.013 0.004 0.001 Horizontal cup/disc ratio 0.008 0.010 0.437 LnVertical optic disc size (mm 2 ) -0.004 0.003 0.174 LnVertical cup area (mm 2 ) 0.008 0.002 <0.0001 Vertical cup/disc ratio 0.028 0.011 0.009 Arc spot to optic disc area ratio 0.004 0.000 <0.0001 Average density of leopard print spots -0.007 0.001 <0.0001 Comparison between project groups based on the quartiles of arc spot to optic disc area ratio Table 4 Comparison between project groups based on the quartiles of arc spot to optic disc area ratio[ M ( Q 1, Q 3)] Factors Q 1( n = 1068) Q 2( n = 1062) Q3( n = 1060) Q 4( n = 1062) H Value P Value Age (years) 37(33,42) 37(33,41) 36(33,41) 36(32,41) ab 14.698 0.002 Body mass index (kg/m 2 ) 24.33(22.57,26.09) 24.28(22.49,26.03) 24.16(22.38.25.94) 24(22.19,25.66) abc 13.309 0.004 Waist (cm) 85(79,90) 85(78,90) 84(79,90) 84(78,89) abc 10.735 0.013 Mean blood pressure (mmHg) 88.67(81.67,95.33) 88(81.33,95.00) 87.33(81.67,94.33) 86.67(80.00,93.67) abc 12.778 0.005 Central retinal artery equivalent (um) 0.021(0.020,0.024) 0.021(0.020,0.024) 0.021(0.020,0.025) ab 0.022(0.020,0.027) abc 44.664 <0.0001 Central retinal vein equivalent (um) 0.030(0.027,0.033) 0.030(0.027,0.033) 0.030(0.027,0.034) ab 0.030(0.027,0.037) abc 20.071 <0.0001 Arteriovenous ratio 0.72(0.67,0.77) 0.72(0.67,0.77) 0.73(0.69,0.78) ab 0.73(0.69,0.79) ab 29.590 <0.0001 Horizontal optic disc size (mm 2 ) 510(420,605) 510(426,610) 498(415,580) ab 460(372,545) abc 136.246 <0.0001 Horizontal cup area (mm 2 ) 1250(1170,1332) 1215(1140,1300) a 1183.5(1100,1274) ab 1115(1030,1195) abc 562.838 <0.0001 Horizontal cup/disc ratio 0.41(0.35,0.47) 0.42(0.36,0.50) a 0.42(0.36,0.48) a 0.41(0.35,0.47) bc 20.392 <0.0001 Vertical optic disc size (mm 2 ) 443(369,533) 443(372,541) 431(362,510) ab 410(336,483) abc 80.789 <0.0001 Vertical cup area (mm 2 ) 1362(1288,1433) 1365(1290,1435) 1368(1297,1434) 1369(1292,1435) b 2.694 0.441 Vertical cup/disc ratio 0.33(0.27,0.39) 0.33(0.27,0.40) 0.32(0.27,0.38) ab 0.3(0.25,0.36) ac 90.578 <0.0001 Average density of leopard print spots 0.016(0.003,0.043) 0.34(0.011,0.079) a 0.073(0.026,0.140) ab 0.132(0.063,0.230) abc 1106.672 <0.0001 a represents P < 0.05 compared to Q 1 group b represents P < 0.05 compared to Q 2 group c represents P < 0.05 compared to Q 3 group Comparison between project groups based on the quartiles of average density of leopard print spots Table 5 Comparison between project groups based on the quartiles of average density of leopard print spots[ M ( Q 1, Q 3)] Factors Q 1( n = 1094) Q 2( n = 1045) Q 3( n = 1057) Q 4( n = 1056) H Value P Value Age (years) 37(33,42) 37(33,41) a 36(32,40) a 37(33,41) c 19.193 <0.0001 Body mass index (kg/m 2 ) 24.16(22.44,26.13) 24.28(22.39,26.00) 24.22(22.33,25.95) 24.11(22.50,25.75) 1.905 <0.0001 Waist (cm) 84(78,90) 84(79,90) 84(78,90) 84(78,90) 2.307 0.607 Mean blood pressure (mmHg) 87.67(81,94) 87.33(81,95) 88(82,95) 87.33(81,95) 1.835 0.607 Central retinal artery equivalent (um) 0.021(0.02,0.025) 0.022(0.02,0.025) 0.022(0.02,0.025) ab 0.021(0.02,0.025) a 8.606 0.035 Central retinal vein equivalent (um) 0.030(0.027,0.033) 0.030(0.027,0.034) 0.030(0.027,0.035) a 0.029(0.026,0.035) 8.919 0.030 Arteriovenous ratio 0.72(0.67,0.77) 0.73(0.675,0.77) 0.73(0.69,0.78) ab 0.73(0.69,0.79) ab 21.758 <0.0001 Horizontal optic disc size (mm 2 ) 490(405,580) 496(415,580) 492(410,585) 498(410,585) 1.346 0.718 Horizontal cup area (mm 2 ) 1210(1125,1295.25) 1195(1115,1290) 1185(1090,1275.5) a 1180(1085,1285) a 22.674 <0.0001 Horizontal cup/disc ratio 0.41(0.35,0.48) 0.42(0.35,0.48) 0.42(0.36,0.49) a 0.42(0.36,0.49) 7.014 0.071 Vertical optic disc size (mm 2 ) 433(358.75,517) 436(362,523) 430(358,515) 432(359.25,509.75) 1.722 0.632 Vertical cup area (mm 2 ) 1369.5(1288,1436.25) 1364(1294.5,1432.5) 1362(1290,1430.5) 1369.5(1294,1435) 1.203 0.752 Vertical cup/disc ratio 0.32(0.26,0.38) 0.32(0.27,0.39) 0.32(0.27,0.38) 0.32(0.26,0.38) 2.398 0.494 Arc spot to optic disc area ratio 0.088(0.025,0.1905) 0.168(0.063,0.29) a 0.258(0.145,0.394) ab 0.382(0.23875,0.56725) abc 3987.104 <0.0001 a represents P < 0.05 compared to Q 1 group b represents P < 0.05 compared to Q 2 group c represents P < 0.05 compared to Q 3 group Discussion Numerous studies have investigated the effects of common systemic factors (e.g., age, weight, and blood pressure) on retinal blood vessel diameter [ 1 – 5 ]. However, research examining the influence of myopia-related parameters on retinal vasculature remains relatively limited. Elucidating the relationship between myopic refractive status and retinal vascular characteristics could provide valuable insights into the role of ocular circulation in myopia development. Such understanding may facilitate early diagnosis and management of myopia-associated retinal pathology [ 6 – 9 ] and inform public health strategies for blindness prevention. Furthermore, microvascular morphological parameters may serve as potential biomarkers for monitoring myopia progression and detecting vascular abnormalities in future studies. Notably, a 10-year prospective follow-up study demonstrated an association between reduced central retinal arteriolar equivalent (CRAE) and incident primary open-angle glaucoma (POAG) [ 10 – 11 ]. In the current study of normal adults, reduced CRAE correlated with smaller neuroretinal rim area and greater vertical cup-to-disc ratio (v-C/D). These findings suggest that normotensive individuals exhibiting reduced CRAE or central retinal venular equivalent (CRVE) alongside structural optic nerve changes may represent a subpopulation with early vascular dysfunction and potentially increased susceptibility to glaucomatous damage [ 12 – 13 ]. Myopia and high myopia have emerged as significant global public health challenges in the 21st century, with their rapidly increasing prevalence raising considerable medical and societal concerns. These refractive errors are particularly worrisome due to their well-documented association with potentially blinding ocular pathologies such as glaucoma, retinal detachment, and myopic macular degeneration [ 14 ]. A growing body of evidence has demonstrated that myopia induces distinct vascular alterations in the retina, with studies consistently showing that the severity of myopia correlates with measurable changes in macular and peripapillary vessel densities as well as retinal nerve fiber layer thickness, even among young healthy individuals [ 15 – 16 ]. These vascular abnormalities manifest through several characteristic findings, including diminished capillary perfusion in both foveal and peripapillary regions, progressive enlargement of the foveal avascular zone [ 17 – 19 ], noticeable narrowing of retinal vessels, and increased areas of peripheral avascularity. Of particular clinical relevance is the recognition that fundamental myopia-related parameters - including axial length, refractive error, optic disc morphology, and choroidal thickness - exert substantial influence on retinal vessel caliber measurements obtained through fundus photography, underscoring the importance of considering these factors in both clinical practice and research settings to ensure accurate interpretation of retinal vascular findings. The development of artificial intelligence algorithms for retinal vascular analysis requires particular attention to myopia-related anatomical variations to ensure measurement accuracy and clinical relevance. This necessitates the implementation of robust training protocols utilizing diverse patient cohorts and the integration of specific compensation mechanisms for characteristic myopia-induced structural alterations [ 20 ]. Our investigations reveal that patients with high myopia demonstrate the most significant vascular compromise, exhibiting markedly diminished perfusion density in both the superficial and deep macular capillary plexuses, as well as in the peripapillary microvasculature. These vascular parameters display a progressive deterioration pattern strongly correlated with axial elongation, manifesting as reduced macular and peripapillary vessel densities, attenuated retinal nerve fiber layer thickness, and expanded foveal avascular zone dimensions, while concurrently demonstrating paradoxical increases in foveal thickness [ 21 – 22 ]. These findings underscore the essential consideration of refractive status in the clinical interpretation of retinal vascular metrics. The mechanistic insights provided by this research may facilitate the establishment of more sensitive diagnostic protocols and targeted intervention strategies for myopia-related retinal disorders at earlier, potentially more treatable stages. The ratio of arc-shaped spots to optic disc area and the average density of leopard print patterns serve as clinically significant biomarkers for assessing retinal health in patients with high myopia and retinal pathology, enabling earlier detection and intervention of sight-threatening conditions. Our findings demonstrate that these morphological parameters substantially influence retinal vessel caliber (RVC) measurements obtained from fundus photography. As retinal vessel analysis plays a pivotal role in diagnosing and monitoring both ocular and systemic disorders, it is crucial to recognize how myopia-induced anatomical changes may confound these measurements [ 23 – 24 ]. Progressive axial elongation in myopic eyes induces retinal stretching, potentially causing artifactual narrowing of retinal vessels and subsequent underestimation of true vascular diameters [ 25 ]. This phenomenon poses particular challenges for artificial intelligence systems, as algorithms trained predominantly on emmetropic eyes may erroneously interpret these myopia-related vascular alterations as pathological changes, leading to inaccurate clinical assessments [ 26 ]. Furthermore, the characteristic retinal thinning and vascular remodeling associated with higher myopia degrees significantly alter vessel morphology and apparent dimensions. These refractive-error-dependent variations necessitate specific algorithmic compensation to prevent systematic measurement errors and vessel caliber misclassification. Additional complexity arises from myopia-associated peripheral retinal thinning and vascular attenuation, which may be incorrectly identified as pathological vessel narrowing without proper adjustment for refractive status. Artificial intelligence systems face the critical challenge of distinguishing genuine vascular pathology from myopia-related anatomical variations to prevent diagnostic misinterpretation. This distinction is particularly crucial given the characteristic ocular features associated with myopia, including tilted optic discs and peripapillary atrophy, which can significantly alter the appearance of peripapillary retinal vessels and potentially confound vascular assessment [ 27 – 28 ]. To achieve reliable clinical measurements, AI algorithms require specialized training to recognize and computationally compensate for these distinctive myopic fundus features. Additional technical challenges arise from the reduced image quality frequently encountered in highly myopic eyes, resulting from increased light scatter and optical aberrations that may impair accurate vessel segmentation and quantitative analysis. Furthermore, the characteristic choroidal thinning observed in myopic eyes influences retinal vessel visibility and apparent dimensions, suggesting that optimal AI performance should incorporate choroidal thickness parameters into vessel caliber assessment protocols to enhance measurement precision [ 29 – 30 ]. While our study benefits from a substantial sample size, it is important to acknowledge certain limitations, particularly regarding demographic representation as our cohort was predominantly male. Future investigations would benefit from expanded recruitment strategies to ensure more balanced gender representation and greater geographical diversity. A more significant methodological consideration stems from the current reliance of artificial intelligence algorithms on training datasets primarily composed of non-myopic eyes, which may limit their generalizability and introduce systematic biases when applied to myopic populations. This underscores the critical need for incorporating representative myopic samples in training datasets to develop robust AI models with enhanced diagnostic validity. Looking ahead, the development of specialized AI algorithms tailored to varying degrees of myopia could provide valuable insights into how myopia-related parameters influence diverse retinal pathologies. Such advancements would not only improve diagnostic precision and efficiency but also facilitate more effective clinical implementation of artificial intelligence technologies in ophthalmic practice. Conclusions Our research found that edge area, the ratio of arc spot to optic disc area, or the average density of leopard print spots have a significant impact on RVC measurement results. Incorporating these covariates improves the accuracy of systemic and ocular factor assessments in myopia, offering potential for earlier detection and targeted management of retinal pathology. Abbreviations RVC retinal vessel caliber CRAE central retinal artery equivalent CRVE central retinal vein equivalent AVR arteriovenous ratio AL axial length POAG primary open angle glaucoma Dh/Dv the ratio of horizontal disc diameter to vertical disc diameter C/D cup/disc Declarations Ethics approval and consent to participate All participants provided written informed consent before being included in the study. Our study is a retrospective study that has been reviewed by the Ethics Committee of Jinling Hospital affiliated with Nanjing University (Ethics Code: 2024DZKY-015-01). Consent for publication Not Applicable. Availability of data and materials The data that support the findings of this study are available from the authors. Competing Interests The authors declare no competing interests. Funding This study has been approved by Key Project of Cadre Health Care in Jiangsu Province (Approval Number: BJ2407). Authors' contributions RZ, YZ, YH, WN, DL, TJ, YW, LM, SZ and YZ participated in the study design and statistical analysis. RZ, YZ, YH, WN analyzed the data together and drafted the manuscript. DL, TJ, YW participated in data collection, and LM, SZ and YZ participated in statistical analysis. All authors read and approved the fnal manuscript. Acknowledgements We thank all the participants in the study and the members of the survey teams, as well as the fnancial support. References Wong T, Klein R, Klein B, et al. Retinal vessel diameters and their associations with age and blood pressure[J]. 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Association between retinal microvasculature and optic disc alterations in high myopia[J].Eye, 33(9):1494-1503. Wang Y X, Panda-Jonas S, Jonas J B. Optic nerve head anatomy in myopia and glaucoma, including parapapillary zones alpha, beta, gamma and delta: histology and clinical features[J]. Progress in retinal and eye research, 2021, 83: 100933. Lim L S, Lim X H, Tan L. Retinal vascular oxygen saturation and its variation with refractive error and axial length[J]. Translational Vision Science & Technology, 2019, 8(4): 22-22. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6316298","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":453425558,"identity":"d404dc25-cdf4-4c86-a056-1b88f3bb9c7b","order_by":0,"name":"Rui Zhang","email":"","orcid":"","institution":"Jinling Hospital, Afliated Hospital of Medical School, Nanjing University","correspondingAuthor":false,"prefix":"","firstName":"Rui","middleName":"","lastName":"Zhang","suffix":""},{"id":453425559,"identity":"6656f2b4-9e22-4322-a276-961eba106edc","order_by":1,"name":"Ying Zhou","email":"","orcid":"","institution":"Jinling Hospital, Afliated Hospital of Medical School, Nanjing University","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Zhou","suffix":""},{"id":453425560,"identity":"dabcea45-2cf3-4001-9cb8-a7f52858ed7a","order_by":2,"name":"Ya Huang","email":"","orcid":"","institution":"Jinling Hospital, Afliated Hospital of Medical School, Nanjing University","correspondingAuthor":false,"prefix":"","firstName":"Ya","middleName":"","lastName":"Huang","suffix":""},{"id":453425561,"identity":"09fc910b-e040-4a7f-bc0a-08a966218bec","order_by":3,"name":"Wenji Ni","email":"","orcid":"","institution":"Jinling Hospital, Afliated Hospital of Medical School, Nanjing University","correspondingAuthor":false,"prefix":"","firstName":"Wenji","middleName":"","lastName":"Ni","suffix":""},{"id":453425562,"identity":"70521af7-a142-4da0-a6b2-740cfce0b581","order_by":4,"name":"Dandan Li","email":"","orcid":"","institution":"Jinling Hospital, Afliated Hospital of Medical School, Nanjing University","correspondingAuthor":false,"prefix":"","firstName":"Dandan","middleName":"","lastName":"Li","suffix":""},{"id":453425563,"identity":"bdd39b79-669f-4988-af67-a095615ae145","order_by":5,"name":"Tao Jin","email":"","orcid":"","institution":"Jinling Hospital, Afliated Hospital of Medical School, Nanjing University","correspondingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Jin","suffix":""},{"id":453425564,"identity":"254e0936-4316-4ad8-bb48-1ea939088f8e","order_by":6,"name":"Yanhui Wan","email":"","orcid":"","institution":"Jinling Hospital, Afliated Hospital of Medical School, Nanjing University","correspondingAuthor":false,"prefix":"","firstName":"Yanhui","middleName":"","lastName":"Wan","suffix":""},{"id":453425565,"identity":"130e42d7-5c5e-4926-b34d-2d895a8b7110","order_by":7,"name":"Linying Mao","email":"","orcid":"","institution":"Jinling Hospital, Afliated Hospital of Medical School, Nanjing University","correspondingAuthor":false,"prefix":"","firstName":"Linying","middleName":"","lastName":"Mao","suffix":""},{"id":453425566,"identity":"11afe38b-0381-43c1-a152-3937a248e2af","order_by":8,"name":"Siwen Zhu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYBAC+/uHDz78YGBjx9jeQKyeG2zJxhIFacnMPQeI1sJjJsDz4TBj+4wEInUwzm4wY5AwSGPmnfl44w2GGptoglqYZQ6kPSgwsOGTnJ1WbMFwLC23gZAWNoaE4wYgWwxn55hJMDYcJqyFhyGxTYLH4DDj/ptniNQiIZHMBtbSOIOHSC0GPMeYjYEOS2bsAfolgRi/GLD3f3z44Q8oKg9vvPGhxoawFhTtEgmkKIdoIVXHKBgFo2AUjAwAADPMP3eaNbKFAAAAAElFTkSuQmCC","orcid":"","institution":"Jinling Hospital, Afliated Hospital of Medical School, Nanjing University","correspondingAuthor":true,"prefix":"","firstName":"Siwen","middleName":"","lastName":"Zhu","suffix":""},{"id":453425567,"identity":"cbd620f6-2cac-4ca0-9907-bafb85b64f22","order_by":9,"name":"Yong Zhong","email":"","orcid":"","institution":"Jinling Hospital, Afliated Hospital of Medical School, Nanjing University","correspondingAuthor":false,"prefix":"","firstName":"Yong","middleName":"","lastName":"Zhong","suffix":""}],"badges":[],"createdAt":"2025-03-27 02:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6316298/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6316298/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82276959,"identity":"25b8392d-965f-43b8-bc4e-5793f8e24e90","added_by":"auto","created_at":"2025-05-08 14:48:55","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":497674,"visible":true,"origin":"","legend":"\u003cp\u003ePlane measurement and AI analysis of fundus photographs\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6316298/v1/3c9da5ee8d53e0ec297f02f2.jpeg"},{"id":83817788,"identity":"e96aa54f-8460-4f3b-b62a-74acf177dcf6","added_by":"auto","created_at":"2025-06-03 08:02:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1457299,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6316298/v1/57407cd2-a951-4373-ae34-ffff4354fe9d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of myopia-related parameters on retinal vessel calibers measurement results on AI fundus photographs","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRetinal vessel caliber (RVC) is a simple and clinical useful index refexing cardiovascular disorders and a variety of demographic and life-style factors and systemic medical conditions. RVC also is afected by a variety of ocular disorders. The ratio of arc point to optic disc area and the average density of leopard print are important indicators for evaluating the retinal health of patients with retinal lesions and high myopia, which can help detect and intervene in retinal lesions early. This study explores the influence of myopia related parameters on the measurement results of retinal vessel diameter in artificial intelligence fundus photographs.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cb\u003eStudy design\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe survey targets 4252 medical examination personnel aged 20\u0026ndash;60 years old from the department of health medicine, Jinling hospital, Afliated hospital of medical school, Nanjing university. The research plan has been approved by the Key Project of Cadre Health Care in Jiangsu Province (Approval Number: BJ2407). All participants provided written informed consent before being included in the study.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStudy subjects\u003c/b\u003e \u003c/p\u003e \u003cp\u003eCollect basic information such as age, height, weight, BMI, waist circumference, systolic blood pressure, and diastolic blood pressure of the research subjects. Experienced professional ophthalmologists conducted international standard visual acuity testing and slit lamp examination on all research subjects. Excluded from the group due to one or more of the following conditions, the medical examination data is severely incomplete and cannot be analyzed; Opacity of refractive media leads to the inability to obtain clear fundus photographs; Having fundus diseases, such as retinal detachment, retinal vein occlusion, diabetes retinopathy; Has mental cognitive behavioral disorders.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMeasurement of RVC\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe Japanese Topcon TRC-NW400 fully automatic non mydriatic fundus camera was used in the darkroom to capture binocular fundus images of patients. Use Eagle Eye Airdoc automatic analysis software to measure retinal blood vessels. Measure the diameters of four retinal arteries (superior temporal artery, inferior temporal artery, superior nasal artery, inferior nasal artery) and retinal veins (superior temporal vein, inferior temporal vein, superior nasal vein, inferior nasal vein) in zone B (within 1/2 to 1 diameter of the optic disc edge), as shown in Fig.\u0026nbsp;1. Based on the measured pixel diameters of blood vessels, the actual diameters of four retinal arteries and veins were obtained. Then, using the corrected Parr Hubbard formula [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], the central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), retinal artery vein ratio (AVR), cup horizontal diameter (\u0026micro;m), cup vertical diameter (\u0026micro;m), disc horizontal diameter (\u0026micro;m), disc vertical diameter (\u0026micro;m), horizontal cup to disc ratio, vertical cup to disc ratio, arc spot to disc area ratio, leopard spot average density.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ei is the width of the lower rim; s is the width of the upper edge of the disc; n is the width of the nasal side disc edge; t is the width of the temporal disc edge; A is the diameter of the horizontal viewing cup; B is the diameter of the vertical viewing cup; Dh/Dv is the ratio of horizontal disc diameter to vertical disc diameter; C/D is the cup to plate ratio. Intelligent segmentation of retinal arteries and veins, with red blood vessels representing retinal arteries and blue blood vessels representing retinal veins. The area between the first and second dashed lines near the optic nerve is designated as Zone B.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eMultiple regression analysis was adopted where the dependent variable was CRAE, CRVE and AVR and explanatory variables were whole body and eye related indicators. Kruskal Wallis \u003cem\u003eH\u003c/em\u003e test was adopted to compare the differences between multiple groups. Measurement data that conform to normal distribution are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (\u0026oline;x\u0026thinsp;\u0026plusmn;\u0026thinsp;s), while measurement data that do not conform to normal distribution are described as \u003cem\u003eM\u003c/em\u003e (\u003cem\u003eQ\u003c/em\u003e1, \u003cem\u003eQ\u003c/em\u003e3). \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically signifcant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003eBaseline characteristics\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSubject Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. right eyes (subjects)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4252/4252\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale/female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3746/506\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.27\u0026thinsp;\u0026plusmn;\u0026thinsp;7.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e172.54\u0026thinsp;\u0026plusmn;\u0026thinsp;6.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody weight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72.34\u0026thinsp;\u0026plusmn;\u0026thinsp;10.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.23\u0026thinsp;\u0026plusmn;\u0026thinsp;2.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWaist (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83.98\u0026thinsp;\u0026plusmn;\u0026thinsp;8.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic blood pressure (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118.50\u0026thinsp;\u0026plusmn;\u0026thinsp;12.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiastolic blood pressure (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72.94\u0026thinsp;\u0026plusmn;\u0026thinsp;9.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean blood pressure (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88.13\u0026thinsp;\u0026plusmn;\u0026thinsp;9.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral retinal artery equivalent (um)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral retinal vein equivalent (um)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArteriovenous ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHorizontal optic disc size (mm\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e438.51\u0026thinsp;\u0026plusmn;\u0026thinsp;125.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHorizontal cup area (mm\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1366.35\u0026thinsp;\u0026plusmn;\u0026thinsp;139.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHorizontal cup/disc ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVertical optic disc size (mm\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e496.82\u0026thinsp;\u0026plusmn;\u0026thinsp;139.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVertical cup area (mm\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1198.16\u0026thinsp;\u0026plusmn;\u0026thinsp;134.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVertical cup/disc ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArc spot to optic disc area ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage density of leopard print spots\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFigures are mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEffects on central retinal artery equivalent\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEffects on central retinal artery equivalent. results of multiple regression analysis including arc spot to optic disc area ratio and average density of leopard print spots as explanatory variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePartial Regression\u003c/p\u003e \u003cp\u003eCoefcient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.216\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLnAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLnMean blood pressure (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLnWaist (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.240\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLnBody mass index (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLnHorizontal optic disc size (mm\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLnHorizontal cup area (mm\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHorizontal cup/disc ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.336\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLnVertical optic disc size (mm\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.194\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLnVertical cup area (mm\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVertical cup/disc ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArc spot to optic disc area ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage density of leopard print spots\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eEffects on central retinal vein equivalent.\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEffects on central retinal vein equivalent. results of multiple regression analysis including arc spot to optic disc area ratio and average density of leopard print spots as explanatory variables、\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePartial Regression\u003c/p\u003e \u003cp\u003eCoefcient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.899\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLnAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLnMean blood pressure (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.556\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLnWaist (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLnBody mass index (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.190\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLnHorizontal optic disc size (mm\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLnHorizontal cup area (mm\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHorizontal cup/disc ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.437\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLnVertical optic disc size (mm\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.174\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLnVertical cup area (mm\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVertical cup/disc ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArc spot to optic disc area ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage density of leopard print spots\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eComparison between project groups based on the quartiles of arc spot to optic disc area ratio\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison between project groups based on the quartiles of arc spot to optic disc area ratio[\u003cem\u003eM\u003c/em\u003e(\u003cem\u003eQ\u003c/em\u003e1,\u003cem\u003eQ\u003c/em\u003e3)]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eQ\u003c/em\u003e1(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1068)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eQ\u003c/em\u003e2(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1062)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQ3(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1060)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eQ\u003c/em\u003e4(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1062)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eH\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37(33,42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37(33,41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36(33,41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36(32,41)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14.698\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.33(22.57,26.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.28(22.49,26.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.16(22.38.25.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24(22.19,25.66)\u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13.309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWaist (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85(79,90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85(78,90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84(79,90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84(78,89)\u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10.735\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean blood pressure (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88.67(81.67,95.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88(81.33,95.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87.33(81.67,94.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e86.67(80.00,93.67)\u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12.778\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral retinal artery equivalent (um)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.021(0.020,0.024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.021(0.020,0.024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.021(0.020,0.025)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.022(0.020,0.027)\u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e44.664\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral retinal vein equivalent (um)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.030(0.027,0.033)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.030(0.027,0.033)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.030(0.027,0.034)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.030(0.027,0.037)\u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArteriovenous ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.72(0.67,0.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.72(0.67,0.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.73(0.69,0.78)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.73(0.69,0.79)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e29.590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHorizontal optic disc size (mm\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e510(420,605)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e510(426,610)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e498(415,580)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e460(372,545)\u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e136.246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHorizontal cup area (mm\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1250(1170,1332)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1215(1140,1300)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1183.5(1100,1274)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1115(1030,1195)\u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e562.838\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHorizontal cup/disc ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.41(0.35,0.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.42(0.36,0.50)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.42(0.36,0.48)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.41(0.35,0.47)\u003csup\u003ebc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20.392\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVertical optic disc size (mm\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e443(369,533)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e443(372,541)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e431(362,510)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e410(336,483)\u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e80.789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVertical cup area (mm\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1362(1288,1433)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1365(1290,1435)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1368(1297,1434)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1369(1292,1435)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.694\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.441\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVertical cup/disc ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.33(0.27,0.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.33(0.27,0.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.32(0.27,0.38)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.3(0.25,0.36)\u003csup\u003eac\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e90.578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage density of leopard print spots\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.016(0.003,0.043)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.34(0.011,0.079)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.073(0.026,0.140)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.132(0.063,0.230)\u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1106.672\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ea\u003c/sup\u003e represents \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 compared to \u003cem\u003eQ\u003c/em\u003e1 group\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003eb\u003c/sup\u003e represents \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 compared to \u003cem\u003eQ\u003c/em\u003e2 group\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ec\u003c/sup\u003e represents \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 compared to \u003cem\u003eQ\u003c/em\u003e3 group\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eComparison between project groups based on the quartiles of average density of leopard print spots\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison between project groups based on the quartiles of average density of leopard print spots[\u003cem\u003eM\u003c/em\u003e(\u003cem\u003eQ\u003c/em\u003e1,\u003cem\u003eQ\u003c/em\u003e3)]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eQ\u003c/em\u003e1(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1094)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eQ\u003c/em\u003e2(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1045)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eQ\u003c/em\u003e3(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1057)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eQ\u003c/em\u003e4(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1056)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eH\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37(33,42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37(33,41)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36(32,40)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37(33,41)\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e19.193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.16(22.44,26.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.28(22.39,26.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.22(22.33,25.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.11(22.50,25.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.905\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWaist (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84(78,90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84(79,90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84(78,90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84(78,90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.607\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean blood pressure (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87.67(81,94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.33(81,95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88(82,95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87.33(81,95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.835\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.607\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral retinal artery equivalent (um)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.021(0.02,0.025)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.022(0.02,0.025)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.022(0.02,0.025)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.021(0.02,0.025)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8.606\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral retinal vein equivalent (um)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.030(0.027,0.033)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.030(0.027,0.034)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.030(0.027,0.035)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.029(0.026,0.035)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8.919\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArteriovenous ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.72(0.67,0.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.73(0.675,0.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.73(0.69,0.78)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.73(0.69,0.79)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e21.758\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHorizontal optic disc size (mm\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e490(405,580)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e496(415,580)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e492(410,585)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e498(410,585)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.718\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHorizontal cup area (mm\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1210(1125,1295.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1195(1115,1290)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1185(1090,1275.5)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1180(1085,1285)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e22.674\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHorizontal cup/disc ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.41(0.35,0.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.42(0.35,0.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.42(0.36,0.49)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.42(0.36,0.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVertical optic disc size (mm\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e433(358.75,517)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e436(362,523)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e430(358,515)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e432(359.25,509.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.722\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.632\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVertical cup area (mm\u003csup\u003e2\u003c/sup\u003e )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1369.5(1288,1436.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1364(1294.5,1432.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1362(1290,1430.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1369.5(1294,1435)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.203\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.752\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVertical cup/disc ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.32(0.26,0.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.32(0.27,0.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.32(0.27,0.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.32(0.26,0.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.494\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArc spot to optic disc area ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.088(0.025,0.1905)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.168(0.063,0.29)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.258(0.145,0.394)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.382(0.23875,0.56725)\u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3987.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ea\u003c/sup\u003e represents \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 compared to \u003cem\u003eQ\u003c/em\u003e1 group\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003eb\u003c/sup\u003e represents \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 compared to \u003cem\u003eQ\u003c/em\u003e2 group\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ec\u003c/sup\u003e represents \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 compared to \u003cem\u003eQ\u003c/em\u003e3 group\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eNumerous studies have investigated the effects of common systemic factors (e.g., age, weight, and blood pressure) on retinal blood vessel diameter [\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, research examining the influence of myopia-related parameters on retinal vasculature remains relatively limited. Elucidating the relationship between myopic refractive status and retinal vascular characteristics could provide valuable insights into the role of ocular circulation in myopia development. Such understanding may facilitate early diagnosis and management of myopia-associated retinal pathology [\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and inform public health strategies for blindness prevention. Furthermore, microvascular morphological parameters may serve as potential biomarkers for monitoring myopia progression and detecting vascular abnormalities in future studies. Notably, a 10-year prospective follow-up study demonstrated an association between reduced central retinal arteriolar equivalent (CRAE) and incident primary open-angle glaucoma (POAG) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In the current study of normal adults, reduced CRAE correlated with smaller neuroretinal rim area and greater vertical cup-to-disc ratio (v-C/D). These findings suggest that normotensive individuals exhibiting reduced CRAE or central retinal venular equivalent (CRVE) alongside structural optic nerve changes may represent a subpopulation with early vascular dysfunction and potentially increased susceptibility to glaucomatous damage [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMyopia and high myopia have emerged as significant global public health challenges in the 21st century, with their rapidly increasing prevalence raising considerable medical and societal concerns. These refractive errors are particularly worrisome due to their well-documented association with potentially blinding ocular pathologies such as glaucoma, retinal detachment, and myopic macular degeneration [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. A growing body of evidence has demonstrated that myopia induces distinct vascular alterations in the retina, with studies consistently showing that the severity of myopia correlates with measurable changes in macular and peripapillary vessel densities as well as retinal nerve fiber layer thickness, even among young healthy individuals [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. These vascular abnormalities manifest through several characteristic findings, including diminished capillary perfusion in both foveal and peripapillary regions, progressive enlargement of the foveal avascular zone [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], noticeable narrowing of retinal vessels, and increased areas of peripheral avascularity. Of particular clinical relevance is the recognition that fundamental myopia-related parameters - including axial length, refractive error, optic disc morphology, and choroidal thickness - exert substantial influence on retinal vessel caliber measurements obtained through fundus photography, underscoring the importance of considering these factors in both clinical practice and research settings to ensure accurate interpretation of retinal vascular findings. The development of artificial intelligence algorithms for retinal vascular analysis requires particular attention to myopia-related anatomical variations to ensure measurement accuracy and clinical relevance. This necessitates the implementation of robust training protocols utilizing diverse patient cohorts and the integration of specific compensation mechanisms for characteristic myopia-induced structural alterations [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Our investigations reveal that patients with high myopia demonstrate the most significant vascular compromise, exhibiting markedly diminished perfusion density in both the superficial and deep macular capillary plexuses, as well as in the peripapillary microvasculature. These vascular parameters display a progressive deterioration pattern strongly correlated with axial elongation, manifesting as reduced macular and peripapillary vessel densities, attenuated retinal nerve fiber layer thickness, and expanded foveal avascular zone dimensions, while concurrently demonstrating paradoxical increases in foveal thickness [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. These findings underscore the essential consideration of refractive status in the clinical interpretation of retinal vascular metrics. The mechanistic insights provided by this research may facilitate the establishment of more sensitive diagnostic protocols and targeted intervention strategies for myopia-related retinal disorders at earlier, potentially more treatable stages.\u003c/p\u003e \u003cp\u003eThe ratio of arc-shaped spots to optic disc area and the average density of leopard print patterns serve as clinically significant biomarkers for assessing retinal health in patients with high myopia and retinal pathology, enabling earlier detection and intervention of sight-threatening conditions. Our findings demonstrate that these morphological parameters substantially influence retinal vessel caliber (RVC) measurements obtained from fundus photography. As retinal vessel analysis plays a pivotal role in diagnosing and monitoring both ocular and systemic disorders, it is crucial to recognize how myopia-induced anatomical changes may confound these measurements [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Progressive axial elongation in myopic eyes induces retinal stretching, potentially causing artifactual narrowing of retinal vessels and subsequent underestimation of true vascular diameters [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This phenomenon poses particular challenges for artificial intelligence systems, as algorithms trained predominantly on emmetropic eyes may erroneously interpret these myopia-related vascular alterations as pathological changes, leading to inaccurate clinical assessments [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Furthermore, the characteristic retinal thinning and vascular remodeling associated with higher myopia degrees significantly alter vessel morphology and apparent dimensions. These refractive-error-dependent variations necessitate specific algorithmic compensation to prevent systematic measurement errors and vessel caliber misclassification. Additional complexity arises from myopia-associated peripheral retinal thinning and vascular attenuation, which may be incorrectly identified as pathological vessel narrowing without proper adjustment for refractive status. Artificial intelligence systems face the critical challenge of distinguishing genuine vascular pathology from myopia-related anatomical variations to prevent diagnostic misinterpretation. This distinction is particularly crucial given the characteristic ocular features associated with myopia, including tilted optic discs and peripapillary atrophy, which can significantly alter the appearance of peripapillary retinal vessels and potentially confound vascular assessment [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. To achieve reliable clinical measurements, AI algorithms require specialized training to recognize and computationally compensate for these distinctive myopic fundus features. Additional technical challenges arise from the reduced image quality frequently encountered in highly myopic eyes, resulting from increased light scatter and optical aberrations that may impair accurate vessel segmentation and quantitative analysis. Furthermore, the characteristic choroidal thinning observed in myopic eyes influences retinal vessel visibility and apparent dimensions, suggesting that optimal AI performance should incorporate choroidal thickness parameters into vessel caliber assessment protocols to enhance measurement precision [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile our study benefits from a substantial sample size, it is important to acknowledge certain limitations, particularly regarding demographic representation as our cohort was predominantly male. Future investigations would benefit from expanded recruitment strategies to ensure more balanced gender representation and greater geographical diversity. A more significant methodological consideration stems from the current reliance of artificial intelligence algorithms on training datasets primarily composed of non-myopic eyes, which may limit their generalizability and introduce systematic biases when applied to myopic populations. This underscores the critical need for incorporating representative myopic samples in training datasets to develop robust AI models with enhanced diagnostic validity. Looking ahead, the development of specialized AI algorithms tailored to varying degrees of myopia could provide valuable insights into how myopia-related parameters influence diverse retinal pathologies. Such advancements would not only improve diagnostic precision and efficiency but also facilitate more effective clinical implementation of artificial intelligence technologies in ophthalmic practice.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur research found that edge area, the ratio of arc spot to optic disc area, or the average density of leopard print spots have a significant impact on RVC measurement results. Incorporating these covariates improves the accuracy of systemic and ocular factor assessments in myopia, offering potential for earlier detection and targeted management of retinal pathology.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eRVC \u0026nbsp; \u0026nbsp; \u0026nbsp;retinal vessel caliber\u003c/p\u003e\n\u003cp\u003eCRAE \u0026nbsp; \u0026nbsp; central retinal artery equivalent\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCRVE \u0026nbsp; \u0026nbsp; central retinal vein equivalent\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAVR \u0026nbsp; \u0026nbsp; \u0026nbsp;arteriovenous ratio\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAL \u0026nbsp; \u0026nbsp; \u0026nbsp; axial length\u003c/p\u003e\n\u003cp\u003ePOAG \u0026nbsp; \u0026nbsp;primary open angle glaucoma\u003c/p\u003e\n\u003cp\u003eDh/Dv \u0026nbsp; \u0026nbsp;the ratio of horizontal disc diameter to vertical disc diameter\u003c/p\u003e\n\u003cp\u003eC/D \u0026nbsp; \u0026nbsp; \u0026nbsp;cup/disc\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided written informed consent before being included in the study. Our study is a retrospective study that has been reviewed by the Ethics Committee of Jinling Hospital affiliated with Nanjing University (Ethics Code: 2024DZKY-015-01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has been approved by Key Project of Cadre Health Care in Jiangsu Province (Approval Number: BJ2407).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRZ, YZ, YH, WN, DL, TJ, YW, LM, SZ and YZ participated in the study design and statistical analysis. RZ, YZ, YH, WN analyzed the data together and drafted the manuscript. DL, TJ, YW participated in data collection, and LM, SZ and YZ participated in statistical analysis. All authors read and approved the fnal manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all the participants in the study and the members of the survey teams, as well as the fnancial support.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWong T, Klein R, Klein B, et al. Retinal vessel diameters and their associations with age and blood pressure[J]. Investigative ophthalmology \u0026amp; visual science, 2003, 44(11): 4644-4650.\u003c/li\u003e\n\u003cli\u003ePoplin R, Varadarajan A V, Blumer K, et al. Prediction of cardiovascular risk factors from retinal fundus photographs via deep learning[J]. Nature biomedical engineering, 2018, 2(3): 158-164.\u003c/li\u003e\n\u003cli\u003eJackson V E, Wu Y, Bonelli R, et al. Multi-omic spatial effects on high-resolution AI-derived retinal thickness[J]. Nature Communications, 2025, 16(1): 1317.\u003c/li\u003e\n\u003cli\u003eZhang R, Zhou Y, Ni W, et al. The application value of artificial intelligence retinal microvascular analysis in the complications of diabetes [J]. Journal of Practical Medicine, 2024,40 (08): 1142-1147.\u003c/li\u003e\n\u003cli\u003eZhang R, Zhou Y, Zhong Y. Artificial intelligence assisted analysis of the correlation between coronary artery calcification score and retinal arteriosclerosis [J]. Chinese Journal of Atherosclerosis, 2024, 32 (08): 690-696.\u003c/li\u003e\n\u003cli\u003ePoplin, Ryan, Varadarajan, et al. Prediction of cardiovascular risk factors from retinal fundus photographs via deep learning[J]. Nature biomedical engineering, 2018, 2(3):158-164.\u003c/li\u003e\n\u003cli\u003eYanjun MA, Jianhao X, Yidan Z, et al. Deep learning algorithm using fundus photographs for 10-year risk assessment of ischemic cardiovascular diseases in China[J]. Science Bulletin, 2022, 67(1):17-20.\u003c/li\u003e\n\u003cli\u003eHe J, Cao T, Xu F, et al. Artificial intelligence-based screening for diabetic retinopathy at community hospital[J]. Eye, 2020, 34(3):572-576.\u003c/li\u003e\n\u003cli\u003eSeidelmann SB, Claggett B, Bravo PE,et al. Retinal vessel calibers in predicting long-term cardiovascular outcomes: the atherosclerosis risk in communities study[J]. Circulation. 2016, 134(18):1328-1338.\u003c/li\u003e\n\u003cli\u003eKawasaki R, Wang JJ, Rochtchina E, et al. Retinal vessel caliber Is associated with the 10-year incidence of glaucoma - The Blue Mountains Eye Study[J].Ophthalmology. 2003, 120(1):84-90.\u003c/li\u003e\n\u003cli\u003eYanagi M, Kawasaki R, Wang JJ, et al. Vascular risk factors in glaucoma: a review[J]. Clin Exp Ophthalmol. 2011, 39(3):252-258.\u003c/li\u003e\n\u003cli\u003eMataki N, Tomidokoro A, Iwase A , et al. Beta-peripapillary atrophy of the optic disc and its determinants in Japanese eyes: a population-based study[J]. Acta Ophthalmol. 2018, 96(6):e701-706. \u003c/li\u003e\n\u003cli\u003eSun C, Wang JJ, Mackey DA, Wong TY. Retinal vascular caliber: Systemic, environmental, and genetic associations[J]. Surv Ophthalmol. 2009;54(1):74\u0026ndash;95 \u003c/li\u003e\n\u003cli\u003eResnikoff S , Jonas J B , Friedman D , et al. Myopia - A 21st Century Public Health Issue[J].Investigative ophthalmology \u0026amp; visual science, 2019, (6):60.\u003c/li\u003e\n\u003cli\u003eYang D, Cao D, Zhang L, et al. Macular and peripapillary vessel density in myopic eyes of young Chinese adults[J]. Clinical and Experimental Optometry, 2020, 103(6): 830-837.\u003c/li\u003e\n\u003cli\u003eMastropasqua R, Viggiano P, Borrelli E, et al. 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Modern Diagnostic Techniques for the Assessment of Ocular Blood Flow in Myopia: Current State of Knowledge[J].Journal of Ophthalmology, 2018, 2018:1-8.\u003c/li\u003e\n\u003cli\u003eZhao M, Lam A K C, Ying M T C, et al. Hemodynamic and morphological changes of the central retinal artery in myopic eyes[J]. Scientific reports, 2022, 12(1): 7104.\u003c/li\u003e\n\u003cli\u003eLi F, Chen H, Liu Z, et al. Deep learning-based automated detection of retinal diseases using optical coherence tomography images[J]. Biomedical optics express, 2019, 10(12): 6204-6226.\u003c/li\u003e\n\u003cli\u003eMitchell P, Hourihan F, Sandbach J, et al. The relationship between glaucoma and myopia: the Blue Mountains Eye Study[J]. 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Clinical and Experimental Optometry. 2020, 103(6):830-837.\u003c/li\u003e\n\u003cli\u003eHe, J, Chen, Q, Yin, Y, et al. Association between retinal microvasculature and optic disc alterations in high myopia[J].Eye, 33(9):1494-1503.\u003c/li\u003e\n\u003cli\u003eWang Y X, Panda-Jonas S, Jonas J B. Optic nerve head anatomy in myopia and glaucoma, including parapapillary zones alpha, beta, gamma and delta: histology and clinical features[J]. Progress in retinal and eye research, 2021, 83: 100933.\u003c/li\u003e\n\u003cli\u003eLim L S, Lim X H, Tan L. Retinal vascular oxygen saturation and its variation with refractive error and axial length[J]. Translational Vision Science \u0026amp; Technology, 2019, 8(4): 22-22.\u003c/li\u003e\n\u003c/ol\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Central Retinal Artery Equivalent (CRAE), Central retinal vein equivalent (CRVE), Arteriovenous ratio (AVR), Optic Nerve Head-Related Structures, Fundus Photographs","lastPublishedDoi":"10.21203/rs.3.rs-6316298/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6316298/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground：\u003c/strong\u003eThere has been a paucity of information on the efects of myopia-related parameters factors on the retinal vessel caliber (RVC). Information on this relationship should be useful in studying possible roles of refractive status in the development and progression of ocular circulation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods：\u003c/strong\u003eSubjects were from the Health Medicine Department of Jinling Hospital, Afliated Hospital of Medical School, Nanjing University in China aged 20 to 60 years. All participants underwent fundus photography examination. Parameters assessed were central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), Arteriovenous ratio (AVR), cup/disc ratio, optic disc size, cup area,cup/disc ratio, arc spot to optic disc area ratio, and average density of leopard print spots. Normal subjects and eyes were defined according to standardized systemic and ocular examinations. The central retinal artery and vein equivalents (CRAE, CRVE, Arc spot to optic disc area ratio, Average density of leopard print spots and other indicators) were determined on fundus photographs by correcting the magnifcation using the refractive error, corneal curvature, and axial length (AL) of an individual eye and paraxial ray tracing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults：\u003c/strong\u003eIn a total of 4252 right eyes (4252 normal subjects), aged 37.27±7.29 (standard deviation) years with gradable\u003c/p\u003e\n\u003cp\u003ephotographs and planimetric results, CRAE averaged 0.02±0.01μm and CRVE 0.03±0.01 μm. After adjustment for\u003c/p\u003e\n\u003cp\u003ethe efects of confounding factors in multivariate analysis, the horizontal cup area (\u003cem\u003eP\u003c/em\u003e＜0.0001), vertical cup area(\u003cem\u003eP\u003c/em\u003e＜0.0001), vertical cup/disc ratio (\u003cem\u003eP\u003c/em\u003e＝0.036) and arc spot to optic disc area ratio (\u003cem\u003eP\u003c/em\u003e＜0.0001) positively with CRAE and the Age (\u003cem\u003eP\u003c/em\u003e＜0.0001), mean blood pressure (\u003cem\u003eP\u003c/em\u003e＝0.011 ), body mass index (\u003cem\u003eP\u003c/em\u003e＝0.003 ), horizontal optic disc size (\u003cem\u003eP\u003c/em\u003e＝0.005 ), horizontal cup area (\u003cem\u003eP\u003c/em\u003e＜0.0001 ) and average density of leopard print spots (\u003cem\u003eP\u003c/em\u003e＜0.0001 ) correlated negatively with CRAE; the horizontal cup area (\u003cem\u003eP\u003c/em\u003e＝0.001), vertical cup area(\u003cem\u003eP\u003c/em\u003e＜0.0001), vertical cup/disc ratio (\u003cem\u003eP\u003c/em\u003e＝0.009) and arc spot to optic disc area ratio (\u003cem\u003eP\u003c/em\u003e＜0.0001) positively with CRVE and the age (\u003cem\u003eP\u003c/em\u003e＜0.0001), horizontal optic disc size (\u003cem\u003eP\u003c/em\u003e＝0.021 ), and average density of leopard print spots (\u003cem\u003eP\u003c/em\u003e＜0.0001 ) correlated negatively with CRVE. There were differences in CRAE, CRVE, AVR based on the quartile of the ratio of arc point to optic disc area (all \u003cem\u003eP\u003c/em\u003e＜0.0001), and there were also differences in CRAE, CRVE, AVR based on the quartile of the average density of leopard point (\u003cem\u003eP\u003c/em\u003e＝0.035, \u003cem\u003eP\u003c/em\u003e＝0.030, \u003cem\u003eP\u003c/em\u003e＜0.0001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions：\u003c/strong\u003eThe current study showed signifcant efects of arc spot to optic disc area ratio, average density of leopard print spots on the photographs on the RVC measurement results. Further, it showed a necessity to incorporate the myopia related parameters as co-variables to correctly estimate the efects of various factors on the RVC.\u003c/p\u003e","manuscriptTitle":"Effects of myopia-related parameters on retinal vessel calibers measurement results on AI fundus photographs","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-08 14:48:50","doi":"10.21203/rs.3.rs-6316298/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e7233383-ec19-462d-8b37-bf22ce3baea8","owner":[],"postedDate":"May 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-03T07:53:52+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-08 14:48:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6316298","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6316298","identity":"rs-6316298","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}