1
|
Yii F, Bernabeu MO, Dhillon B, Strang N, MacGillivray T. Retinal Changes From Hyperopia to Myopia: Not All Diopters Are Created Equal. Invest Ophthalmol Vis Sci 2024; 65:25. [PMID: 38758640 PMCID: PMC11107950 DOI: 10.1167/iovs.65.5.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/30/2024] [Indexed: 05/19/2024] Open
Abstract
Purpose To quantitatively characterize retinal changes across different quantiles of refractive error in 34,414 normal eyes of 23,064 healthy adults in the UK Biobank. Methods Twelve optic disc (OD), foveal and vascular parameters were derived from color fundus photographs, correcting for ocular magnification as appropriate. Quantile regression was used to test the independent associations between these parameters and spherical equivalent refraction (SER) across 34 refractive quantiles (high hyperopia to high myopia)-controlling for age, sex and corneal radius. Results More negative SER was nonlinearly associated with greater Euclidian (largely horizontal) OD-fovea distance, larger OD, less circular OD, more obliquely orientated OD (superior pole tilted towards the fovea), brighter fovea, lower vascular complexity, less tortuous vessels, more concave (straightened out towards the fovea) papillomacular arterial/venous arcade and wider central retinal arterioles/venules. In myopia, these parameters varied more strongly with SER as myopia increased. For example, while every standard deviation (SD) decrease in vascular complexity was associated with 0.63 D (right eye: 95% confidence interval [CI], 0.58-0.68) to 0.68 D (left eye: 95% CI, 0.63-0.73) higher myopia in the quantile corresponding to -0.60 D, it was associated with 1.61 D (right eye: 95% CI, 1.40-1.82) to 1.70 D (left eye: 95% CI, 1.56-1.84) higher myopia in the most myopic quantile. OD-fovea angle (degree of vertical separation between OD and fovea) was found to vary linearly with SER, but the magnitude was of little practical importance (less than 0.10 D variation per SD change in angle in almost all refractive quantiles) compared with the changes in OD-fovea distance. Conclusions Several interrelated retinal changes indicative of an increasing (nonconstant) rate of mechanical stretching are evident at the posterior pole as myopia increases. These changes also suggest that the posterior pole stretches predominantly in the temporal horizontal direction.
Collapse
Affiliation(s)
- Fabian Yii
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Curle Ophthalmology Laboratory, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, United Kingdom
| | - Miguel O. Bernabeu
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- The Bayes Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Baljean Dhillon
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Curle Ophthalmology Laboratory, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, United Kingdom
- Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom
| | - Niall Strang
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Tom MacGillivray
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Curle Ophthalmology Laboratory, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
2
|
Engelmann J, Kearney S, McTrusty A, McKinlay G, Bernabeu MO, Strang N. Retinal Fractal Dimension Is a Potential Biomarker for Systemic Health-Evidence From a Mixed-Age, Primary-Care Population. Transl Vis Sci Technol 2024; 13:19. [PMID: 38607632 PMCID: PMC11019596 DOI: 10.1167/tvst.13.4.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/03/2024] [Indexed: 04/13/2024] Open
Abstract
Purpose To investigate whether fractal dimension (FD), a retinal trait relating to vascular complexity and a potential "oculomics" biomarker for systemic disease, is applicable to a mixed-age, primary-care population. Methods We used cross-sectional data (96 individuals; 183 eyes; ages 18-81 years) from a university-based optometry clinic in Glasgow, Scotland, to study the association between FD and systemic health. We computed FD from color fundus images using Deep Approximation of Retinal Traits (DART), an artificial intelligence-based method designed to be more robust to poor image quality. Results Despite DART being designed to be more robust, a significant association (P < 0.001) between image quality and FD remained. Consistent with previous literature, age was associated with lower FD (P < 0.001 univariate and when adjusting for image quality). However, FD variance was higher in older patients, and some patients over 60 had FD comparable to those of patients in their 20s. Prevalent systemic conditions were significantly (P = 0.037) associated with lower FD when adjusting for image quality and age. Conclusions Our work suggests that FD as a biomarker for systemic health extends to mixed-age, primary-care populations. FD decreases with age but might not substantially decrease in everyone. This should be further investigated using longitudinal data. Finally, image quality was associated with FD, but it is unclear whether this finding is measurement error caused by image quality or confounded by age and health. Future work should investigate this to clarify whether adjusting for image quality is appropriate. Translational Relevance FD could potentially be used in regular screening settings, but questions around image quality remain.
Collapse
Affiliation(s)
- Justin Engelmann
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
- School of Informatics, University of Edinburgh, Edinburgh, UK
| | - Stephanie Kearney
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Alice McTrusty
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Greta McKinlay
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Miguel O. Bernabeu
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
- The Bayes Centre, University of Edinburgh, Edinburgh, UK
| | - Niall Strang
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| |
Collapse
|
3
|
Wagner SK, Bountziouka V, Hysi P, Rahi JS. Associations between unilateral amblyopia in childhood and cardiometabolic disorders in adult life: a cross-sectional and longitudinal analysis of the UK Biobank. EClinicalMedicine 2024; 70:102493. [PMID: 38685932 PMCID: PMC11056416 DOI: 10.1016/j.eclinm.2024.102493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 05/02/2024] Open
Abstract
Background Amblyopia is a common neurodevelopmental condition and leading cause of childhood visual impairment. Given the known association between neurodevelopmental impairment and cardiometabolic dysfunction in later life, we investigated whether children with amblyopia have increased risk of cardiometabolic disorders in adult life. Methods This was a cross-sectional and longitudinal analysis of 126,399 United Kingdom Biobank cohort participants who underwent ocular examination. A subset of 67,321 of these received retinal imaging. Data analysis was conducted between November 1st 2021 and October 15th 2022. Our primary objective was to investigate the association between amblyopia and a number of components of metabolic syndrome and individual cardiometabolic diseases. Childhood amblyopia, dichotomised as resolved or persisting by adulthood, cardiometabolic disease and mortality were defined using ophthalmic assessment, self-reported, hospital admissions and death records. Morphological features of the optic nerve and retinal vasculature and sublayers were extracted from retinal photography and optical coherence tomography. Associations between amblyopia and cardiometabolic disorders as well as retinal markers were investigated in multivariable-adjusted regression models. Findings Individuals with persisting amblyopia (n = 2647) were more likely to be obese (adjusted odds ratio (95% confidence interval): 1.16 (1.05; 1.28)), hypertensive (1.25 (1.13; 1.38)) and diabetic (1.29 (1.04; 1.59)) than individuals without amblyopia (controls, (n = 18,481)). Amblyopia was also associated with an increased risk of myocardial infarction (adjusted hazard ratio: 1.38 (1.11; 1.72)) and death (1.36 (1.15; 1.60)). On retinal imaging, amblyopic eyes had significantly increased venular caliber (0.29 units (0.21; 0.36)), increased tortuosity (0.11 units (0.03; 0.19)), but lower fractal dimension (-0.23 units (-0.30; -0.16)) and thinner ganglion cell-inner plexiform layer (mGC-IPL, -2.85 microns (-3.47; -2.22)). Unaffected fellow eyes of individuals with amblyopia also had significantly lower retinal fractal dimension (-0.08 units (-0.15; -0.01)) and thinner mGC-IPL (-1.14 microns (-1.74; -0.54)). Amblyopic eyes with a persisting visual deficit had smaller optic nerve disc height (-0.17 units (-0.25; -0.08)) and width (-0.13 units (-0.21; -0.04)) compared to control eyes. Interpretation Although further research is needed to understand the basis of the observed associations, healthcare professionals should be cognisant of greater cardiometabolic dysfunction in adults who had childhood amblyopia. Differences in retinal features in both the amblyopic eye and the unaffected non-amblyopic suggest generalised versus local processes. Funding Medical Research Council (MR/T000953/1) and the National Institute for Health and Care Research.
Collapse
Affiliation(s)
- Siegfried Karl Wagner
- Institute of Ophthalmology, University College London, London, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology London, UK
| | - Vasiliki Bountziouka
- Computer Simulation, Genomics and Data Analysis Laboratory, Department of Food Science and Nutrition, University of the Aegean, Greece
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Cardiovascular Research Centre, Department of Cardiovascular Science, University of Leicester, Leicester, UK
| | - Pirro Hysi
- Section of Ophthalmology, School of Life Course Sciences, King's College London, London, UK
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Jugnoo Sangeeta Rahi
- Institute of Ophthalmology, University College London, London, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
- Ulverscroft Vision Research Group, University College London, London, UK
- NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, UK
| |
Collapse
|
4
|
Arnould L, Meriaudeau F, Guenancia C, Germanese C, Delcourt C, Kawasaki R, Cheung CY, Creuzot-Garcher C, Grzybowski A. Using Artificial Intelligence to Analyse the Retinal Vascular Network: The Future of Cardiovascular Risk Assessment Based on Oculomics? A Narrative Review. Ophthalmol Ther 2023; 12:657-674. [PMID: 36562928 PMCID: PMC10011267 DOI: 10.1007/s40123-022-00641-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
The healthcare burden of cardiovascular diseases remains a major issue worldwide. Understanding the underlying mechanisms and improving identification of people with a higher risk profile of systemic vascular disease through noninvasive examinations is crucial. In ophthalmology, retinal vascular network imaging is simple and noninvasive and can provide in vivo information of the microstructure and vascular health. For more than 10 years, different research teams have been working on developing software to enable automatic analysis of the retinal vascular network from different imaging techniques (retinal fundus photographs, OCT angiography, adaptive optics, etc.) and to provide a description of the geometric characteristics of its arterial and venous components. Thus, the structure of retinal vessels could be considered a witness of the systemic vascular status. A new approach called "oculomics" using retinal image datasets and artificial intelligence algorithms recently increased the interest in retinal microvascular biomarkers. Despite the large volume of associated research, the role of retinal biomarkers in the screening, monitoring, or prediction of systemic vascular disease remains uncertain. A PubMed search was conducted until August 2022 and yielded relevant peer-reviewed articles based on a set of inclusion criteria. This literature review is intended to summarize the state of the art in oculomics and cardiovascular disease research.
Collapse
Affiliation(s)
- Louis Arnould
- Ophthalmology Department, Dijon University Hospital, 14 Rue Paul Gaffarel, 21079, Dijon CEDEX, France. .,University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR U1219, 33000, Bordeaux, France.
| | - Fabrice Meriaudeau
- Laboratory ImViA, IFTIM, Université Bourgogne Franche-Comté, 21078, Dijon, France
| | - Charles Guenancia
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases, (EA 7460), Faculty of Health Sciences, Université de Bourgogne Franche-Comté, Dijon, France.,Cardiology Department, Dijon University Hospital, Dijon, France
| | - Clément Germanese
- Ophthalmology Department, Dijon University Hospital, 14 Rue Paul Gaffarel, 21079, Dijon CEDEX, France
| | - Cécile Delcourt
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR U1219, 33000, Bordeaux, France
| | - Ryo Kawasaki
- Artificial Intelligence Center for Medical Research and Application, Osaka University Hospital, Osaka, Japan
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Catherine Creuzot-Garcher
- Ophthalmology Department, Dijon University Hospital, 14 Rue Paul Gaffarel, 21079, Dijon CEDEX, France.,Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Poznan, Poland
| |
Collapse
|
5
|
French C, Heitmar R. Comparison of Static Retinal Vessel Caliber Measurements by Different Commercially Available Platforms. Optom Vis Sci 2021; 98:1104-1112. [PMID: 34570034 DOI: 10.1097/opx.0000000000001774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Commercially available platforms show good agreement in clinical outcomes for retinal vessel caliber measurements, despite differing absolute values. Tighter agreement is observed when right and left eye data are averaged, suggesting an approach suitable for clinical practice. PURPOSE The purpose of this study was to compare the retinal vessel caliber measurements generated by different commercially available platforms and their associations with systemic blood pressure and age. METHODS A total of 209 participants were recruited from a UK optometric practice. After a routine eye examination, participants had disc-centered retinal photographs and systemic blood pressure taken. Retinal vessel calibers (central retinal artery equivalent, central retinal vein equivalent, and arteriovenous ratio) were calculated using both MONA REVA and VesselMap. RESULTS An inverse Pearson correlation was observed between central retinal artery equivalent and mean arterial blood pressure on both platforms (r = -0.275 [P ≤ .001] and r = -0.388 [P ≤ .001] for MONA REVA and VesselMap, respectively); this correlation was also observed with arteriovenous ratio and blood pressure. An inverse correlation was observed between central retinal artery equivalent and age (r = -0.362 [P ≤ .001] and r = -0.404 [P ≤ .001] for MONA REVA and VesselMap, respectively); this was also seen between central retinal vein equivalent and age (r = -0.322 [P ≤ .001] and r = -0.369 [P ≤ .001]). Arteriovenous ratio remained independent from age for both platforms. Bland-Altman plots demonstrated good agreement between the platforms for all three variables. CONCLUSIONS Although absolute caliber measurements differed between the platforms, the correlations observed were of similar magnitudes, with good agreement between the two platforms. Tighter spaced limits of agreement were observed when right and left eye data were averaged for each subject. In the absence of localized ocular pathology, this approach should be used.
Collapse
|
6
|
Lye WK, Paterson E, Patterson CC, Maxwell AP, Binte Mohammed Abdul RB, Tai ES, Cheng CY, Kayama T, Yamashita H, Sarnak M, Shlipak M, Matsushita K, Mutlu U, Ikram MA, Klaver C, Kifley A, Mitchell P, Myers C, Klein BE, Klein R, Wong TY, Sabanayagam C, McKay GJ. A systematic review and participant-level meta-analysis found little association of retinal microvascular caliber with reduced kidney function. Kidney Int 2021; 99:696-706. [PMID: 32810524 PMCID: PMC7898278 DOI: 10.1016/j.kint.2020.06.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 01/09/2023]
Abstract
Previously, variation in retinal vascular caliber has been reported in association with chronic kidney disease (CKD) but findings remain inconsistent. To help clarify this we conducted individual participant data meta-analysis and aggregate data meta-analysis on summary estimates to evaluate cross-sectional associations between retinal vascular caliber and CKD. A systematic review was performed using Medline and EMBASE for articles published until October 2018. The aggregate analysis used a two-stage approach combining summary estimates from eleven studies (44,803 patients) while the individual participant analysis used a one-stage approach combining raw data from nine studies (33,222 patients). CKD stages 3-5 was defined as an estimated glomerular filtration rate under 60 mL/min/1.73m2. Retinal arteriolar and venular caliber (central retinal arteriolar and venular equivalent) were assessed from retinal photographs using computer-assisted methods. Logistic regression estimated relative risk of CKD stages 3-5 associated with a 20 μm decrease (approximately one standard deviation) in central retinal arteriolar and venular equivalent. Prevalence of CKD stages 3-5 was 11.2% of 33,222 and 11.3% of 44,803 patients in the individual participant and aggregate data analysis, respectively. No significant associations were detected in adjusted analyses between central retinal arteriolar and venular equivalent and CKD stages 3-5 in the aggregate analysis for central retinal arteriolar relative risk (0.98, 95% confidence interval 0.94-1.03); venular equivalent (0.99, 0.95-1.04) or individual participant central retinal arteriolar (0.99, 0.95-1.04) or venular equivalent (1.01, 0.97-1.05). Thus, meta-analysis provided little evidence to suggest that cross sectional direct measurements of retinal vascular caliber was associated with CKD stages 3-5 in the general population. Hence, meta-analyses of longitudinal studies evaluating the association between retinal parameters and CKD stages 3-5 may be warranted.
Collapse
Affiliation(s)
- Weng Kit Lye
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Euan Paterson
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | - Alexander P Maxwell
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | - E Shyong Tai
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Ching Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Takamasa Kayama
- Department of Advanced Cancer Science, Yamagata University, Yamagata, Japan
| | | | - Mark Sarnak
- William B. Schwartz Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Michael Shlipak
- Division of Nephrology, Department of Medicine, San Francisco VA Medical Center, San Francisco, California, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Unal Mutlu
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mohammad A Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Caroline Klaver
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Annette Kifley
- Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Chelsea Myers
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Barbara E Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | | | - Gareth J McKay
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK.
| |
Collapse
|
7
|
Dascalu J, Liu M, Lycett K, Grobler AC, He M, Burgner DP, Wong TY, Wake M. Retinal microvasculature: population epidemiology and concordance in Australian children aged 11-12 years and their parents. BMJ Open 2019; 9:44-52. [PMID: 31273015 PMCID: PMC6624026 DOI: 10.1136/bmjopen-2018-022399] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To describe distributions and concordance of retinal microvasculature measurements in a population-based sample of Australian parent-child dyads at child age 11-12 years. DESIGN Cross-sectional Child Health CheckPoint study, between waves 6 and 7 of the national population-based Longitudinal Study of Australian Children (LSAC). SETTING Assessment centres in seven Australian cities, February 2015-March 2016. PARTICIPANTS Of the 1874 participating families, 1288 children (51% girls) and 1264 parents (87% mothers, mean age 43.7) were analysed. Diabetic participants and non-biological pairs were excluded from concordance analyses. OUTCOME MEASURES Retinal photographs were taken by non-mydriatic fundus camera. Trained graders scored vascular calibre using semi-automated software, yielding estimates of central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) and arteriolar-venular ratio (AVR). Pearson's correlation coefficients and multivariable linear regression models assessed parent-child concordance. Survey weights and methods accounted for LSAC's complex sampling, stratification and clustering within postcodes. RESULTS Mean (SD) of CRAE and CRVE were larger in children (159.5 (11.8) and 231.1 (16.5) μm, respectively) than parents (151.5 (14.0) and 220.6 (19.0) μm), yielding similar AVR (children 0.69 (0.05), parents 0.69 (0.06)). Correlation coefficients for parent-child pairs were 0.22 (95% CI 0.16 to 0.27) for CRAE, 0.23 (95% CI 0.17 to 0.28) for CRVE and 0.18 (95% CI 0.13 to 0.24) for AVR. Mother-child and father-child values were similar (0.20 and 0.32 for CRAE, 0.22 and 0.29 for CRVE, respectively). Relationships attenuated slightly on adjustment for age, sex, blood pressure, diabetes and body mass index. Percentiles and concordance are presented for the whole sample and by sex. CONCLUSIONS Arteriolar and venular calibre were similar to previously documented measures in midlife adult and late childhood populations. Population parent-child concordance values align with moderate polygenic heritability reported in smaller studies.
Collapse
Affiliation(s)
- Julian Dascalu
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Mengjiao Liu
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Kate Lycett
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Anneke C Grobler
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Mingguang He
- Centre for Eye Research Australia, The University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - David P Burgner
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Tien Yin Wong
- Centre for Eye Research Australia, The University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Melissa Wake
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics and The Liggins Institute, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
8
|
Chaichian S, Mehdizadehkashi K, Pazouki A, Jafarzadehpour E, Akhlaghdoust M, Sheikhvatan M. Hyperopic Shift in Obese Patients After Bariatric Surgery: A Clinical Trial. Bariatr Surg Pract Patient Care 2018. [DOI: 10.1089/bari.2018.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shahla Chaichian
- Minimally Invasive Techniques Research Center in Women, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Khashayar Mehdizadehkashi
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Meisam Akhlaghdoust
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Sheikhvatan
- Genetic Ward, Neurology Department, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
9
|
Waizel M, Türksever C, Todorova MG. Normative values of retinal vessel oximetry in healthy children against adults. Acta Ophthalmol 2018; 96:e828-e834. [PMID: 30187646 DOI: 10.1111/aos.13726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 01/21/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Retinal oximetry (RO) has been established as a non-invasive method to analyse oxygen saturation in retinal vessels. The aim of our study was to compare the RO parameters of healthy children to those in adults. METHODS A total of 200 eyes of 104 healthy subjects were examined: 20 eyes of children aged <10 years and 62 eyes of children aged 10-19 years were compared to the eyes of adult controls from five different age groups (20-29 years:n = 24; 30-39 years:n = 32; 40-49 years:n = 15; 50-59 years:n = 20, 60-80 years:n = 27; n indicates the number of analysed eyes). The oxygen saturation was estimated with the oxygen saturation measurement tool of the Retinal Vessel Analyser (RVA; IMEDOS Systems UG, Jena, Germany). The global oxygen saturations, within 1.0-1.5 optic disc diameters from the disc margin, in the peripapillary retinal arterioles (A-SO2 ; %) and venules (V-SO2 ; %) were estimated and their difference (A-V SO2 ; %) was calculated. In addition, we evaluated the mean diameter in all four major retinal arterioles (D-A; μm) and venules (D-V; μm). The ratio between venular and arterial vessel diameter (D-V/A; μm) was calculated thereafter. For statistical evaluation, anova-based linear mixed-effects models were calculated with spss® . RESULTS Based on our results, younger children (<10 years) present a statistically significant lower A-SO2 and A-V SO2 when compared to adult subgroups. The D-A values revealed to be significantly lower in 10 + children when compared to the other groups, while the D-V values did not show significant differences. CONCLUSION These data indicate that the retinal oxygen metabolism changes throughout lifetime. Therefore, normative data for different age groups are mandatory.
Collapse
Affiliation(s)
- Maria Waizel
- Department of Ophthalmology; University of Basel; Basel Switzerland
| | | | | |
Collapse
|
10
|
Effect of Axial Eye Length on Retinal Vessel Parameters in 6 to 12-Year-Old Malay Girls. PLoS One 2017; 12:e0170014. [PMID: 28107389 PMCID: PMC5249240 DOI: 10.1371/journal.pone.0170014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 12/25/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Retinal vessel analysis is affected by both systemic and ocular factors. Malays are the major ethnicity in South East Asia. Data on the retinal microvasculature in Malays is limited, especially among children. We aim to evaluate the influence of ocular biometry on retinal vessel parameters in young Malay girls. METHODS This was a cross-sectional, hospital-based study involving 86 Malay girls aged 6 to 12 years old in Hospital Universiti Sains Malaysia from 2015-2016. Ocular examination, refraction, biometry, retinal photography, and anthropometric measurements were performed. The central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE) and overall fractal dimension (Df) were measured using validated computer-based methods (Singapore I vessel analyzer, SIVA version 3.0, Singapore). The associations of ocular biometry and CRAE, CRVE and Df were analyzed using multivariable analysis. RESULTS The mean CRAE, CRVE and Df in Malay girls were 171.40 (14.40) um, 248.02 (16.95) um and 1.42 (0.05) respectively. Each 1 mm increase in axial length was associated with a reduction of 4.25 um in the CRAE (p = 0.03) and a reduction of 0.02 in the Df (p = 0.02), after adjustment for age, blood pressure and body mass index. No association was observed between axial length and CRVE. Anterior chamber depth and corneal curvature had no association with CRAE, CRVE or Df. CONCLUSION Axial length affects retinal vessel measurements. Narrower retinal arterioles and reduced retinal fractal dimension were observed in Malay girls with longer axial lengths.
Collapse
|
11
|
Evidence of Microvascular Changes in the Retina following Kawasaki Disease. Sci Rep 2017; 7:40513. [PMID: 28094311 PMCID: PMC5240332 DOI: 10.1038/srep40513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 12/06/2016] [Indexed: 01/19/2023] Open
Abstract
It is unclear whether all children with Kawasaki disease (KD) have increased later cardiovascular risk. The retinal microvasculature reflects changes in the microcirculation and is associated with traditional cardiovascular risk factors and events. The aim of this study was to investigate retinal microvascular parameters in two populations of patients with previous KD and control participants. We performed case-control studies of 116 (57 patients and 59 control participants) Australian and 156 (78 patients and 78 control participants) Singaporean individuals, at least two years since their acute illness. Standardised retinal photographs were graded by trained technicians using a semi-automated software, which quantifies the retinal microvasculature (calibre, branching angle, fractal dimensions, and tortuosity). Retinal venules of Singaporean KD patients were 9.67 μm (95% CI 4.87 to 14.51, p < 0.001) larger than control participants following correction for traditional cardiovascular risk factors. An incremental increase in the size of retinal venules in those with coronary artery abnormalities was observed. There was limited evidence that retinal venules were larger in Australian KD patients with coronary artery abnormalities compared to control participants (7.34 μm, 95% CI 1.30 to 15.99, p = 0.10). Differences in retinal microvasculature were particularly evident in Singaporean KD patients. Larger retinal venules may reflect chronic inflammation and endothelial dysfunction, and are associated with coronary artery disease in adults.
Collapse
|
12
|
Yesil GD, Gishti O, Felix JF, Reiss I, Ikram MK, Steegers EAP, Hofman A, Jaddoe VWV, Gaillard R. Influence of Maternal Gestational Hypertensive Disorders on Microvasculature in School-Age Children: The Generation R Study. Am J Epidemiol 2016; 184:605-615. [PMID: 27756719 DOI: 10.1093/aje/kww059] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 09/07/2016] [Indexed: 12/19/2022] Open
Abstract
Gestational hypertensive disorders may lead to vascular changes in the offspring. We examined the associations of maternal blood pressure development and hypertensive disorders during pregnancy with microvasculature adaptations in the offspring in childhood. This study was performed as part of the Generation R Study in Rotterdam, the Netherlands (2002-2012), among 3,748 pregnant mothers and their children for whom information was available on maternal blood pressure in different periods of pregnancy and gestational hypertensive disorders. Childhood retinal arteriolar and venular calibers were assessed at the age of 6 years. We found that higher maternal systolic and diastolic blood pressures in early pregnancy were associated with childhood retinal arteriolar narrowing (P < 0.05). Higher maternal systolic blood pressure in late pregnancy, but not in middle pregnancy, was associated with childhood narrower retinal venular caliber (standard deviation score per standardized residual increase in systolic blood pressure: -0.05; 95% confidence interval: -0.08, -0.01). Paternal blood pressure was not associated with childhood retinal vessel calibers. Children of mothers with gestational hypertensive disorders tended to have narrower retinal arteriolar caliber (standard deviation score: -0.13, 95% confidence interval: -0.27, 0.01). Our results suggest that higher maternal blood pressure during pregnancy is associated with persistent microvasculature adaptations in their children. Further studies are needed to replicate these observations.
Collapse
|
13
|
Wei FF, Zhang ZY, Petit T, Cauwenberghs N, Gu YM, Thijs L, Raaijmakers A, Jacobs L, Yang WY, Allegaert K, Kuznetsova T, Verhamme P, Struijker-Boudier HAJ, Li Y, Asayama K, Staessen JA. Retinal microvascular diameter, a hypertension-related trait, in ECG-gated vs. non-gated images analyzed by IVAN and SIVA. Hypertens Res 2016; 39:886-892. [DOI: 10.1038/hr.2016.81] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/19/2016] [Accepted: 05/22/2016] [Indexed: 11/09/2022]
|
14
|
Gishti O, Jaddoe VWV, Felix JF, Reiss I, Steegers E, Hofman A, Ikram MK, Gaillard R. Impact of maternal smoking during pregnancy on microvasculature in childhood. The Generation R Study. Early Hum Dev 2015; 91:607-11. [PMID: 26298032 DOI: 10.1016/j.earlhumdev.2015.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 07/23/2015] [Accepted: 07/28/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Fetal exposure to maternal smoking is associated with an adverse cardiovascular risk profile in later life. Early microvasculature adaptations might be part of the underlying mechanisms for these associations. AIMS The aim of this study was to examine the influence of maternal smoking during pregnancy on retinal vessel calibers in children. STUDY DESIGN We performed a population-based prospective cohort study among 3564 school-age children. Maternal smoking patterns during pregnancy were assessed by questionnaires. OUTCOME MEASURES At the median age of 6.0 years (95% range 5.8, 8.0 years), we measured childhood retinal vessel calibers from retinal photographs. RESULTS No differences were observed in childhood retinal arteriolar and venular calibers among offspring from mothers who smoked in the first trimester and mothers who continued smoking throughout pregnancy, as compared to mothers who did not smoke during pregnancy. Also, no dose-dependent associations of the number of cigarettes smoked during pregnancy with childhood retinal vessel calibers were present. CONCLUSION Maternal smoking during pregnancy did not influence childhood retinal arteriolar and venular calibers. The mechanisms linking fetal smoke exposure with cardiovascular risk factors in later life may include other mechanisms than structural microvasculature adaptations.
Collapse
Affiliation(s)
- Olta Gishti
- Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - Janine F Felix
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Irwin Reiss
- Department of Neonatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Eric Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Mohammad Kamran Ikram
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Singapore Eye Research Institute, Singapore; Duke-NUS Graduate Medical School, National University of Singapore, Singapore; Memory Aging & Cognition Centre (MACC), National University Health System, Singapore
| | - Romy Gaillard
- Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
15
|
Fuchs SC, Pakter HM, Maestri MK, Beltrami-Moreira M, Gus M, Moreira LB, Oliveira MM, Fuchs FD. Are Retinal Vessels Calibers Influenced by Blood Pressure Measured at the Time of Retinography Acquisition? PLoS One 2015; 10:e0136678. [PMID: 26375034 PMCID: PMC4572709 DOI: 10.1371/journal.pone.0136678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 08/10/2015] [Indexed: 11/19/2022] Open
Abstract
Background Retinal arterial narrowing is associated with higher office blood pressure (BP) and ambulatory blood pressure monitoring, and increased incidence of cardiovascular disease, but it is still unknown if the vessel caliber is associated with BP measured at the time of retinography acquisition. Methods Retinal arteriolar and venular calibers were measured by the microdensitometric method in 448 patients with hypertension. Participants underwent 24-hours ambulatory blood pressure (24-h ABP) monitoring simultaneously with the retinography acquisition. Association between arteriolar and venular calibers with increase of 10 mmHg in the mean 24-hours, daily, and nightly BP, and with BP measured at the time of retinography, was evaluated by ANOVA and multivariate analyses. Results Mean 24-hours, daytime and nighttime systolic and diastolic BP were inversely associated with the arteriolar caliber, but not with the venular caliber. Arteriolar caliber decreased -0.8 (95% CI -1.4 to -0.2) μm per 10-mmHg increase in 24-hours mean systolic BP, adjusted for age, gender, fellow vessel, and duration of hypertension (P = 0.01). The corresponding decreasing in arteriolar caliber by 10 mmHg of increasing in mean diastolic BP was -1.1 μm (-2.0 to -0.2, P = 0.02). The decrease of arteriolar caliber by the same increasing of BP measured at the time of retinography was lower and not statistically significant, particularly for mean diastolic BP and outer arterioles calibers: -1.0 (-1.8 to -0.2) μm in the daytime BP average versus -0.3 (-0.9 to 0.3) at the moment of retinography acquisition. Conclusions These findings suggest that the caliber of arteriolar retinal vessels in patients with uncontrolled hypertension are not significantly influenced by blood pressure measured at the time of retinography acquisition.
Collapse
Affiliation(s)
- Sandra C. Fuchs
- Postgraduate Studies Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
- Postgraduate Studies Program in Cardiology, School of Medicine, and Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
- * E-mail:
| | - Helena M. Pakter
- Postgraduate Studies Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
| | - Marcelo K. Maestri
- Division of Ophthalmology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2350, CEP 90035–003, Porto Alegre, RS, Brazil
| | - Marina Beltrami-Moreira
- Postgraduate Studies Program in Cardiology, School of Medicine, and Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
| | - Miguel Gus
- Postgraduate Studies Program in Cardiology, School of Medicine, and Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
| | - Leila B. Moreira
- Postgraduate Studies Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
- Postgraduate Studies Program in Cardiology, School of Medicine, and Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
| | - Manuel M. Oliveira
- Informatics Institute, Universidade Federal do Rio Grande do Sul, Caixa Postal 15064, CEP 91501–970, Porto Alegre, RS, Brazil
| | - Flavio D. Fuchs
- Postgraduate Studies Program in Cardiology, School of Medicine, and Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
- National Institute of Science and Technology for Health Technology Assessment (IATS)-CNPq, Hospital de Clinicas de Porto Alegre, UFRGS, Porto Alegre, Brazil
| |
Collapse
|
16
|
Abstract
Antiaging therapies show promise in model organism research. Translation to humans is needed to address the challenges of an aging global population. Interventions to slow human aging will need to be applied to still-young individuals. However, most human aging research examines older adults, many with chronic disease. As a result, little is known about aging in young humans. We studied aging in 954 young humans, the Dunedin Study birth cohort, tracking multiple biomarkers across three time points spanning their third and fourth decades of life. We developed and validated two methods by which aging can be measured in young adults, one cross-sectional and one longitudinal. Our longitudinal measure allows quantification of the pace of coordinated physiological deterioration across multiple organ systems (e.g., pulmonary, periodontal, cardiovascular, renal, hepatic, and immune function). We applied these methods to assess biological aging in young humans who had not yet developed age-related diseases. Young individuals of the same chronological age varied in their "biological aging" (declining integrity of multiple organ systems). Already, before midlife, individuals who were aging more rapidly were less physically able, showed cognitive decline and brain aging, self-reported worse health, and looked older. Measured biological aging in young adults can be used to identify causes of aging and evaluate rejuvenation therapies.
Collapse
|
17
|
Impact of birth parameters and early life growth patterns on retinal microvascular structure in children. J Hypertens 2015; 33:1429-37. [DOI: 10.1097/hjh.0000000000000561] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
Gishti O, Jaddoe VWV, Hofman A, Wong TY, Ikram MK, Gaillard R. Body fat distribution, metabolic and inflammatory markers and retinal microvasculature in school-age children. The Generation R Study. Int J Obes (Lond) 2015; 39:1482-7. [PMID: 26028060 DOI: 10.1038/ijo.2015.99] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 01/13/2015] [Accepted: 05/22/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the associations of body fatness, metabolic and inflammatory markers with retinal vessel calibers among children. DESIGN We performed a population-based cohort study among 4145 school-age children. At the median age of 6.0 years (95% range 5.8, 8.0 years), we measured body mass index, total and abdominal fat mass, metabolic and inflammatory markers (blood levels of lipids, insulin and C-peptide and C-reactive protein) and retinal vascular calibers from retinal photographs. RESULTS We observed that compared with normal weight children, obese children had narrower retinal arteriolar caliber (difference -0.21 s.d. score (SDS; 95% confidence interval (CI) -0.35, -0.06)), but not venular caliber. Continuous analyses showed that higher body mass index and total body fat mass, but not android/gynoid fat mass ratio and pre-peritoneal fat mass, were associated with narrower retinal arteriolar caliber (P<0.05 for body mass index and total body fat mass), but not with retinal venular caliber. Lipid and insulin levels were not associated with retinal vessel calibers. Higher C-reactive protein was associated with only wider retinal venular caliber (difference 0.10 SDS (95% CI 0.06, 0.14) per SDS increase in C-reactive protein). This latter association was not influenced by body mass index. CONCLUSIONS Higher body fatness is associated with narrower retinal arteriolar caliber, whereas increased C-reactive protein levels are associated with wider retinal venular caliber. Increased fat mass and inflammation correlate with microvascular development from school-age onwards.
Collapse
Affiliation(s)
- O Gishti
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - V W V Jaddoe
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A Hofman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - T Y Wong
- Singapore Eye Research Institute, Singapore.,Duke-NUS Graduate Medical School, National University of Singapore, Singapore.,Memeory Aging & Cognition Centre (MACC), National University Health System, Singapore
| | - M K Ikram
- Singapore Eye Research Institute, Singapore.,Duke-NUS Graduate Medical School, National University of Singapore, Singapore.,Memeory Aging & Cognition Centre (MACC), National University Health System, Singapore.,Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - R Gaillard
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
19
|
Gishti O, Jaddoe VWV, Felix JF, Klaver CCW, Hofman A, Wong TY, Ikram MK, Gaillard R. Retinal microvasculature and cardiovascular health in childhood. Pediatrics 2015; 135:678-85. [PMID: 25755243 DOI: 10.1542/peds.2014-3341] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Alterations in retinal microvasculature are associated with increased risk of cardiovascular disease. We examined the associations of retinal vessel caliber with cardiovascular markers in school-age children. METHODS Among 4007 school-age children (median age of 6.0 years), we measured cardiovascular markers and retinal vessel calibers from digitized retinal photographs. RESULTS Narrower retinal arteriolar caliber was associated with higher systolic and diastolic blood pressure (-0.20 SD score [SDS] [95% confidence interval (CI) -0.24 to -0.18] and -0.14 SDS [-0.17 to -0.11], respectively, per SDS increase in retinal arteriolar caliber), mean arterial pressure, and pulse pressure, but not with carotid-femoral pulse wave velocity, heart rate, cardiac output, or left ventricular mass. A wider retinal venular caliber was associated with lower systolic blood pressure, mean arterial pressure, and pulse pressure and higher carotid-femoral pulse wave velocity (carotid-femoral pulse wave velocity difference = 0.04 SDS [95% CI 0.01 to 0.07] per SDS increase in retinal venular caliber). Both narrower retinal arteriolar and venular calibers were associated with higher risk of hypertension at the age of 6 years, with the strongest association for retinal arteriolar caliber (odds ratio 1.35 [95% CI 1.21 to 1.45] per SDS decrease in arteriolar caliber). Adjustment for parental and infant sociodemographic factors did not influence the observed associations. CONCLUSIONS Both retinal arteriolar and venular calibers are associated with blood pressure in school-age children, whereas retinal venular caliber is associated with carotid-femoral pulse wave velocity. Microvascular adaptations in childhood might influence cardiovascular health and disease from childhood onward.
Collapse
Affiliation(s)
- Olta Gishti
- The Generation R Study Group, Department of Pediatrics, Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Department of Pediatrics, Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands;
| | - Janine F Felix
- The Generation R Study Group, Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | | | - Albert Hofman
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore; and Duke-NUS Graduate Medical School, National University of Singapore, Singapore
| | - Mohammad Kamran Ikram
- Singapore Eye Research Institute, Singapore; and Duke-NUS Graduate Medical School, National University of Singapore, Singapore
| | - Romy Gaillard
- The Generation R Study Group, Department of Pediatrics, Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| |
Collapse
|
20
|
Gishti O, Jaddoe VW, Felix JF, Reiss I, Hofman A, Ikram MK, Steegers EA, Gaillard R. Influence of Maternal Angiogenic Factors During Pregnancy on Microvascular Structure in School-Age Children. Hypertension 2015; 65:722-8. [DOI: 10.1161/hypertensionaha.114.05008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Olta Gishti
- From the Generation R Study Group (O.G., V.W.V.J., J.F.F., R.G.), and Departments of Pediatrics (O.G., V.W.V.J., I.R., R.G.), Epidemiology (O.G., V.W.V.J., J.F.F., A.H., R.G.), Ophthalmology (M.K.I.), Obstetrics and Gynecology (E.A.P.S.), and Neonatology (I.R.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute and Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore (M.K.I.); and Memory Aging & Cognition
| | - Vincent W.V. Jaddoe
- From the Generation R Study Group (O.G., V.W.V.J., J.F.F., R.G.), and Departments of Pediatrics (O.G., V.W.V.J., I.R., R.G.), Epidemiology (O.G., V.W.V.J., J.F.F., A.H., R.G.), Ophthalmology (M.K.I.), Obstetrics and Gynecology (E.A.P.S.), and Neonatology (I.R.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute and Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore (M.K.I.); and Memory Aging & Cognition
| | - Janine F. Felix
- From the Generation R Study Group (O.G., V.W.V.J., J.F.F., R.G.), and Departments of Pediatrics (O.G., V.W.V.J., I.R., R.G.), Epidemiology (O.G., V.W.V.J., J.F.F., A.H., R.G.), Ophthalmology (M.K.I.), Obstetrics and Gynecology (E.A.P.S.), and Neonatology (I.R.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute and Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore (M.K.I.); and Memory Aging & Cognition
| | - Irwin Reiss
- From the Generation R Study Group (O.G., V.W.V.J., J.F.F., R.G.), and Departments of Pediatrics (O.G., V.W.V.J., I.R., R.G.), Epidemiology (O.G., V.W.V.J., J.F.F., A.H., R.G.), Ophthalmology (M.K.I.), Obstetrics and Gynecology (E.A.P.S.), and Neonatology (I.R.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute and Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore (M.K.I.); and Memory Aging & Cognition
| | - Albert Hofman
- From the Generation R Study Group (O.G., V.W.V.J., J.F.F., R.G.), and Departments of Pediatrics (O.G., V.W.V.J., I.R., R.G.), Epidemiology (O.G., V.W.V.J., J.F.F., A.H., R.G.), Ophthalmology (M.K.I.), Obstetrics and Gynecology (E.A.P.S.), and Neonatology (I.R.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute and Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore (M.K.I.); and Memory Aging & Cognition
| | - Mohammad Kamran Ikram
- From the Generation R Study Group (O.G., V.W.V.J., J.F.F., R.G.), and Departments of Pediatrics (O.G., V.W.V.J., I.R., R.G.), Epidemiology (O.G., V.W.V.J., J.F.F., A.H., R.G.), Ophthalmology (M.K.I.), Obstetrics and Gynecology (E.A.P.S.), and Neonatology (I.R.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute and Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore (M.K.I.); and Memory Aging & Cognition
| | - Eric A.P. Steegers
- From the Generation R Study Group (O.G., V.W.V.J., J.F.F., R.G.), and Departments of Pediatrics (O.G., V.W.V.J., I.R., R.G.), Epidemiology (O.G., V.W.V.J., J.F.F., A.H., R.G.), Ophthalmology (M.K.I.), Obstetrics and Gynecology (E.A.P.S.), and Neonatology (I.R.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute and Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore (M.K.I.); and Memory Aging & Cognition
| | - Romy Gaillard
- From the Generation R Study Group (O.G., V.W.V.J., J.F.F., R.G.), and Departments of Pediatrics (O.G., V.W.V.J., I.R., R.G.), Epidemiology (O.G., V.W.V.J., J.F.F., A.H., R.G.), Ophthalmology (M.K.I.), Obstetrics and Gynecology (E.A.P.S.), and Neonatology (I.R.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute and Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore (M.K.I.); and Memory Aging & Cognition
| |
Collapse
|
21
|
Retinal microvascular structure and function in patients with risk factors of atherosclerosis and coronary artery disease. Atherosclerosis 2014; 233:478-484. [PMID: 24530782 DOI: 10.1016/j.atherosclerosis.2013.12.044] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 12/02/2013] [Accepted: 12/02/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Retinal microvascular signs are markers of cardiovascular disease risk. There are limited data, on relationships between retinal microvascular signs and retinal microvascular endothelial function. We sought to determine the relationship of retinal vascular signs with retinal microvascular endothelial function in patients with or at high risk of coronary artery disease. METHODS Participants with atherosclerosis risk factors and coronary disease (n=258; mean age 57±11 years) were recruited to have static and dynamic retinal vascular assessment. Retinal arteriolar dilatation in response to flicker light (FI-RAD) was measured using the Digital Vessel Analyser and expressed as percentage increase over baseline diameter. Static retinal photographs were acquired utilising a digital fundus camera for measurement of central retinal artery and vein equivalent (CRAE and CRVE), arteriovenous nicking (AVN) and focal arteriolar narrowing (FAN). RESULTS Intra-class correlation coefficient was 0.82 for flicker-light induced retinal arteriolar dilatation. There were modest associations in retinal vascular measurements between eyes. For each 10 μm decrease in retinal arteriolar diameter, the absolute increase in FI-RAD was 0.28% (95% CI 0.11, 0.45; p=0.002) independent of age, gender and atherosclerosis risk factors. AVN and FAN were associated with attenuated FI-RAD (β=-0.67%; 95% CI -1.20, -0.15; p=0.012) and (β=-0.83%; 95% CI -1.44, -0.23; p=0.007) respectively after adjustment for age and gender. CONCLUSION Assessment of retinal microvascular endothelial function is reproducible and correlated with retinal microvascular structure and signs, independent of atherosclerosis risk factors. Assessment of retinal vascular structure and function may provide insights into atherosclerotic disease.
Collapse
|
22
|
Sasongko MB, Wong TY, Wang JJ. Retinal microvascular structure: determinants and potential utility of novel imaging measurements. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.10.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
23
|
Meier MH, Shalev I, Moffitt TE, Kapur S, Keefe RSE, Wong TY, Belsky DW, Harrington H, Hogan S, Houts R, Caspi A, Poulton R. Microvascular abnormality in schizophrenia as shown by retinal imaging. Am J Psychiatry 2013; 170:1451-9. [PMID: 24030514 PMCID: PMC3857729 DOI: 10.1176/appi.ajp.2013.13020234] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Retinal and cerebral microvessels are structurally and functionally homologous, but unlike cerebral microvessels, retinal microvessels can be noninvasively measured in vivo by retinal imaging. The authors tested the hypothesis that individuals with schizophrenia exhibit microvascular abnormality and evaluated the utility of retinal imaging as a tool for schizophrenia research. METHOD Participants were members of the Dunedin Study, a population-representative cohort followed from birth with 95% retention. Study members underwent retinal imaging at age 38. The authors assessed retinal arteriolar and venular caliber for all members of the cohort, including individuals who developed schizophrenia. RESULTS Study members who developed schizophrenia were distinguished by wider retinal venules, suggesting microvascular abnormality reflective of insufficient brain oxygen supply. Analyses that controlled for confounding health conditions suggested that wider retinal venules are not simply an artifact of co-occurring health problems in schizophrenia patients. Wider venules were also associated with a dimensional measure of adult psychosis symptoms and with psychosis symptoms reported in childhood. CONCLUSIONS The findings provide initial support for the hypothesis that individuals with schizophrenia show microvascular abnormality. Moreover, the results suggest that the same vascular mechanisms underlie subthreshold symptoms and clinical disorder and that these associations may begin early in life. These findings highlight the promise of retinal imaging as a tool for understanding the pathogenesis of schizophrenia.
Collapse
|
24
|
Kim JM, Park KH, Kim SJ, Jang HJ, Noh E, Kim MJ, Kim TW, Kim DM, Caprioli J. Comparison of localized retinal nerve fiber layer defects in highly myopic, myopic, and non-myopic patients with normal-tension glaucoma: a retrospective cross-sectional study. BMC Ophthalmol 2013; 13:67. [PMID: 24188326 PMCID: PMC3828014 DOI: 10.1186/1471-2415-13-67] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 10/31/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the relationship between patterns of localized retinal nerve fiber layer (RNFL) defects and the degree of myopia in patients with normal-tension glaucoma (NTG). METHODS We retrospectively reviewed medical records of patients with high myopia (42 eyes; spherical equivalent [SE] < -6.0 diopters [D]), low to moderate myopia (93 eyes; SE -6.0D ~ and -0.5D), and emmetropia (65 eyes; SE -0.5D ~ +0.5D), all of which were diagnosed as having NTG with localized RNFL defects. On RNFL photographs, the proximity of the RNFL defect to the center of the fovea (angle I) and the sum of the angular width of the defects (angle II) were determined. The patterns of localized RNFL defects were then compared with respect to differences in angles I and II. RESULTS Angle I was significantly smaller in the high myopia group than in the low to moderate myopia group (p = 0.028) and the emmetropia group (p = 0.044), while angle II was significantly larger in the high myopia group compared with the low to moderate myopia group and the emmetropia group (p < 0.001, p = 0.007). CONCLUSIONS Among subjects with NTG, localized RNFL defects are wider and closer to the fovea in eyes with high myopia than those with low to moderate myopia or emmetropia.
Collapse
Affiliation(s)
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, South Korea.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
The earliest detectable change in Alzheimer's disease (AD) is the buildup of amyloid plaque in the brain. Early detection of AD, prior to irreversible neurological damage, is important for the efficacy of current interventions as well as for the development of new treatments. Although PiB-PET imaging and CSF amyloid are the gold standards for early AD diagnosis, there are practical limitations for population screening. AD-related pathology occurs primarily in the brain, but some of the hallmarks of the disease have also been shown to occur in other tissues, including the retina, which is more accessible for imaging. Retinal vascular changes and degeneration have previously been reported in AD using optical coherence tomography and laser Doppler techniques. This report presents results from analysis of retinal photographs from AD and healthy control participants from the Australian Imaging, Biomarkers and Lifestyle (AIBL) Flagship Study of Ageing. This is the first study to investigate retinal blood vessel changes with respect to amyloid plaque burden in the brain. We demonstrate relationships between retinal vascular parameters, neocortical brain amyloid plaque burden and AD. A number of RVPs were found to be different in AD. Two of these RVPs, venular branching asymmetry factor and arteriolar length-to-diameter ratio, were also higher in healthy individuals with high plaque burden (P = 0.01 and P = 0.02 respectively, after false discovery rate adjustment). Retinal photographic analysis shows potential as an adjunct for early detection of AD or monitoring of AD-progression or response to treatments.
Collapse
|
26
|
Shankar A, Peppard PE, Young T, Klein BEK, Klein R, Nieto FJ. Sleep-disordered breathing and retinal microvascular diameter. Atherosclerosis 2013; 226:124-8. [PMID: 23137824 PMCID: PMC3529805 DOI: 10.1016/j.atherosclerosis.2012.10.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 10/16/2012] [Accepted: 10/17/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is an emerging risk factor for cardiovascular disease (CVD). Microvascular dysfunction has been proposed as a potential mechanism in the pathogenesis of CVD in SDB. The retinal vasculature offers a unique opportunity to investigate the systemic effects of microvascular dysfunction as it can be viewed non-invasively and is also structurally and functionally similar to microvasculature elsewhere in the body. We therefore examined the association between SDB and retinal microvascular diameter after adjusting for major confounders. METHODS We examined n = 476 participants from the Wisconsin Sleep Cohort Study. SDB was characterized using the apnea-hypopnea index (AHI) as <5 events/h, 5-14.9 events/h, and ≥15 events/h. Outcomes of interest included the presence of retinal arteriolar narrowing (mean retinal arteriolar diameter <141.0 um) and retinal venular widening (mean venular diameter >223.0 um). RESULTS Higher AHI was found to be positively associated with retinal venular dilatation, independent of body mass index, hypertension, diabetes, and lipid levels. Compared to an AHI of <5 events/h (referent), the multivariable-adjusted odds ratio of retinal venular widening for an AHI of 5-14.9 events/h was 1.31 (0.75-2.28) and for an AHI of >15 events/h was 2.08 (1.03-2.16); p-trend = 0.045. In contrast, there was no association between AHI and retinal arteriolar narrowing (p-trend = 0.72). CONCLUSION Higher AHI, a marker of SDB, was positively associated with wider retinal venules, independent of age, gender, BMI, hypertension, diabetes, and lipid levels. These data suggest that the association of SDB with cardiovascular disease may be mediated, in part, by microvasculature.
Collapse
Affiliation(s)
- Anoop Shankar
- Department of Community Medicine, West Virginia University School of Medicine, 1 Medical Center Drive, PO Box 9190, Morgantown, WV 26506, USA.
| | | | | | | | | | | |
Collapse
|
27
|
Pathai S, Weiss HA, Lawn SD, Peto T, D’Costa LM, Cook C, Wong TY, Gilbert CE. Retinal arterioles narrow with increasing duration of anti-retroviral therapy in HIV infection: a novel estimator of vascular risk in HIV? PLoS One 2012; 7:e51405. [PMID: 23251521 PMCID: PMC3519635 DOI: 10.1371/journal.pone.0051405] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 11/01/2012] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES HIV infection is associated with an increased risk of age-related morbidity mediated by immune dysfunction, atherosclerosis and inflammation. Changes in retinal vessel calibre may reflect cumulative structural damage arising from these mechanisms. The relationship of retinal vessel calibre with clinical and demographic characteristics was investigated in a population of HIV-infected individuals in South Africa. METHODS Case-control study of 491 adults ≥30 years, composed of 242 HIV-infected adults and 249 age- and gender-matched HIV-negative controls. Retinal vessel calibre was measured using computer-assisted techniques to determine mean arteriolar and venular diameters of each eye. RESULTS The median age was 40 years (IQR: 35-48 years). Among HIV-infected adults, 87.1% were receiving highly active antiretroviral therapy (HAART) (median duration, 58 months), their median CD4 count was 468 cells/µL, and 84.3% had undetectable plasma viral load. Unadjusted mean retinal arteriolar diameters were 163.67±17.69 µm in cases and 161.34±17.38 µm in controls (p = 0.15). Unadjusted mean venular diameters were 267.77±18.21 µm in cases and 270.81±18.98 µm in controls (p = 0.07). Age modified the effect of retinal arteriolar and venular diameters in relation to HIV status, with a tendency towards narrower retinal diameters in HIV cases but not in controls. Among cases, retinal arteriolar diameters narrowed with increasing duration of HAART, independently of age (167.83 µm <3 years of HAART vs. 158.89 µm >6 years, p-trend = 0.02), and with a HIV viral load >10,000 copies/mL while on HAART (p = 0.05). HIV-related venular changes were not detected. CONCLUSIONS Narrowing of retinal arteriolar diameters is associated with HAART duration and viral load, and may reflect heightened inflammatory and pro-atherogenic states of the systemic vasculature. Measurement of retinal vascular calibre could be an innovative non-invasive method of estimating vascular risk in HIV-infected individuals.
Collapse
Affiliation(s)
- Sophia Pathai
- International Centre for Eye Health, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- * E-mail: (SP); (CEG)
| | - Helen A. Weiss
- MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Stephen D. Lawn
- Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Tunde Peto
- NIHR Biomedical Research Centre for Ophthalmology, at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Leris M. D’Costa
- International Centre for Eye Health, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Colin Cook
- Department of Ophthalmology, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Tien Y. Wong
- Singapore Eye Research Institute, National University of Singapore, Singapore, Singapore
| | - Clare E. Gilbert
- International Centre for Eye Health, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail: (SP); (CEG)
| |
Collapse
|
28
|
Kawasaki R, Wang JJ, Rochtchina E, Lee AJ, Wong TY, Mitchell P. Retinal vessel caliber is associated with the 10-year incidence of glaucoma: the Blue Mountains Eye Study. Ophthalmology 2012; 120:84-90. [PMID: 23062656 DOI: 10.1016/j.ophtha.2012.07.007] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 06/14/2012] [Accepted: 07/05/2012] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To examine associations between quantitatively measured retinal vessel caliber and the 10-year incidence of primary open-angle glaucoma (OAG). DESIGN Population-based cohort study. PARTICIPANTS The Blue Mountains Eye Study examined 3654 persons at baseline and 2461 persons at either 5 years, 10 years, or both times. After excluding 44 subjects with OAG at baseline, 2417 participants at risk of OAG at the 5- or 10-year examinations were included. METHODS Retinal vessel calibers of baseline retinal photographs were measured using a computer-based program and summarized as central retinal artery and vein equivalents (CRAE, CRVE). Incident OAG was defined as the development of typical glaucomatous visual field loss combined with matching optic disc rim thinning and an enlarged cup-to-disc (C:D) ratio of >0.7 or C:D asymmetry between the 2 eyes (≥0.3) at either the 5- or 10-year examination. Generalized estimating equation models were used to account for correlation between eyes while adjusting for glaucoma risk characteristics including intraocular pressure (IOP) or ocular perfusion pressure (OPP). MAIN OUTCOME MEASURES We assessed the 10-year incidence of OAG. RESULTS There were 82 persons (104 eyes) who developed incident OAG over the 10-year follow-up. After adjusting for age, sex, family history of glaucoma, smoking, diabetes, hypertension, hypercholesterolemia, body mass index, spherical equivalent refraction, and C:D ratio, narrower CRAE was associated with higher risk of incident OAG (adjusted odds ratio [OR], 1.77; 95% confidence interval [CI], 1.12-2.79, per standard deviation decrease in CRAE). This association persisted after further adjustment for IOP (adjusted OR, 1.87; 95% CI, 1.14-3.05) or OPP (adjusted OR, 1.76; 95% CI, 1.11-2.78), and remained significant when analyses were confined to eyes with IOP<20 mmHg and C:D ratio<0.6 at baseline. There were no independent associations between CRVE and incident OAG. CONCLUSIONS Retinal arteriolar narrowing, quantitatively measured from retinal photographs, was associated with long-term risk of OAG. These data support the concept that early vascular changes are involved in the pathogenesis of OAG and suggest that computer-based measurements of retinal vessel caliber may be useful to identify people with an increased risk of developing the clinical stage of glaucoma. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Collapse
Affiliation(s)
- Ryo Kawasaki
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Australia
| | | | | | | | | | | |
Collapse
|
29
|
Cheung CYL, Ikram MK, Sabanayagam C, Wong TY. Retinal microvasculature as a model to study the manifestations of hypertension. Hypertension 2012; 60:1094-103. [PMID: 23045470 DOI: 10.1161/hypertensionaha.111.189142] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The retinal vasculature allows direct noninvasive visualization of the body's mircrovasculature. Because the retina and other end organs (brain and kidney) share similar anatomical features and physiological properties, the retinal vessels offer a unique and easily accessible window to study the health and disease of the human microcirculation. Advanced retinal vascular imaging technologies have been developed to allow a more objective and precise assessment of retinal vascular changes. The changes in the retinal vasculature associated with hypertension can be broadly divided into 3 groups: (1) classic retinal vascular changes in response to blood pressure (referred to as hypertensive retinopathy signs), (2) changes in retinal vascular caliber, and (3) changes in more global geometrical patterns of the retina. In this review, we summarize the current understanding of the relationship between retinal vascular changes and blood pressure, the evidence for the retinal vasculature as a biological model to study the manifestation and early pathogenic correlates of hypertension, the latest advances in retinal vascular imaging technologies, and the future opportunities and challenges of retinal vascular imaging. We suggest that further development of retinal vascular analyses and standardized measurement protocols, evaluation of the clinical use of retinal vascular imaging in assessing cardiovascular risk prediction, and using retinal vascular imaging to test antihypertensive treatments will allow the translation of retinal vascular imaging as a tool to improve the diagnosis, prognosis, and management of hypertension in clinical practice.
Collapse
Affiliation(s)
- Carol Yim-lui Cheung
- Singapore Eye Research Institute, 11 Third Hospital Ave, Singapore 168751, Singapore
| | | | | | | |
Collapse
|
30
|
Li H, Mitchell P, Rochtchina E, Burlutsky G, Wong TY, Wang JJ. Retinal vessel caliber and myopic retinopathy: the blue mountains eye study. Ophthalmic Epidemiol 2012; 18:275-80. [PMID: 22053837 DOI: 10.3109/09286586.2011.602508] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate changes in the retinal vasculature in eyes with myopic retinopathy. METHODS Population-based, cross-sectional study. Emmetropic and myopic participants from the Blue Mountains Eye Study baseline survey were included in this study. Myopia was defined as a refractive error of less than -1.00 diopter. Myopic retinopathy was defined if either staphyloma, lacquer crack, Fuchs' spot or chorioretinal atrophy were present in myopic eyes. Retinal vascular caliber was measured from fundus photographs using standardized methods. The association of retinal vascular caliber with myopic retinopathy was assessed using generalized estimating equation models. RESULTS A total of 2598 eyes of 1409 subjects were selected from 3654 baseline participants, with 2076 emmetropic eyes (normal controls), 486 myopic eyes without myopic retinopathy (myopic controls) and 36 myopic eyes with myopic retinopathy (cases). After adjusting for age, gender, height, body mass index and blood pressure, eyes with myopic retinopathy had significantly narrower mean arteriolar (166.6μm) and venular caliber (213.3μm), compared to normal (188.1μm and 226.9μm, respectively) or myopic control eyes (190.4μm and 227.0μm, respectively) (all P < 0.001). These retinal vessel caliber differences between myopic retinopathy and the two control groups remained significant after additional adjustment for refraction (all P < 0.001). CONCLUSIONS Our findings suggest that myopic retinopathy is associated with attenuation of retinal vessels.
Collapse
Affiliation(s)
- Haitao Li
- Centre for Vision Research, Department of Ophthalmology &Westmead Millennium Institute, University of Sydney, Australia
| | | | | | | | | | | |
Collapse
|
31
|
Grauslund J. Eye complications and markers of morbidity and mortality in long-term type 1 diabetes. Acta Ophthalmol 2011; 89 Thesis 1:1-19. [PMID: 21443578 DOI: 10.1111/j.1755-3768.2010.02105.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The incidence of type 1 diabetes is rising all over the world. Furthermore, the increased life-expectancy of type 1 diabetic patients is likely to cause a higher number of diabetes-related micro- and macrovascular complications in the years to come. In order to examine the level of long-term complications in type 1 diabetes as well as potential markers of micro- and macroangiopathy, a population-based cohort of Danish type 1 diabetic patients was examined in order to achieve the following aims: 1. To evaluate diabetic retinopathy as a long-term marker of all-cause mortality in type 1 diabetes (Paper I). 2. To estimate the long-term incidence and associated risk factors of blindness (Paper II) and cataract surgery (Paper III) in type 1 diabetes. 3 To use retinal vascular analyses in order to investigate the associations of long-term micro- and macrovascular complications and retinal vascular diameters (Paper IV) and retinal fractals (Paper V) in type 1 diabetes. 4. To examine N-terminal pro brain natriuretic peptide (Paper VI) and osteoprotegerin (Paper VII) as non-invasive markers of micro- and macrovascular complications in type 1 diabetes. In Paper I it was a major finding that, despite a mean age of only 38.3 years at baseline, 44.7% of the patients died during the 25-year follow-up. Patients who had proliferative retinopathy as well as proteinuria at the baseline examination had a significantly higher mortality. For these, the 10-year survival was only 22.2%. As demonstrated in Paper II, blindness is an important issue in type 1 diabetes. The 25-year cumulative incidence of blindness was 7.5%. Glycaemic regulation and maculopathy at baseline were both identified as risk factors of blindness. Finally, mortality was higher in patients who went blind during the follow-up. Cataract surgery is quite common in type 1 diabetes. In Paper III a 25-year cumulative incidence of 20.8% was found. Adjusted for mortality, this was even higher (29.4%). As compared to patients without diabetes, cataract surgery takes place approximately 20 years earlier in type 1 diabetic patients. Age and maculopathy at baseline were both identified as predictors of cataract surgery. In Paper IV it was demonstrated that patients with retinal arteriolar narrowing were 2.17 and 3.17 times more likely to have nephropathy and macrovascular disease, respectively. This was an important finding that suggests that retinal fundus photos may be used in order to predict the risk of non-ophthalmological complications in type 1 diabetes. Retinal fractal analysis is another way to evaluate the vascular system of the retina. In Paper V we found associations between retinal fractal and microvascular - but not macrovascular--disease. For instance, patients with lower fractal dimensions were more likely to have proliferative retinopathy (OR 1.45, 95% CI 1.04-2.03) and neuropathy (OR 1.42, 95% CI 1.01-2.01). NT-proBNP is likely to be a future predictor of diabetes-related complications. In Paper VI higher levels of NT-proBNP were related to nephropathy (OR 5.03, 95% CI 1.77-14.25), neuropathy (OR 4.08, 95% CI 1.52-10.97) and macrovascular disease (OR 5.84, 95% CI 1.65-20.74). These associations should be confirmed in future prospective studies. As opposed to NT-proBNP, osteoprotegerin is less likely to be a predictor of either micro- or macrovascular disease in type 1 diabetes. As demonstrated in Paper VII, even though association between higher levels of OPG and nephropathy were found in an age- and sex-adjusted model (OR 2.54, 95% CI 1.09-5.90), this was no longer statistically significant when other factors were taken into account. Overall, it was demonstrated that various complications such as mortality, blindness and cataract surgery were high in type 1 diabetes. Furthermore, retinal arteriolar narrowing, decreased retinal fractals and plasma NT-proBNP were associated with various micro- and macrovascular complications. If confirmed by prospective studies, these modalities may be used in order to identify patients at risk of diabetes-related complications. This could, ultimately, lead to decreased mortality and morbidity in type 1 diabetic patients.
Collapse
Affiliation(s)
- Jakob Grauslund
- Faculty of Health Science, University of Southern Denmark, Odense, Denmark.
| |
Collapse
|
32
|
Li H, Mitchell P, Liew G, Rochtchina E, Kifley A, Wong TY, Hsu W, Lee ML, Zhang YP, Wang JJ. Lens opacity and refractive influences on the measurement of retinal vascular fractal dimension. Acta Ophthalmol 2010; 88:e234-40. [PMID: 20662797 DOI: 10.1111/j.1755-3768.2010.01975.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To examine the influence of lens opacity and refraction on the measurement of retinal vascular fractal dimension (Df). METHODS Optic disc photographs (right eyes) of 3654 baseline Blue Mountains Eye Study participants (aged 49-97) were digitized. Retinal vascular Df was quantified using a computer-based program. Summated severity scores for nuclear, cortical and posterior subcapsular (PSC) cataract were assessed from lens photographs. Refraction data were converted to spherical equivalent refraction (SER), as sum spherical plus 0.5 cylinder power. Axial length was measured at 10-year follow-up examinations using an IOL master. RESULTS Mean Df of the retinal vasculature was 1.444±0.023 for 2859 eligible participants. Increasing lens opacity scores were associated with significant reduction in Df (β=-0.0030, p<0.0001). Both cortical and PSC cataract involving central lens area were associated with reduced Df, after controlling for confounding factors (p(trend) ≤0.0105). Increasing myopia severity was associated with reduced Df after adjusting for lens opacity scores and other confounders (p(trend) <0.0001). The slope of Df decrease per SER reduction was 0.0040 in eyes with SER≤-4D, compared to -0.0016 in eyes with SER>-4D. For axial length quintiles, there were no significant differences in mean Df in all groups except a reduction in the fifth quintile (axial length ≥24.15mm) (all p<0.05). CONCLUSION Ocular media opacity independently influenced retinal vascular Df measurement, but we found no evidence supporting any refractive axial magnification effect on this measure. Myopic refraction ≤-4D was associated with a reduction in Df, suggesting rarefaction of retinal vasculature associated with high myopia.
Collapse
Affiliation(s)
- Haitao Li
- Centre for Vision Research, Department of Ophthalmology & Westmead Millennium Institute, University of Sydney, Sydney, NSW, Australia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Grauslund J, Hodgson L, Kawasaki R, Green A, Sjølie AK, Wong TY. Retinal vessel calibre and micro- and macrovascular complications in type 1 diabetes. Diabetologia 2009; 52:2213-7. [PMID: 19618163 DOI: 10.1007/s00125-009-1459-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 06/22/2009] [Indexed: 10/20/2022]
Abstract
AIMS/HYPOTHESIS The purpose of the study was to evaluate the association between retinal vascular calibre and micro- and macrovascular complications in a population-based cohort of Danish type 1 diabetic patients. METHODS This was a cross-sectional study of 208 long-surviving type 1 diabetic patients from a population-based Danish cohort. Retinal photographs were obtained at a clinical examination attended by each participant in 2007-2008, and retinal vascular calibre was measured and summarised as the central retinal artery or vein equivalent (CRAE or CRVE) using a computer-based program and a standardised protocol. Associations between retinal vascular calibre and micro- and macrovascular complications were examined after adjusting for confounding clinical characteristics. RESULTS Retinal photographs were gradable for 188 of 208 patients (90.3%). The median age and duration of diabetes for patients with gradable photos were 57.9 and 42 years, respectively. After multivariate adjustments, individuals with narrower retinal arterioles were more likely to have nephropathy (OR 2.17, 95% CI 1.29-3.68, per SD decrease in CRAE) and macrovascular disease (OR 3.17, 95% CI 1.59-6.34, per SD decrease in CRAE), but not neuropathy (OR 1.10, 95% CI 0.70-1.71, per SD decrease in CRAE). Retinal venular calibre was not associated with any micro- or macrovascular complications. CONCLUSIONS/INTERPRETATION In type 1 diabetic patients, retinal arteriolar narrowing is associated with nephropathy and macrovascular disease independently of other clinical characteristics. If supported by further prospective studies, measurement of retinal vessel diameter may allow a non-invasive evaluation of the risk of diabetes-related complications.
Collapse
Affiliation(s)
- J Grauslund
- Department of Ophthalmology, Odense University Hospital, Denmark.
| | | | | | | | | | | |
Collapse
|
34
|
Lim LS, Saw SM, Cheung N, Mitchell P, Wong TY. Relationship of retinal vascular caliber with optic disc and macular structure. Am J Ophthalmol 2009; 148:368-75. [PMID: 19481730 DOI: 10.1016/j.ajo.2009.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 04/07/2009] [Accepted: 04/08/2009] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the relationships of retinal vascular caliber with optic disc, macular, and retinal nerve fiber layer (RNFL) characteristics as measured with optical coherence tomography (OCT). DESIGN Observational cross-sectional study. METHODS This study included a subset of healthy children enrolled in the Singapore Cohort Study of the Risk Factors of Myopia (SCORM). Optic disc, macular, and RNFL morphology were measured with Stratus OCT 3. Digital retinal photography was performed and retinal arteriolar and venular caliber measured using validated imaging software. RESULTS One hundred and four children (mean age 11.51 +/- 0.52 years; 50% male) were included. In multivariate analyses, smaller horizontal integrated rim width and rim area were associated with narrower retinal arterioles and venules (all P < .05), and shorter horizontal rim length was associated with narrower venules (P = .04). Optic disc diameter was not associated with arteriolar or venular caliber. Larger vertical cup-to-disc ratios and cup-to-disc-area ratios were associated with narrower venules but not arterioles (P = .01 and P = .003, respectively). A thinner average RNFL measurement was associated with narrower arterioles and venules, and smaller total macular volume was associated with narrower venules. CONCLUSIONS Thinner optic disc rims and RNFL measurements were associated with narrower retinal arterioles and venules, and larger cup-to-disc ratios with narrower venules. These findings suggest that retinal vessel caliber varies systematically with morphologic differences in the optic nerve head, retina, and macula.
Collapse
|
35
|
Comparison of the retinal microvasculature in European and African-Caribbean people with diabetes. Clin Sci (Lond) 2009; 117:229-36. [DOI: 10.1042/cs20080538] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Diabetes aggravates the impact of elevated BP (blood pressure) on the microcirculation, and people of African ancestry with diabetes are more susceptible to microvascular damage than Europeans. In the present study, we investigated possible differences in the retinal microcirculation in people of European and African-Caribbean ethnicity with diabetes that might account for this. A total of 51 subjects with Type 2 diabetes (age 40–65 years; 25 male; 29 African-Caribbean) were studied. Clinic and 24 h ambulatory BP, and fasting glucose, insulin and lipids were measured. Digital retinal images were analysed using custom-written semi-automatic software to determine: LDR (length/diameter ratio) and AVR (arteriolar/venular diameter ratio), branching angles, vessel tortuosity and NT (number of terminal vessel branches). Arterioles were narrower in European people with diabetes than in African-Caribbean people with diabetes [mean (S.D.) arteriolar diameter, 76 (7) compared with 82 (11) μm respectively (P=0.03); arteriolar LDR, 28.1 (8.5) compared with 23.7 (7.0) respectively (P=0.046); and AVR, 0.66 (0.21) compared with 0.90 (0.36) respectively (P=0.028)]. Ethnic differences in arteriolar LDR, arteriolar diameter and AVR were not explained by differences in BP, but were attenuated by adjustment for the duration of diabetes. There was no significant relationship between BP and arteriolar narrowing in the group as a whole, although the relationship between arteriolar LDR and systolic BP was stronger in Europeans than African-Caribbeans [β=0.08 (0.07) compared with β=0.03 (0.06); P=0.03]. In conclusion, in the presence of diabetes, a relationship between BP and retinal arteriolar diameter was not evident and implies impaired small artery remodelling in the presence of diabetes. African-Caribbean people with diabetes have wider retinal arterioles and this could contribute to enhanced microvascular damage in this ethnic group.
Collapse
|
36
|
Hughes AD, Wong TY, Witt N, Evans R, Thom SAM, Klein BE, Chaturvedi N, Klein R. Determinants of retinal microvascular architecture in normal subjects. Microcirculation 2009; 16:159-66. [PMID: 19206002 DOI: 10.1080/10739680802353868] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Recent studies have shown that changes in the retinal microvasculature predict cardiovascular disease (CVD); however, little is known regarding influences on the retinal microvasculature in healthy people without overt cardiovascular or metabolic disease. METHODS We used a semiautomated computerized technique to analyze digitized retinal photographs from a total of 167 healthy people (age range, 45-75 years; 83 female), without clinical CVD, diabetes, or hypertension, randomly sampled from the population-based Beaver Dam Eye Study. We assessed arteriolar and venular narrowing, arteriolar optimality deviation, and other quantitative aspects of the retinal microvasculature. RESULTS Arterioles were significantly narrower and longer, had wider branching angles, and were more tortuous than venules. Increased arteriolar length to diameter ratio (an index of ratio arteriolar narrowing) was positively and independently associated with older age and elevated systolic blood pressure. Arteriolar optimality deviation (an index of microvascular endothelial dysfunction) increased with greater body mass index. Current smoking and increased white blood cell (WBC) count was associated with wider venules. After controlling for smoking, WBC was no longer a significant predictor of venular diameter. CONCLUSIONS CVD risk factors are associated with retinal microvascular changes in healthy individuals without evidence of CVD, diabetes, or hypertension. CVD risk factors have different influences on the arteriolar and venular bed.
Collapse
Affiliation(s)
- Alun D Hughes
- Clinical Pharmacology, NHLI Division, International Centre for Circulatory Health, Faculty of Medicine, Imperial College London, UK.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Affiliation(s)
- Ning Cheung
- Royal Victorian Eye and Ear Hospital, Victoria, Australia
| |
Collapse
|
38
|
Sun C, Wang JJ, Mackey DA, Wong TY. Retinal Vascular Caliber: Systemic, Environmental, and Genetic Associations. Surv Ophthalmol 2009; 54:74-95. [PMID: 19171211 DOI: 10.1016/j.survophthal.2008.10.003] [Citation(s) in RCA: 277] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Cong Sun
- Centre for Eye Research Australia, University of Melbourne, Victoria, Australia
| | | | | | | |
Collapse
|
39
|
Hoki SL, Varma R, Lai MY, Azen SP, Klein R. Prevalence and associations of asymptomatic retinal emboli in Latinos: the Los Angeles Latino Eye Study (LALES). Am J Ophthalmol 2008; 145:143-8. [PMID: 17981255 DOI: 10.1016/j.ajo.2007.08.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 08/21/2007] [Accepted: 08/22/2007] [Indexed: 12/17/2022]
Abstract
PURPOSE To study the prevalence and associations of asymptomatic retinal emboli in a cohort of Latinos and to compare these findings with those of previous population studies. DESIGN Population-based cross-sectional study. METHODS All participants in this study underwent a comprehensive eye examination, including fundus photography. Photographs were graded by trained masked graders. Lifestyle factors and medical history were obtained during extensive interviews. Blood pressure, serum glucose, and glycosylated hemoglobin were measured. Age- and gender-specific prevalence rates were calculated. Odds ratios (ORs) were calculated using stepwise logistic regression analyses to identify independent risk factor associated with asymptomatic retinal emboli. RESULTS Photographs gradable for retinal emboli were obtained from 5,959 participants. For all participants, the prevalence of definite asymptomatic retinal emboli was 0.4% (n = 26). Stepwise logistic regression analyses identified smoking (> five pack years; OR, 4.3) and history of coronary artery disease (OR, 2.8) to be associated independently with retinal emboli (P < .05). CONCLUSIONS We found a lower prevalence of asymptomatic retinal emboli compared with previous population-based studies. This could be secondary to the Los Angeles Latino Eye Study (LALES) population being younger, having lower blood pressure, and having fewer smokers than other studies. As in other studies, smoking emerges as the strongest association with retinal emboli.
Collapse
|
40
|
Cheung N, Islam FMA, Jacobs DR, Sharrett AR, Klein R, Polak JF, Cotch MF, Klein BE, Ouyang P, Wong TY. Arterial compliance and retinal vascular caliber in cerebrovascular disease. Ann Neurol 2007; 62:618-24. [DOI: 10.1002/ana.21236] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
41
|
Cheung N, Tikellis G, Saw SM, Amirul Islam FM, Mitchell P, Wang JJ, Wong TY. Relationship of axial length and retinal vascular caliber in children. Am J Ophthalmol 2007; 144:658-662. [PMID: 17869206 DOI: 10.1016/j.ajo.2007.07.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Revised: 07/18/2007] [Accepted: 07/20/2007] [Indexed: 11/25/2022]
Abstract
PURPOSE Previous studies in older adults suggest that longer axial length is associated with narrower arteriolar caliber. In this study, we re-examined this relationship in a cohort of children, while controlling for the effects of ocular magnification. DESIGN Cross-sectional study of 767 children aged 7 to 9 years. METHODS Retinal vascular calibers were measured from retinal photographs using a computer-based program. Ocular magnification was corrected using the Bengtsson formula. Standardized examination of refraction and ultrasound ocular biometry was performed for all children. RESULTS In models that adjusted for age, gender, ethnicity, body mass index, blood pressure, and birth weight, longer axial length was associated strongly with narrower retinal arteriolar caliber (3.18-microm decrease per standard deviation increase in axial length; P < .001) and venular caliber (4.62-microm decrease standard deviation increase in axial length; P < .001) before correction for ocular magnification. However, after correction, these associations no longer were significant (0.44 microm; P = .31, change for arteriolar caliber; and 0.70 microm; P = .25, for venular caliber). CONCLUSIONS Our study in children found no association between axial length and retinal vascular caliber after correcting for ocular magnification, suggesting that the previously reported association was likely related to differences in ocular magnification.
Collapse
Affiliation(s)
- Ning Cheung
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | | | | | | | |
Collapse
|
42
|
Cheung N, Sharrett AR, Klein R, Criqui MH, Islam FMA, Macura KJ, Cotch MF, Klein BEK, Wong TY. Aortic distensibility and retinal arteriolar narrowing: the multi-ethnic study of atherosclerosis. Hypertension 2007; 50:617-22. [PMID: 17698721 DOI: 10.1161/hypertensionaha.107.091926] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Increased aortic stiffness and retinal arteriolar narrowing are subclinical vascular effects of chronic hypertension and predict future cardiovascular events. The relationship between these 2 vascular measures is uncertain and is examined in the Multi-Ethnic Study of Atherosclerosis. This cross-sectional analysis involves 3425 participants (aged 45 to 85 years) free of clinical cardiovascular disease. Retinal vascular caliber was quantified from digital retinal photographs using standardized protocols. Aortic distensibility was determined from chest MRI. After controlling for age, squared age, gender, race, study center, height, weight, heart rate, cigarette smoking, past and current systolic blood pressure, use of antihypertensive medications, diabetes, fasting glucose, lipid profile, and C-reactive protein, reduced aortic distensibility (first versus fourth distensibility quartile) was associated with increased odds of retinal arteriolar narrowing (odds ratio: 1.72; 95% CI: 1.15 to 2.58, comparing lowest to highest quartile of arteriolar caliber). Further adjustments for atherosclerotic measures (carotid intima-media thickness, coronary calcium score, and ankle brachial index) had minimal impact on this association (odds ratio: 1.70; 95% CI: 1.13 to 2.55). Reduced aortic distensibility was not associated with retinal venular caliber. We conclude that increased aortic stiffness is associated with retinal arteriolar narrowing, independent of measured blood pressure levels and vascular risk factors. These data suggest that changes in the microvasculature may play a role linking aortic stiffness with clinical cardiovascular events.
Collapse
Affiliation(s)
- Ning Cheung
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Cheung N, Bluemke DA, Klein R, Sharrett AR, Islam FMA, Cotch MF, Klein BEK, Criqui MH, Wong TY. Retinal arteriolar narrowing and left ventricular remodeling: the multi-ethnic study of atherosclerosis. J Am Coll Cardiol 2007; 50:48-55. [PMID: 17601545 PMCID: PMC4547559 DOI: 10.1016/j.jacc.2007.03.029] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 03/02/2007] [Accepted: 03/06/2007] [Indexed: 12/26/2022]
Abstract
OBJECTIVES This study sought to examine the relationships of retinal vascular signs with left ventricular (LV) mass, volume, and concentric remodeling. BACKGROUND Microvascular disease, reflected as retinopathy lesions, has been shown to predict clinical congestive heart failure. Whether these retinal vascular changes are related to early structural alterations and remodeling of the heart in asymptomatic individuals is unknown. METHODS A cross-sectional, population-based study of 4,593 participants ages 45 to 85 years, free of clinical cardiovascular disease. Retinal vascular calibers and retinopathy were graded from retinal photographs according to standardized protocols. The LV mass and volume were measured from cardiac magnetic resonance imaging. Extent of LV concentric remodeling was determined by the ratio of LV mass to end-diastolic volume (M/V ratio). RESULTS After controlling for age, gender, race, center, past and current systolic blood pressure, body mass index, smoking, antihypertensive medications, diabetes, diabetes duration, glycosylated hemoglobin, lipid profile, and C-reactive protein, narrower retinal arteriolar caliber was associated with concentric (highest quintile of M/V ratio) remodeling (odds ratio [OR] 2.06, 95% confidence interval 1.57 to 2.70). This association was seen in men and women, and was present even in those without diabetes, without hypertension, and without significant coronary calcification. In multivariate analysis, the presence of retinopathy (OR 1.31, 95% confidence interval 1.08 to 1.61) was also associated with concentric remodeling. CONCLUSIONS Narrower retinal arteriolar caliber is associated with LV concentric remodeling independent of traditional risk factors and coronary atherosclerotic burden, supporting the hypothesis that microvascular disease may contribute to cardiac remodeling.
Collapse
Affiliation(s)
- Ning Cheung
- Centre for Eye Research Australia, University of Melbourne, Victoria, Australia
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David A. Bluemke
- Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ronald Klein
- Department of Ophthalmology and Visual Science, University of Wisconsin, Madison, Wisconsin
| | - A. Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - F. M. Amirul Islam
- Centre for Eye Research Australia, University of Melbourne, Victoria, Australia
| | - Mary Frances Cotch
- Division of Epidemiology and Clinical Research, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Barbara E. K. Klein
- Department of Ophthalmology and Visual Science, University of Wisconsin, Madison, Wisconsin
| | - Michael H. Criqui
- Department of Medicine, University of California San Diego, San Diego, California
| | - Tien Yin Wong
- Centre for Eye Research Australia, University of Melbourne, Victoria, Australia
- Singapore Eye Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
44
|
Hughes AD. The clinical assessment of retinal microvascular structure and therapeutic implications. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2007; 9:236-41. [PMID: 17601388 DOI: 10.1007/s11936-007-0018-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Examination of the retinal microvasculature is widely used to assess diabetic eye disease and as an indicator of target organ damage in hypertension. The diagnostic value of grading of hypertensive retinopathy is dubious; however, many recent studies have demonstrated that hypertensive retinopathy is associated with a range of risk factors for cardiovascular disease and may predict cardiovascular events independently of blood pressure. Developments in digital imaging and computer-assisted analysis have facilitated the quantitative assessment of microvascular changes in cardiovascular disease. These approaches may be useful for assessing cardiovascular risk and targeting therapeutic intervention.
Collapse
Affiliation(s)
- Alun D Hughes
- Clinical Pharmacology, International Centre for Circulatory Health, NHLI Division, Faculty of Medicine, Imperial College London, St. Mary's Campus, London W2 1NY, UK.
| |
Collapse
|
45
|
Wang JJ, Liew G, Wong TY, Smith W, Klein R, Leeder SR, Mitchell P. Retinal vascular calibre and the risk of coronary heart disease-related death. Heart 2006; 92:1583-7. [PMID: 16840510 PMCID: PMC1861253 DOI: 10.1136/hrt.2006.090522] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine whether retinal vascular calibre independently predicts risk of coronary heart disease (CHD) -related death. METHODS In a population-based cohort study of 3654 Australians aged > or = 49 years, retinal arteriolar and venular calibres were measured from baseline retinal photographs and the arteriole to venule ratio (AVR) was calculated. CHD-related death was confirmed from the Australian National Death Index. RESULTS Over nine years, 78 women (4.1%) and 114 men (7.8%) had incident CHD-related deaths. In people aged 49-75 years, wider venules were associated with CHD death, with relative risk (RR) 1.8 (95% confidence interval (CI) 1.1 to 2.7) and RR 2.0 (95% CI 1.1 to 3.6) per standard deviation (SD) increase in venular calibre for men and women, respectively, after adjustment for traditional risk factors. Additionally, in women aged 49-75 years, smaller AVR and narrower arterioles were associated with CHD death (RR 1.5, 95% CI 1.1 to 2.2, and RR 1.9, 95% CI 1.0 to 3.5 per SD decrease in AVR and arteriolar calibre, respectively, after adjustment). These associations were not observed in people aged > 75 years. CONCLUSIONS These findings suggest that microvascular disease processes may have a role in CHD development in middle-aged people, particularly in women. Retinal photography may be useful in cardiovascular risk prediction.
Collapse
Affiliation(s)
- J J Wang
- Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, Sydney, Australia.
| | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
OBJECTIVE To assess whether migraine is associated with retinal microvascular caliber. BACKGROUND Migraine is believed to be associated with vascular disease, but few studies have investigated the relationship between structural microvascular changes and migraine. DESIGN Population-based cross-sectional study. METHODS Participants in the Blue Mountains Eye Study follow-up (1997 to 1999, n = 2,335, aged 54+) had retinal photographs taken. A computer-assisted method was used to measure average retinal arteriolar and venular diameters and calculate the arteriole-to-venule ratio. History of migraine was recorded by interview using International Headache Society criteria (1988). RESULTS Subjects giving a history of migraine without aura (n = 128) had narrower retinal arterioles than subjects giving a history of migraine with aura (n = 182) or subjects with no migraine history (n = 1619). After multivariate adjustment, mean retinal arteriolar diameter was 4.3 microm (95% confidence interval 0.5, 8.1) narrower in subjects reporting migraine without aura as compared to subjects with no migraine. CONCLUSIONS Individuals with a history of migraine without aura were more likely to have slightly narrower retinal arteriolar caliber than individuals without migraine. This relationship was not present for migraine with aura. These data support the hypothesis that microvascular disease may be associated with certain types of migraine.
Collapse
Affiliation(s)
- Gerald Liew
- Department of Ophthalmology, Centre for Vision Research, University of Sydney, Sydney, Australia
| | | | | | | |
Collapse
|
47
|
Liew G, Mitchell P, Wang JJ, Wong TY. Effect of axial length on retinal vascular network geometry. Am J Ophthalmol 2006; 141:597; author reply 597-8. [PMID: 16490528 DOI: 10.1016/j.ajo.2005.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Revised: 11/01/2005] [Accepted: 11/09/2005] [Indexed: 11/23/2022]
|
48
|
Patton N, Maini R, MacGillivary T, Aslam TM, Deary IJ, Dhillon B. Effect of axial length on retinal vascular network geometry. Am J Ophthalmol 2005; 140:648-53. [PMID: 16140248 DOI: 10.1016/j.ajo.2005.04.040] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2004] [Revised: 04/17/2005] [Accepted: 04/19/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE To explore the association between axial length and retinal vascular network geometry (arteriovenous diameter ratio [AVR], arteriolar branching angles, and junctional exponents). DESIGN Prospective, cross-sectional study. METHODS Patients were recruited from a pseudophakic population that had preexisting axial length measurements. Mean arterial blood pressure and previous medical history were recorded. Fundal photographs were taken. Digital image analysis was used to determine the AVR, mean arteriolar bifurcation angle, and junctional exponent for each subject. RESULTS In total, 52 subjects were analyzed. Axial length had no association with AVR (R = -0.01, P = .941), mean angles at arteriolar bifurcations (R = -.134, P = .342), or junctional exponents (R = .003, P = .982). However, increased axial length was associated with a trend for lower measured retinal venular and arteriolar diameters (R = -.28, P = .04 and R = -.23, P = .10, respectively). Junctional exponents correlated with both the AVR (R = .32, P = .019) and vascular bifurcation angles (omega) (R = .317, P = .022). CONCLUSIONS Increased axial length is associated with narrowing of both arteriolar and venular diameters, but not on the AVR, or vessel junctions. Future studies exploring the influence of systemic disease on retinal vascular topography do not need to consider axial length as a potential confounding variable when utilizing measures such as AVR or vessel junctions. Vascular arteriolar junctional exponents may serve as a good measure of overall altered retinal vascular geometry in cardiovascular disease.
Collapse
Affiliation(s)
- Niall Patton
- Sir Charles Gairdner Hospital, Perth, Western Australia.
| | | | | | | | | | | |
Collapse
|
49
|
Patton N, Aslam TM, MacGillivray T, Deary IJ, Dhillon B, Eikelboom RH, Yogesan K, Constable IJ. Retinal image analysis: concepts, applications and potential. Prog Retin Eye Res 2005; 25:99-127. [PMID: 16154379 DOI: 10.1016/j.preteyeres.2005.07.001] [Citation(s) in RCA: 257] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
As digital imaging and computing power increasingly develop, so too does the potential to use these technologies in ophthalmology. Image processing, analysis and computer vision techniques are increasing in prominence in all fields of medical science, and are especially pertinent to modern ophthalmology, as it is heavily dependent on visually oriented signs. The retinal microvasculature is unique in that it is the only part of the human circulation that can be directly visualised non-invasively in vivo, readily photographed and subject to digital image analysis. Exciting developments in image processing relevant to ophthalmology over the past 15 years includes the progress being made towards developing automated diagnostic systems for conditions, such as diabetic retinopathy, age-related macular degeneration and retinopathy of prematurity. These diagnostic systems offer the potential to be used in large-scale screening programs, with the potential for significant resource savings, as well as being free from observer bias and fatigue. In addition, quantitative measurements of retinal vascular topography using digital image analysis from retinal photography have been used as research tools to better understand the relationship between the retinal microvasculature and cardiovascular disease. Furthermore, advances in electronic media transmission increase the relevance of using image processing in 'teleophthalmology' as an aid in clinical decision-making, with particular relevance to large rural-based communities. In this review, we outline the principles upon which retinal digital image analysis is based. We discuss current techniques used to automatically detect landmark features of the fundus, such as the optic disc, fovea and blood vessels. We review the use of image analysis in the automated diagnosis of pathology (with particular reference to diabetic retinopathy). We also review its role in defining and performing quantitative measurements of vascular topography, how these entities are based on 'optimisation' principles and how they have helped to describe the relationship between systemic cardiovascular disease and retinal vascular changes. We also review the potential future use of fundal image analysis in telemedicine.
Collapse
Affiliation(s)
- Niall Patton
- Lions Eye Institute, 2, Verdun Street, Nedlands, WA 6009, Australia.
| | | | | | | | | | | | | | | |
Collapse
|