Relationship of axial length and retinal vascular caliber in children

Retinal Changes From Hyperopia to Myopia: Not All Diopters Are Created Equal

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.

Optic disc and retinal vascular features in first 6 years of Chinese children

Purpose

Retinal microvasculature plays an important role in children's fundus lesions and even in their later life. However, little was known on the features of normal retina in early life. The purpose of this study was to explore the normal retinal features in the first 6 years of life and provide information for future research.

Methods

Children, aged from birth to 6 years old and diagnosed with various unilateral ocular diseases were included. Venous phase fundus fluorescein angiography images with the optic disc at the center were collected. Based on the ResUNet convolutional neural network, optic disc and retinal vascular features in the posterior retina were computed automatically.

Results

A total of 146 normal eyes of 146 children were included. Among different age groups, no changes were shown in the optic disc diameter (y = -0.00002x + 1.362, R² = 0.025, p = 0.058). Retinal vessel density and fractal dimension are linearly and strongly correlated (r = 0.979, p < 0.001). Older children had smaller value of fractal dimension (y = -0.000026x + 1.549, R²= 0.075, p = 0.001) and narrower vascular caliber if they were less than 3 years old (y = -0.008x + 84.861, R²= 0.205, p < 0.001). No differences were in the density (y = -0.000007x + 0.134, R²= 0.023, p = 0.067) and the curvature of retinal vessels (lnC = -0.00001x - 4.657, R²= 0.001, p = 0.667).

Conclusions

Age and gender did not impact the optic disc diameter, vessel density, and vessel curvature significantly in this group of children. Trends of decreased vessel caliber in the first 3 years of life and decreased vessel complexity with age were observed. The structural characteristics provide information for future research to better understand the developmental origin of the healthy and diseased retina.

Changes in retinal vascular bifurcation in eyes with myopia

Objective

To evaluate the effect of myopia on retinal vascular bifurcation.

Methods

A cross-sectional study that retrospectively analyzed the fundus photographs and clinical data of 493 people who participated in routine physical examinations in Huadong Sanatorium. One eye of each subject was included in the analysis. Retinal vascular bifurcation measurements were extracted by using a validated computer program. One-way ANOVA and analysis of covariance were performed to compare the measurements across high myopia, low to moderate myopia, and non-myopia groups.

Results

The mean age was 41.83 ± 10.43 years and 63.49% were women. The mean spherical equivalent refraction (SER) was − 4.59 ± 3.07 D. Ninety-nine (20.08%) eyes met the definition of high myopia (SER ≤ -6.0 D), along with 234 (47.46%) low to moderate myopia (-6.0 D < SER <-0.5 D), and 160 (32.45%) non-myopia (SER ≥ -0.5 D). The differences in the arteriolar branching angle, venular branching coefficient, venular asymmetry ratio, venular angular asymmetry, and venular junctional exponent among the three groups remained significant (p < 0.05) after multivariate adjustment. Pairwise comparisons showed arteriolar branching angle and venular angular asymmetry in high myopia were significantly lower than low to moderate myopia (p < 0.001, p = 0.014 respectively) and non-myopia (p = 0.007, p = 0.048 respectively). Venular asymmetry ratio and venular branching coefficient in high myopia were significantly higher than low to moderate myopia (p = 0.029, p = 0.001 respectively) and non-myopia (p = 0.041, p = 0.043 respectively). There was a significant difference in venular junctional exponent between high myopia and low to moderate myopia (p = 0.031).

Conclusion

The vascular bifurcation differs in dependence on the myopic refractive error and a significant increase in the difference can be observed in high myopic eyes.

Macular Retinal Microvasculature of Hyperopia, Emmetropia, and Myopia in Children

Purpose

To compare macular retinal microcirculation in myopia, emmetropia, and hyperopia groups and investigate the relationship between macular retinal microcirculation and axial length (AL) in children.

Methods

Forty myopic, 29 emmetropic, and 34 hyperopic eyes were included. All the recruited eyes underwent optical coherence tomography angiography (OCTA) examinations. After adjusting the image size by the Littmann method and Bennett formula, the vessel density (VD) of the deep capillary plexus (DCP) and superficial vascular plexus (SVP) were assessed.

Results

The VD of the DCP was significantly lower in the myopia group than in the hyperopia group, whereas no significant differences in the VD of the SVP were observed among the myopia, emmetropia, and hyperopia groups. The VD of the DCP was significantly associated with AL, spherical equivalent (SE), and foveal retinal thickness (FRT), whereas the VD of the SVP was only significantly associated with FRT but not with AL or SE.

Conclusions

The myopic VD of the DCP was significantly lower than the hyperopic one, and the VD of the DCP was significantly associated with AL, indicating that myopia has a lower VD of the DCP, and AL could have a negative effect on the VD of the DCP. Thus, early myopic axial stretching might decrease retinal blood perfusion of the DCP in children.

Short-Term Effects of Atropine 0.01% on the Structure and Vasculature of the Choroid and Retina in Myopic Chinese Children

Introduction

To explore the short-term effects of atropine 0.01% on the structure and vasculature of the choroid and retina in myopic Chinese children.

Methods

This study was a single-center randomized clinical trial. A total of 40 subjects with myopia < − 6.0 D were enrolled and randomized to receive atropine 0.01% once nightly with regular single-vision lenses or to simply wear regular single-vision lenses at an allocation ratio of 1:1. Follow-up visits were planned at 1 month and 3 months. Choroidal thickness (ChT) was obtained by optical coherence tomography (OCT). Retinal vessel density (RVD), retinal thickness (RT), foveal avascular zone (FAZ) and choriocapillaris flow (CCF) were measured by optical coherence tomography angiography (OCTA). The RVD and RT were measured at fovea, parafovea and perifovea area and four quadrants.

Results

Twenty-one subjects were allocated into the atropine group and 19 subjects into the control group. Over 3 months, the control group showed greater progression of myopia than those in the atropine group. ChT in the atropine group increased 11.12 ± 13.96 μm, which was not significant compared with that of the control group. None of the retinal sectors in atropine-treated eyes showed significant changes of RT and RVD compared with the control group. Besides, FAZ and CCF of the atropine group were not affected by atropine use over time, and there was no difference between the two groups.

Conclusion

Administration of atropine 0.01% eye drops demonstrated no effect on RVD, FAZ and CCF over 3 months, while a modest increase of ChT was observed in atropine-treated eyes.

Trial Registration Number

ChiCTR1800017154.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40123-022-00476-0.

[Retinal vascular network: Changes with aging and systemic vascular disease (cardiac and cerebral)]

For over 10 years, the description of the retinal microvascular network has benefited from the development of new imaging techniques. Automated retinal image analysis software, as well as OCT angiography (OCT-A), are able to highlight subtle, early changes in the retinal vascular network thanks to a large amount of microvascular quantitative data. The challenge of current research is to demonstrate the association between these microvascular changes, the systemic vascular aging process, and cerebrovascular and cardiovascular disease. Indeed, a pathophysiological continuum exists between retinal microvascular changes and systemic vascular diseases. In the Montrachet study, we found that a suboptimal retinal vascular network, as identified by the Singapore I Vessel Assessment (SIVA) software, was significantly associated with treated diabetes and an increased risk of cardiovascular mortality. In addition, we supplemented our research on the retinal vascular network with the use of OCT-A. In the EYE-MI study, we showed the potential role of quantitative characterization of the retinal microvascular network by OCT-A in order to assess the cardiovascular risk profile of patients with a history of myocardial infarction. A high AHA (American Heart Association) risk score was associated with low retinal vascular density independently of hemodynamic changes. Thus, a better understanding of the association between the retinal microvasculature and macrovascular disease might make its use conceivable for early identification of at-risk patients and to suggest a personalized program of preventative care. The retinal vascular network could therefore represent an indicator of systemic vascular disease as well as an interesting predictive biomarker for vascular events.

Retinal microvascular parameters are not associated with diabetes in the Northern Ireland Cohort for the Longitudinal Study of Ageing

BACKGROUND

The retinal microvasculature offers unique non-invasive evaluation of systemic microvascular abnormalities. Previous studies reported associations between retinal microvascular parameters (RMPs) and diabetes. The aim of this study was to assess associations between RMPs and diabetes in a cross-sectional analysis of older persons from the Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA).

METHODS

RMPs (central retinal arteriolar/venular equivalents, arteriolar to venular ratio, fractal dimension, and tortuosity) were measured from optic disc-centred fundus images using semi-automated software. Associations were assessed between RMPs and diabetes status with adjustment for potential confounders.

RESULTS

Data were included for 1762 participants with 209 classified as having diabetes. Participants had a mean age of 62.1 ± 8.5 years, and 54% were female. As expected, participants with diabetes had significantly higher mean glycated haemoglobin A1c compared to participants without diabetes (57.4 ± 17.6 mmol/mol versus 37.0 ± 4.2 mmol/mol, respectively). In unadjusted and minimally adjusted regression, arteriolar to venular ratio, arteriolar tortuosity and venular tortuosity were significantly associated with diabetes (minimally adjusted odds ratio [OR] = 0.85; 95% confidence intervals [CIs] 0.73, 0.99; P = 0.04, OR = 1.18; 95% CI 1.02, 1.37; P = 0.03 and OR = 1.20; 95% CI 1.04, 1.38; P = 0.01, respectively), although all failed to remain significant following adjustment for potential confounders. No additional associations between other RMPs and diabetes were detected.

CONCLUSION

Despite previously reported associations between diabetes and RMPs, our study failed to corroborate these associations in an older community-based cohort.

Retinal microvascular parameters are not significantly associated with mild cognitive impairment in the Northern Ireland Cohort for the Longitudinal Study of Ageing

BACKGROUND

The retinal and cerebral microvasculature share similar embryological origins and physiological characteristics. Improved imaging technologies provide opportunistic non-invasive assessment of retinal microvascular parameters (RMPs) against cognitive outcomes. We evaluated baseline measures for associations between RMPs and mild cognitive impairment (MCI) from participants of the Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA).

METHODS

RMPs (central retinal arteriolar / venular equivalents, arteriole to venular ratio, fractal dimension and tortuosity) were measured from optic disc centred fundus images and analysed using semi-automated software. Associations between RMPs and MCI were assessed by multivariable logistic regression with adjustment for potential confounders including age, sex, alcohol consumption, smoking status, educational attainment, physical activity, cardiovascular disease (CVD), hypertension, mean arterial blood pressure, triglycerides, diabetes, body mass index, and high density lipoprotein levels. P < 0.05 was considered statistically significant.

RESULTS

Data were available for 1431 participants, of which 156 (10.9%) were classified with MCI defined by a Montreal Cognitive Assessment (MoCA) score ≤ 26, with subjective cognitive decline, in the absence of depression or problems with activities of daily living. Participants had a mean age of 62.4 ± 8.5 yrs. and 52% were female. As expected, individuals with MCI had a lower MoCA score than those without (23.5 ± 2.6 versus 26.3 ± 2.7, respectively), were more likely to be female, have a lower level of educational attainment, be less physically active, more likely to have CVD, have higher levels of triglycerides and lower levels of high density lipoprotein. No significant associations between RMPs and MCI were detected in unadjusted, minimally adjusted or fully adjusted regression models or subsequent sensitivity analyses.

CONCLUSION

Previous studies have reported both increased retinal venular calibre and reduced fractal dimension in association with mild cognitive impairment. Our study failed to detect any associations between RMPs and those individuals at an early stage of cognitive loss in an older community-based cohort.

Association of reduced retinal arteriolar tortuosity with depression in older participants from the Northern Ireland Cohort for the Longitudinal Study of Ageing

INTRODUCTION

The retina shares similar anatomical and physiological features with the brain and subtle variations in retinal microvascular parameters (RMPs) may reflect similar vascular variation in the brain. The aim of this study was to assess associations between RMPs and measures of depression in the Northern Ireland Cohort for the Longitudinal Study of Ageing.

METHODS

RMPs (arteriolar and venular caliber, fractal dimension and tortuosity) were measured from optic disc centred fundus images using semi-automated software. Depression was characterised by the Centre for Epidemiologic Studies Depression Scale (CES-D) in the absence of mild cognitive impairment or use of anti-depressive medications. Associations between depression and RMPs were assessed by regression analyses with adjustment for potential confounders.

RESULTS

Data were available for 1376 participants of which 113 (8.2%) and 1263 (91.8%) were classified with and without depression. Participants had a mean age of 62.0 ± 8.4 yrs., 52% were female, and 8% were smokers. Individuals with depression had a higher CES-D score than those without (22.0 ± 6.2 versus 4.4 ± 3.9). Lower values of arteriolar tortuosity were significantly associated with depression, before and after adjustment for potential confounders (odds ratio = 0.79; 95% confidence intervals: 0.65, 0.96; P = 0.02).

CONCLUSION

Decreased retinal arteriolar tortuosity, a measure of the complexity of the retinal microvasculature was associated with depression in older adults independent of potential confounding factors. Retinal measures may offer opportunistic assessment of microvascular health associated with outcomes of depression.

Retinal vascular fractal dimension in bipolar disorder and schizophrenia

BACKGROUND

Bipolar disorder (BD) and schizophrenia (SCZ), are associated with greater vascular co-morbidities and adverse vascular events. Owing to shared developmental origins and morphology, retinal vasculature is a proxy assessment measure of the cerebral vasculature. Although retinal vascular fractal dimension (D_f), a measure of vascular geometry and complexity of branching, has been shown to be directly associated with cerebrovascular pathology, it has not been examined in SCZ and BD.

METHODS

We studied 277 participants (92 healthy volunteers, 98 SCZ, and 87 BD) from 18 to 50 years of age. Images were acquired by trained personnel using a non-mydriatic fundus camera and the retinal vascular D_f was calculated by the box-counting method using an automated algorithm. The average D_f across the left and right eyes were calculated.

RESULTS

Both SCZ and BD had significantly increased D_f compared to HV despite controlling for possible confounding factors. However, there was no significant difference between SCZ and BD. These findings suggest abnormal retinal vascular D_f in psychoses.

LIMITATIONS

The study design was cross-sectional, and patients were on medications. Confound of lifestyle factors such as diet and exercise, if any, was not controlled. Sub-group analysis between BD-I and BD-II was not performed in view of the small sample.

CONCLUSIONS

Considering the easy accessibility, affordability, and non-invasive nature of the examination, retinal vascular D_f could serve as a surrogate marker for cerebral vascular abnormality and could potentially identify BD and SCZ patients at risk of developing adverse vascular events.

Deep perifoveal vessel density as an indicator of capillary loss in high myopia

OBJECTIVES

This study investigates the macular vasculature of both vascular layers in different degrees of myopia by optical coherence tomography angiography (OCTA).

METHODS

One hundred and forty-five eyes of 145 healthy subjects with spherical equivalents (SE) ranging from +0.50 to -16.50 dioptres were divided into three groups. The foveal avascular zone (FAZ) area and vessel density (VD) of OCTA images were compared.

RESULTS

Compared with other groups, high myopia had a larger FAZ and less perifoveal VD in both layers and less deep total VD. Compared with other myopia, high myopia had less total VD in the superficial layer and parafoveal VD in the deep layer. Between emmetropia and low myopia, there was a difference only in the deep parafoveal VD. Except for the parafoveal VD in both layers and the superficial total VD, there were significant correlations of the FAZ with axial length (AL) and SE as well as VD. The deep perifoveal VD was most associated with high myopia.

CONCLUSIONS

An increased FAZ and decreased VD in both layers were correlated with AL elongation. The decreasing deep perifoveal VD was most associated with high myopia. OCTA may provide additional information regarding the progression of pathologies in high myopia.

Retinal microvasculature: population epidemiology and concordance in Australian children aged 11-12 years and their parents

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.

Determinants of retinal microvascular features and their relationships in two European populations

Supplemental Digital Content is available in the text

Objectives:

To examine factors influencing retinal vasculature in two environmentally contrasted, cross-sectional studies of adult participants of European descent and to estimate the extent and specificity of genetic contributions to each retinal vasculature feature.

Methods:

Retinal images from 1088 participants in the Orkney Complex Disease Study and 387 in the CROATIA-Korčula study, taken using the same nonmydriatic camera system and graded by the same person, were evaluated. Using general linear models, we estimated the influence of an extensive range of systemic risk factors, calculated retinal traits heritabilities and genetic correlations.

Main results:

Systemic covariates explained little (<4%) of the variation in vessel tortuosity, substantially more (>10%, up to 31.7%) of the variation in vessel width and monofractal dimension. Suggestive not well trodden associations of biological interest included that of urate, tissue plasminogen activator and cardiac PR interval with arteriolar narrowing, that of carotid intima–media thickness with less-tortuous arterioles and of cardiac QT interval with more tortuous venules. The genetic underpinning of tortuosity is largely distinct from that of the other retinal vascular features, whereas that of fractal dimension and vessel width greatly overlaps. The previously recognized influence of ocular axial length on vessel widths was high and can be expected to lead to artefactual genetic associations [genetic correlation with central retinal arteriolar equivalent: −0.53 (standard error 0.11)]. The significant genetic correlation between SBP and central retinal arteriolar equivalent, −0.53 (standard error 0.22) (after adjusting for age, sex and axial length of the eye), augurs more favourably for the discovery of genetic variants relevant to vascular physiology.

A spectrum of retinal vasculature measures and coronary artery disease

BACKGROUND AND AIMS

We aimed to comprehensively describe a spectrum of retinal vessel measures including fractal dimension (D_f) and their associations with indices of coronary artery disease (CAD) extent and severity, as well as hypertension and diabetes.

METHODS

The Australian Heart Eye Study (AHES) is an observational study that surveyed 1680 participants presenting to a tertiary referral hospital for the evaluation of potential CAD by coronary angiography. A range of newer retinal vessel geometric measures (D_f, curvature tortuosity, and branching angle) were quantified from retinal photographs using semi-automated software, the Singapore 'I' Vessel Assessment (SIVA) tool. A combined retinal score was constructed, aiming to assess the joint effect of multiple retinal vessel parameters on CAD, comprising of those variables that were most strongly significant in multivariate analysis - D_f, arteriolar curvature tortuosity, and retinal arteriolar calibre. CAD was objectively quantified using a range of measures obtained from coronary angiography.

RESULTS

A total of 1187 participants had complete data on retinal vessel measurements and coronary vessel evaluation. Retinal vascular D_f and curvature tortuosity decreased with increasing age; women had significantly lower D_f than men (p<0.003). Straighter retinal vessels were associated with CAD extent and Gensini scores in multivariable analysis (p<0.02). Accounting for media opacity by sub-group analysis in pseudophakic patients, the combined retinal score was associated with stenosis greater than 50% in any coronary artery segment (vessel score) and obstructive coronary stenosis in all three main coronary arteries (segment score) (p = 0.01). Lower D_f and narrower arteriolar branching angle were associated with CAD vessel score (p<0.03). In sex-stratified multivariate analyses, straighter arterioles were associated with greater odds of CAD in men, and narrower venular branching angle was associated with CAD in women.

CONCLUSIONS

A range of retinal vessel measures were associated with CAD extent and severity. A sparser retinal microvascular network (smaller D_f) was associated with older age and female gender. After accounting for the impact of media opacity, retinal vessel measures were associated with more diffuse and severe CAD.

Effect of Axial Eye Length on Retinal Vessel Parameters in 6 to 12-Year-Old Malay Girls

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.

Associations between depression and anxiety symptoms and retinal vessel caliber in adolescents and young adults

OBJECTIVE

Previous longitudinal studies suggest that depression and anxiety are associated with risk for cardiovascular disease. The aim of the present study was to test whether an association between depression and anxiety symptoms and retinal vessel caliber, an indicator of subclinical cardiovascular risk, is apparent as early as adolescence and young adulthood.

METHODS

Participants were 865 adolescents and young adults who participated in the Brisbane Longitudinal Twin Study and the Twin Eye Study in Tasmania. Participants completed an assessment of depression/anxiety symptoms (the Somatic and Psychological Health Report) when they were 16.5 years old (mean age), and they underwent retinal imaging, on average, 2.5 years later (range, 2 years before to 7 years after the depression/anxiety assessment). Retinal vessel caliber was assessed using computer software.

RESULTS

Depression and anxiety symptoms were associated with wider retinal arteriolar caliber in this sample of adolescents and young adults (β = 0.09, p = .016), even after adjusting for other cardiovascular risk factors (β = 0.08, p = .025). Multiple regression analyses revealed that affective symptoms of depression/anxiety were associated with retinal vessel caliber independently of somatic symptoms.

CONCLUSIONS

Depression and anxiety symptoms are associated with measurable signs in the retinal microvasculature in early life, suggesting that pathological microvascular mechanisms linking depression/anxiety and cardiovascular disease may be operative from a young age.

Relationship of retinal vascular caliber with optic disc and macular structure

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.

Prevalence and risk factors of retinal arteriolar emboli: the Singapore Malay Eye Study

PURPOSE

To examine the prevalence and risk factors of retinal arteriolar emboli, a risk predictor of stroke, in an Asian population.

DESIGN

Population-based cross-sectional study.

METHODS

Retinal emboli were ascertained from retinal photographs obtained from both eyes of 3,265 Asian Malays, aged 40 to 80 years, according to a standardized protocol. Risk factors were assessed from detailed standardized interviews, clinical examinations, and laboratory investigations.

RESULTS

The overall prevalence of retinal emboli was 0.6% (95% confidence interval [CI], 0.58 to 0.62). A finding of retinal emboli was strongly associated with increasing age (P = .005, for trend), but age-stratified prevalence rates were still lower than those reported from previous population-based studies of White persons. After adjusting for age and gender, the presence of retinal emboli was associated with cigarette smoking (odds ratio [OR], 5.96; 95% CI, 1.75 to 20.32), elevated total cholesterol (OR, 5.21; 95% CI, 1.93 to 12.82), low-density lipoprotein cholesterol (OR, 2.98; 95% CI, 1.20 to 7.39), and self-reported history of angina (OR, 5.67; 95% CI, 1.62 to 19.91). These associations remained significant in multivariate analysis with additional adjustment for other risk factors.

CONCLUSIONS

Retinal emboli are less common in Asians than in similarly aged White persons, but are associated with similar cardiovascular risk factors.