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Ma DJ, Lee H, Choi JM, Park HE, Choi SY, Choi HJ. The role of retinal vessel geometry as an indicator of systemic arterial stiffness assessed by cardio-ankle vascular index. Front Cardiovasc Med 2023; 10:1139557. [PMID: 37416921 PMCID: PMC10321710 DOI: 10.3389/fcvm.2023.1139557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/31/2023] [Indexed: 07/08/2023] Open
Abstract
Objective To determine whether retinal vessel geometry is associated with systemic arterial stiffness, as determined by the cardio-ankle vascular index (CAVI). Methods This single-center retrospective cross-sectional study included 407 eyes of 407 subjects who underwent routine health exams, including CAVI and fundus photography. Retinal vessel geometry was measured using a computer-assisted program (Singapore "I" Vessel Assessment). Subjects were classified into two groups based on CAVI values: high CAVI (≥9) or low CAVI (<9). The main outcome measures included the association of retinal vessel geometry and CAVI value evaluated using multivariable logistic regression models. Results Three hundred forty-three subjects (343, 84.3%) were in the low CAVI group, and 64 (15.7%) subjects were in the high CAVI group. Multivariable logistic linear regression analyses adjusted for age, sex, body mass index, smoking status, mean arterial pressure, and the presence of hypertension, diabetes mellitus, and dyslipidemia showed a significant association between high CAVI values and the following retinal vessel geometry parameters: central retinal arteriolar equivalent caliber (CRAE; adjusted odds ratio [AOR], 0.95; 95% confidence interval [CI], 0.89-1.00; P = 0.043), fractal dimension of arteriolar network (FDa; AOR, 4.21 × 10-4; 95% CI, 2.32 × 10-7-0.77; P = 0.042), and arteriolar branching angle (BAa; AOR, 0.96; 95% CI, 0.93-0.99; P = 0.007). Conclusions Increased systemic arterial stiffness had a significant association with retinal vessel geometry related to arterial narrowing (CRAE), less branching complexity of the arterial tree (FDa), and acute arteriolar bifurcation (BAa).
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Affiliation(s)
- Dae Joong Ma
- Department of Ophthalmology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Heesun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Cardiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Ji Min Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Gastroenterology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Hyo Eun Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Cardiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Su-Yeon Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Cardiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Hyuk Jin Choi
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
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Schanner C, Hautala N, Rauscher FG, Falck A. The impact of the image conversion factor and image centration on retinal vessel geometric characteristics. Front Med (Lausanne) 2023; 10:1112652. [PMID: 37007779 PMCID: PMC10063888 DOI: 10.3389/fmed.2023.1112652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/02/2023] [Indexed: 03/19/2023] Open
Abstract
BackgroundThis study aims to use fundus image material from a long-term retinopathy follow-up study to identify problems created by changing imaging modalities or imaging settings (e.g., image centering, resolution, viewing angle, illumination wavelength). Investigating the relationship of image conversion factor and imaging centering on retinal vessel geometric characteristics (RVGC), offers solutions for longitudinal retinal vessel analysis for data obtained in clinical routine.MethodsRetinal vessel geometric characteristics were analyzed in scanned fundus photographs with Singapore-I-Vessel-Assessment using a constant image conversion factor (ICF) and an individual ICF, applying them to macula centered (MC) and optic disk centered (ODC) images. The ICF is used to convert pixel measurements into μm for vessel diameter measurements and to establish the size of the measuring zone. Calculating a constant ICF, the width of all analyzed optic disks is included, and it is used for all images of a cohort. An individual ICF, in turn, uses the optic disk diameter of the eye analyzed. To investigate agreement, Bland-Altman mean difference was calculated between ODC images analyzed with individual and constant ICF and between MC and ODC images.ResultsWith constant ICF (n = 104 eyes of 52 patients) the mean central retinal equivalent was 160.9 ± 17.08 μm for arteries (CRAE) and 208.7 ± 14.7.4 μm for veins (CRVE). The individual ICFs resulted in a mean CRAE of 163.3 ± 15.6 μm and a mean CRVE of 219.0 ± 22.3 μm. On Bland–Altman analysis, the individual ICF RVGC are more positive, resulting in a positive mean difference for most investigated parameters. Arteriovenous ratio (p = 0.86), simple tortuosity (p = 0.08), and fractal dimension (p = 0.80) agreed well between MC and ODC images, while the vessel diameters were significantly smaller in MC images (p < 0.002).ConclusionScanned images can be analyzed using vessel assessment software. Investigations of individual ICF versus constant ICF point out the asset of utilizing an individual ICF. Image settings (ODC vs. MC) were shown to have good agreement.
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Affiliation(s)
- Carolin Schanner
- Department of Ophthalmology and Medical Research Center, Oulu University Hospital, Oulu, Finland
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Institute for Medical Informatics, Statistics, and Epidemiology, Leipzig University, Leipzig, Germany
| | - Nina Hautala
- Department of Ophthalmology and Medical Research Center, Oulu University Hospital, Oulu, Finland
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Franziska G. Rauscher
- Institute for Medical Informatics, Statistics, and Epidemiology, Leipzig University, Leipzig, Germany
| | - Aura Falck
- Department of Ophthalmology and Medical Research Center, Oulu University Hospital, Oulu, Finland
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- *Correspondence: Aura Falck,
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Quach J, Sharpe GP, Demirel S, Girkin CA, Mardin CY, Scheuerle AF, Burgoyne CF, Chauhan BC, Vianna JR. Asymmetry of Peripapillary Retinal Blood Vessel and Retinal Nerve Fiber Layer Thickness Between Healthy Right and Left Eyes. Invest Ophthalmol Vis Sci 2023; 64:17. [PMID: 36790798 PMCID: PMC9940773 DOI: 10.1167/iovs.64.2.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Purpose The purpose of this study was to determine if there is asymmetry in retinal blood vessel (RBV) position and thickness between right and left eyes (R-L) and evaluate whether R-L asymmetry in RBV thickness is related to R-L asymmetry of retinal nerve fiber layer thickness (RNFLT). Methods We analyzed peripapillary circle scan optical coherence tomography (OCT) examinations from healthy White subjects to measure RNFLT and RBV thickness and position relative to the fovea to Bruch's membrane opening axis, for all visible RBV. The R-L asymmetries of RNFLT and RBV thickness were computed for each A-scan. Four major vessels (superior temporal artery [STA] and superior temporal vein [STV], inferior temporal artery [ITA], and vein [ITV]) were identified using infrared images. Results We included 219 individuals. The mean (standard deviation) number of RBV measured per eye was 15.0 (SD = 2.2). The position of the STV and STA was more superior in left eyes than in right eyes, by 2.4 degrees and 3.7 degrees, respectively (P < 0.01). There was no region with significant R-L asymmetry in RBV thickness. RNFLT was thicker in right eyes in the temporal superior region and thicker in left eyes in the superior and nasal superior regions, with the asymmetry profile resembling in a "W" shape. This shape was also present in post hoc analyses in two different populations. The R-L asymmetries of RBV and RNFLT at each A-scan were not significantly associated (P = 0.37). Conclusions There is little R-L asymmetry in RBV, and it is not related to RNFLT asymmetry. This study suggests that R-L RNFLT asymmetry is due to factors other than RBV.
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Affiliation(s)
- Jack Quach
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada,Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Glen P. Sharpe
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Christopher A. Girkin
- Department of Ophthalmology, University of Alabama at Birmingham, Alabama, United States
| | | | | | | | - Balwantray C. Chauhan
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jayme R. Vianna
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
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Mlinar T, Debevec T, Kapus J, Najdenov P, McDonnell AC, Ušaj A, Mekjavic IB, Jaki Mekjavic P. Retinal blood vessel diameters in children and adults exposed to a simulated altitude of 3,000 m. Front Physiol 2023; 14:1026987. [PMID: 36926190 PMCID: PMC10011172 DOI: 10.3389/fphys.2023.1026987] [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: 08/24/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction: Technological advances have made high-altitude ski slopes easily accessible to skiers of all ages. However, research on the effects of hypoxia experienced during excursions to such altitudes on physiological systems, including the ocular system, in children is scarce. Retinal vessels are embryologically of the same origin as vessels in the brain, and have similar anatomical and physiological characteristics. Thus, any hypoxia-related changes in the morphology of the former may reflect the status of the latter. Objective: To compare the effect of one-day hypoxic exposure, equivalent to the elevation of high-altitude ski resorts in North America and Europe (∼3,000 m), on retinal vessel diameter between adults and children. Methods: 11 adults (age: 40.1 ± 4.1 years) and 8 children (age: 9.3 ± 1.3 years) took part in the study. They spent 3 days at the Olympic Sports Centre Planica (Slovenia; altitude: 940 m). During days 1 and 2 they were exposed to normoxia (FiO2 = 0.209), and day 3 to normobaric hypoxia (FiO2 = 0.162 ± 0.03). Digital high-resolution retinal fundus photographs were obtained in normoxia (Day 2) and hypoxia (Day 3). Central retinal arteriolar equivalent (CRAE) and venular equivalents (CRVE) were determined using an Automated Retinal Image Analyser. Results: Central retinal arteriolar and venular equivalents increased with hypoxia in children (central retinal arteriolar equivalent: 105.32 ± 7.72 µm, hypoxia: 110.13 ± 7.16 µm, central retinal venular equivalent: normoxia: 123.39 ± 8.34 µm, hypoxia: 130.11 ± 8.54 µm) and adults (central retinal arteriolar equivalent: normoxia: 105.35 ± 10.67 µm, hypoxia: 110.77 ± 8.36 µm; central retinal venular equivalent: normoxia: 126.89 ± 7.24 µm, hypoxia: 132.03 ± 9.72 µm), with no main effect of group or group*condition interaction. A main effect of condition on central retinal arteriolar and venular equivalents was observed (central retinal arteriolar equivalent:normoxia: 105.34 ± 9.30 µm, hypoxia: 110.50 ± 7.67 µm, p < 0.001; central retinal venular equivalent: normoxia: 125.41 ± 7.70 µm, hypoxia: 131.22 ± 9.05 µm, p < 0.001). Conclusion: A 20-hour hypoxic exposure significantly increased central retinal arteriolar and venular equivalents in adults and children. These hypoxia-induced increases were not significantly different between the age groups, confirming that vasomotor sensitivity of the retinal vessels to acute hypoxia is comparable between adults and prepubertal children.
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Affiliation(s)
- Tinkara Mlinar
- Department of Automatics, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia.,Jozef Stefan International Postgraduate School, Ljubljana, Slovenia
| | - Tadej Debevec
- Department of Automatics, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia.,Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Jernej Kapus
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Peter Najdenov
- Department of Paediatrics, General Hospital Jesenice, Jesenice, Slovenia
| | - Adam C McDonnell
- Department of Automatics, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Anton Ušaj
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Igor B Mekjavic
- Department of Automatics, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia.,Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Polona Jaki Mekjavic
- Department of Automatics, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia.,Eye Hospital, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Asymmetry between right and left optical coherence tomography images identified using convolutional neural networks. Sci Rep 2022; 12:9925. [PMID: 35705663 PMCID: PMC9200978 DOI: 10.1038/s41598-022-14140-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/17/2022] [Indexed: 11/08/2022] Open
Abstract
In a previous study, we identified biocular asymmetries in fundus photographs, and macula was discriminative area to distinguish left and right fundus images with > 99.9% accuracy. The purposes of this study were to investigate whether optical coherence tomography (OCT) images of the left and right eyes could be discriminated by convolutional neural networks (CNNs) and to support the previous result. We used a total of 129,546 OCT images. CNNs identified right and left horizontal images with high accuracy (99.50%). Even after flipping the left images, all of the CNNs were capable of discriminating them (DenseNet121: 90.33%, ResNet50: 88.20%, VGG19: 92.68%). The classification accuracy results were similar for the right and left flipped images (90.24% vs. 90.33%, respectively; p = 0.756). The CNNs also differentiated right and left vertical images (86.57%). In all cases, the discriminatory ability of the CNNs yielded a significant p value (< 0.001). However, the CNNs could not well-discriminate right horizontal images (50.82%, p = 0.548). There was a significant difference in identification accuracy between right and left horizontal and vertical OCT images and between flipped and non-flipped images. As this could result in bias in machine learning, care should be taken when flipping images.
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Kang TS, Kim BJ, Nam KY, Lee S, Kim K, Lee WS, Kim J, Han YS. Asymmetry between right and left fundus images identified using convolutional neural networks. Sci Rep 2022; 12:1444. [PMID: 35087071 PMCID: PMC8795182 DOI: 10.1038/s41598-021-04323-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 12/21/2021] [Indexed: 11/09/2022] Open
Abstract
We analyzed fundus images to identify whether convolutional neural networks (CNNs) can discriminate between right and left fundus images. We gathered 98,038 fundus photographs from the Gyeongsang National University Changwon Hospital, South Korea, and augmented these with the Ocular Disease Intelligent Recognition dataset. We created eight combinations of image sets to train CNNs. Class activation mapping was used to identify the discriminative image regions used by the CNNs. CNNs identified right and left fundus images with high accuracy (more than 99.3% in the Gyeongsang National University Changwon Hospital dataset and 91.1% in the Ocular Disease Intelligent Recognition dataset) regardless of whether the images were flipped horizontally. The depth and complexity of the CNN affected the accuracy (DenseNet121: 99.91%, ResNet50: 99.86%, and VGG19: 99.37%). DenseNet121 did not discriminate images composed of only left eyes (55.1%, p = 0.548). Class activation mapping identified the macula as the discriminative region used by the CNNs. Several previous studies used the flipping method to augment data in fundus photographs. However, such photographs are distinct from non-flipped images. This asymmetry could result in undesired bias in machine learning. Therefore, when developing a CNN with fundus photographs, care should be taken when applying data augmentation with flipping.
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Affiliation(s)
- Tae Seen Kang
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, #11 Samjeongja-ro, Seongsan-gu, Changwon, 51472, Republic of Korea
| | - Bum Jun Kim
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, #11 Samjeongja-ro, Seongsan-gu, Changwon, 51472, Republic of Korea
| | - Ki Yup Nam
- Department of Ophthalmology, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Seongjin Lee
- Department of AI Convergence Engineering, Gyeongsang National University, Jinju, Republic of Korea
| | - Kyonghoon Kim
- School of Computer Science & Engineering, Kyungpook National University, Daegu, Republic of Korea
| | - Woong-Sub Lee
- Department of Information and Communication Engineering, Gyeongsang National University, Tongyeong, Republic of Korea
| | - Jinhyun Kim
- Department of Information and Communication Engineering, Gyeongsang National University, Tongyeong, Republic of Korea
| | - Yong Seop Han
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, #11 Samjeongja-ro, Seongsan-gu, Changwon, 51472, Republic of Korea. .,Department of Ophthalmology, Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea.
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Retinal microvascular parameters are not associated with diabetes in the Northern Ireland Cohort for the Longitudinal Study of Ageing. Ir J Med Sci 2021; 191:1209-1215. [PMID: 34244911 PMCID: PMC9135822 DOI: 10.1007/s11845-021-02704-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 06/26/2021] [Indexed: 11/01/2022]
Abstract
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.
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Korsiak J, Perepeluk KL, Peterson NG, Kulka R, Weichenthal S. Air pollution and retinal vessel diameter and blood pressure in school-aged children in a region impacted by residential biomass burning. Sci Rep 2021; 11:12790. [PMID: 34140605 PMCID: PMC8211781 DOI: 10.1038/s41598-021-92269-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/07/2021] [Indexed: 11/08/2022] Open
Abstract
Little is known about the early-life cardiovascular health impacts of fine particulate air pollution (PM2.5) and oxidant gases. A repeated-measures panel study was used to evaluate associations between outdoor PM2.5 and the combined oxidant capacity of O3 and NO2 (using a redox-weighted average, Ox) and retinal vessel diameter and blood pressure in children living in a region impacted by residential biomass burning. A median of 6 retinal vessel and blood pressure measurements were collected from 64 children (ages 4-12 years), for a total of 344 retinal measurements and 432 blood pressure measurements. Linear mixed-effect models were used to estimate associations between PM2.5 or Ox (same-day, 3-day, 7-day, and 21-day means) and retinal vessel diameter and blood pressure. Interactions between PM2.5 and Ox were also examined. Ox was inversely associated with retinal arteriolar diameter; the strongest association was observed for 7-day mean exposures, where each 10 ppb increase in Ox was associated with a 2.63 μm (95% CI - 4.63, - 0.63) decrease in arteriolar diameter. Moreover, Ox modified associations between PM2.5 and arteriolar diameter, with weak inverse associations observed between PM2.5 and arteriolar diameter only at higher concentrations of Ox. Our results suggest that outdoor air pollution impacts the retinal microvasculature of children and interactions between PM2.5 and Ox may play an important role in determining the magnitude and direction of these associations.
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Affiliation(s)
- Jill Korsiak
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1100 Pine Avenue West, Montreal, QC, H3A 1A3, Canada
| | - Kay-Lynne Perepeluk
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1100 Pine Avenue West, Montreal, QC, H3A 1A3, Canada
| | - Nicholas G Peterson
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1100 Pine Avenue West, Montreal, QC, H3A 1A3, Canada
| | - Ryan Kulka
- Air Health Science Division, Health Canada, 269 Laurier Ave West, Ottawa, ON, K1A 0K9, Canada
| | - Scott Weichenthal
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1100 Pine Avenue West, Montreal, QC, H3A 1A3, Canada.
- Air Health Science Division, Health Canada, 269 Laurier Ave West, Ottawa, ON, K1A 0K9, Canada.
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Hu G, Wu H, Kuang L, Zee BCY, Huang Y, Huang Z, He L, Zeng Y, Gao Y, Wang H. Clinical study of diabetic peripheral neuropathy screening by retinal vascular geometric parameters. Sci Rep 2021; 11:6784. [PMID: 33762602 PMCID: PMC7990935 DOI: 10.1038/s41598-021-85831-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 03/02/2021] [Indexed: 11/09/2022] Open
Abstract
To investigate the relationship between geometrical changes of retinal vessels and diabetic peripheral neuropathy (DPN), and to determine the effectiveness of retinal vascular geometry analysis and vibration perception threshold (VPT) for DPN assessment. Type 2 diabetes patients (n = 242) were categorized by stage of DPN. VPT and fundus photography was performed to obtain retinal vascular geometry parameters. The risk factors for DPN and the correlation between DPN stages were analyzed. The efficiency of the retinal vascular geometric parameters obtained with VPT as a diagnostic tool for DPN was examined. Stages of DPN showed a linear correlation with VPT (r = 0.818), central retinal vein equivalent (CRVE) (r = 0.716), and fractal dimension arterioles (DFa) (r = - 0.769). VPT, CRVE, DFa, and fractal dimension veins (DFv) showed high sensitivity (80%, 55%, 82%, and 67%, respectively) and specificity (92%, 93%, 82%, and 80%, respectively) for DPN diagnosis. Good agreement was observed between combined use of geometric parameters (CRVE, DFa and DFv) and VPT (Kappa value 0.430). The detection rate of DPN with combined use of geometric parameters of retinal vessels (64.88%) was significantly higher than that with use of VPT (47.52%). Retinal vascular geometry changes demonstrated significant correlation with DPN severity. VPT, CRVE, DFa, and DFv may provide insights for understanding DPN.
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Affiliation(s)
- Guotao Hu
- Department of Endocrinology, Longgang Central Hospital, Shenzhen 1228 Longgang Road, Shenzhen, 518116, Guangdong, China
| | - Hongmei Wu
- Department of Endocrinology, Longgang Central Hospital, Shenzhen 1228 Longgang Road, Shenzhen, 518116, Guangdong, China
| | - Lei Kuang
- Department of Biostatistics, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Benny Chung-Ying Zee
- Department of Biostatistics, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Ying Huang
- Department of Endocrinology, Longgang Central Hospital, Shenzhen 1228 Longgang Road, Shenzhen, 518116, Guangdong, China
| | - Zhen Huang
- Department of Laboratory, Longgang Central Hospital, Shenzhen, 518116, Guangdong, China
| | - Li He
- Department of Nursing, Longgang Central Hospital, Shenzhen, 518116, Guangdong, China
| | - Yuanhong Zeng
- Department of Ophthalmology, Longgang Central Hospital, Shenzhen, 518116, Guangdong, China
| | - Yongbo Gao
- Department of Stomatology, Longgang Central Hospital, Shenzhen, 518116, Guangdong, China
| | - Hailan Wang
- Department of Endocrinology, Longgang Central Hospital, Shenzhen 1228 Longgang Road, Shenzhen, 518116, Guangdong, China.
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O'Neill RA, Maxwell AP, Paterson EN, Kee F, Young I, Hogg RE, Cruise S, Murphy S, McGuinness B, McKay GJ. Retinal microvascular parameters are not significantly associated with mild cognitive impairment in the Northern Ireland Cohort for the Longitudinal Study of Ageing. BMC Neurol 2021; 21:112. [PMID: 33706706 PMCID: PMC7948373 DOI: 10.1186/s12883-021-02137-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 03/03/2021] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- R A O'Neill
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - A P Maxwell
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - E N Paterson
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - F Kee
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - I Young
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - R E Hogg
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - S Cruise
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - S Murphy
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - B McGuinness
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - G J McKay
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland.
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11
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O'Neill RA, Maxwell AP, Kee F, Young I, Hogg RE, Cruise S, McGuinness B, McKay GJ. Association of reduced retinal arteriolar tortuosity with depression in older participants from the Northern Ireland Cohort for the Longitudinal Study of Ageing. BMC Geriatr 2021; 21:62. [PMID: 33446119 PMCID: PMC7809811 DOI: 10.1186/s12877-021-02009-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/04/2021] [Indexed: 01/01/2023] Open
Abstract
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.
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Affiliation(s)
- R A O'Neill
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - A P Maxwell
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - F Kee
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - I Young
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - R E Hogg
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - S Cruise
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - B McGuinness
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - G J McKay
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland.
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12
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Szulc U, Dąbrowska E, Pieczyński J, Białkowski P, Narkiewicz K, Schmieder RE, Harazny J. How to measure retinal microperfusion in patients with arterial hypertension. Blood Press 2020; 30:4-19. [PMID: 32969283 DOI: 10.1080/08037051.2020.1823816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Assessment and monitoring of changes in microcirculatory perfusion, perfusion dynamic, vessel structure and oxygenation is crucial in management of arterial hypertension. Constant search for non-invasive methods has led the clinical focus towards the vasculature of the retina, which offers a large opportunity to detect the early phase of the functional and structural changes in the arterial hypertension and can reflect changes in brain vasculature. We review all the available methods of retinal microcirculation measurements including angiography, oximetry, retinal vasculature assessment software, Optical Coherence Tomography Angiography, Adaptive Optics and Scanning Laser Doppler Flowmetry and their application in clinical research. MATERIALS AND METHODS To further analyse the applicability of described methods in hypertension research we performed a systematic search of the PubMed electronic database (April 2020). In our analysis, we included 111 articles in which at least one of described methods was used for assessment of microcirculation of the retina in hypertensive individuals. RESULTS Up to this point, the methods most commonly published in studies of retinal microcirculation in arterial hypertension were Scanning Laser Doppler Flowmetry followed shortly by Optical Coherence Tomography Angiography and retinal vasculature assessment software. CONCLUSIONS While none of described methods enables the simultaneous measurement of all microcirculatory parameters, certain techniques are widely used in arterial hypertension research, while others gain popularity in screening.
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Affiliation(s)
- Urszula Szulc
- Department of Human Physiology and Pathophysiology, University Warmia and Mazury, Olsztyn, Poland
| | - Edyta Dąbrowska
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland.,First Department of Cardiology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Janusz Pieczyński
- Department of Ophthalmology, University Warmia and Mazury, Olsztyn, Poland
| | - Paweł Białkowski
- Department of Ophthalmology, Provincial Specialist Hospital, Olsztyn, Poland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Roland E Schmieder
- Clinical Research Center, Department of Nephrology and Hypertensiology, University Erlangen-Nuremberg, Erlangen, Germany
| | - Joanna Harazny
- Department of Human Physiology and Pathophysiology, University Warmia and Mazury, Olsztyn, Poland.,Clinical Research Center, Department of Nephrology and Hypertensiology, University Erlangen-Nuremberg, Erlangen, Germany
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13
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Wagner FM, Hoffmann EM, Nickels S, Fiess A, Münzel T, Wild PS, Beutel ME, Schmidtmann I, Lackner KJ, Pfeiffer N, Schuster AKG. Peripapillary Retinal Nerve Fiber Layer Profile in Relation to Refractive Error and Axial Length: Results From the Gutenberg Health Study. Transl Vis Sci Technol 2020; 9:35. [PMID: 32884859 PMCID: PMC7445357 DOI: 10.1167/tvst.9.9.35] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 06/24/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose To investigate the retinal nerve fiber layer profile measured by optical coherence tomography and its relation to refractive error and axial length. Methods The Gutenberg Health Study is a population-based study in Mainz, Germany. At the five-year follow-up examination, participants underwent optical coherence tomography, objective refraction and biometry. Peripapillary retinal nerve fiber layer (pRNFL) was segmented using proprietary software. The pRNFL profiles were compared between different refraction groups and the angle between the maxima, i.e., the peaks of pRNFL thickness in the upper and lower hemisphere (angle between the maxima of pRNFL thickness [AMR]) was computed. Multivariable linear regression analysis was carried out to determine associations of pRNFL profile (AMR) including age, sex, optic disc size, and axial length in model 1 and spherical equivalent in model 2. Results A total of 5387 participants were included. AMR was 145.3° ± 23.4° in right eyes and 151.8° ± 26.7° in left eyes and the pRNFL profile was significant different in the upper hemisphere. The AMR decreased with increasing axial length by −5.86°/mm (95% confidence interval [CI]: [−6.44; −5.29], P < 0.001), female sex (−7.61°; 95% CI: [−8.71; −6.51], P < 0.001) and increased with higher age (0.08°/year; 95% CI: [0.03; 0.14], P = 0.002) and larger optic disc size (2.29°/mm2; 95% CI: [1.18; 3.41], P < 0.001). In phakic eyes, AMR increased with hyperopic refractive error by 2.60°/diopters (dpt) (95% CI: [2.33; 2.88], P < 0.001). Conclusions The pRNFL profiles are related to individual ocular and systemic parameters. Translational Relevance Biometric parameters should be considered when pRNFL profiles are interpreted in diagnostics, i.e., in glaucoma.
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Affiliation(s)
- Felix Mathias Wagner
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Esther Maria Hoffmann
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Stefan Nickels
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Achim Fiess
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Philipp S Wild
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany.,Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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14
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Büttner M, Schuster AK, Vossmerbäumer U, Fischer JE. Associations of cardiovascular risk factors and retinal vessel dimensions at present and their evolution over time in a healthy working population. Acta Ophthalmol 2020; 98:e457-e463. [PMID: 31680467 DOI: 10.1111/aos.14296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/11/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE The aim of this study was to investigate whether an association between retinal vessel diameters with blood pressure and other risk factors exists in a healthy working population and whether current risk factors can be used as predictors for retinal vessel changes over time. METHODS Retinal photographs and medical data were obtained during a voluntary work health check in 2010 and 2013. The central retinal arterial equivalent (CRAE) and central retinal venular equivalent (CRVE) were assessed using a semi-automated software. Linear regression analysis was carried out to determine associations with systemic parameters and cardiovascular risk factors. RESULTS A total of 1685 participants had gradable photographs and full medical data with a mean age of 44.8 years (SD: 10.2) and 80.8% being male; full data were obtained in both 2010 and 2013 for 365 participants allowing for longitudinal analysis. In the cross-sectional analysis, a mean CRAE of 171.2 ±18.3 μm and a mean CRVE 215.8 ± 18.6 μm were found. A significant negative association for CRAE was seen for age, mean arterial blood pressure (MABP), body mass index (BMI) and high-density lipoprotein (HDL), while triglycerides, spherical equivalent (SAE) and being a current smoker were positively associated. For CRVE age, MABP, HbA1c and HDL were negatively associated, while being female, low-density lipoprotein, white blood cell count, SAE and being a current smoker showed a positive association. The linear regression model for the cross-sectional analysis explained 31% and 21% of the variance of CRAE and CRVE, respectively. The longitudinal analysis showed a mean decrease of -1.6 μm (p = 0.04) for CRAE and -2.0 (p = 0.005) for CRVE within the three-year time frame. Linear regression analysis with longitudinal data showed a significant association for HDL and CRAE, while for other factors no statistically significant association between current risk factors and changes in CRAE and CRVE was observed. CONCLUSION The width of both arterial and venous retinal vessels shows associations not only with arterial blood pressure but also with biochemical markers of cardiovascular risk. While such effects are partially established for elderly persons, our study results indicate that they apply also in a young population in working age with seemingly unimpaired health.
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Affiliation(s)
- Matthias Büttner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) University Medical Center Mainz Mainz Germany
| | | | - Urs Vossmerbäumer
- Department of Ophthalmology University Medical Center Mainz Mainz Germany
- Mannheim Medical Faculty Mannheim Institute of Public Health, Social and Preventive Medicine University of Heidelberg Heidelberg Germany
| | - Joachim E. Fischer
- Mannheim Medical Faculty Mannheim Institute of Public Health, Social and Preventive Medicine University of Heidelberg Heidelberg Germany
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15
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Associations between cannabis use and retinal vessel diameter in young adults. Schizophr Res 2020; 219:62-68. [PMID: 30837202 DOI: 10.1016/j.schres.2019.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 12/14/2022]
Abstract
Cannabis appears to have vascular effects that may have implications for cerebrovascular function, but no studies have directly visualized the microvasculature in living cannabis users. The current study used retinal imaging, a tool taken from ophthalmology, to visualize the small retinal microvessels in cannabis users. We compared retinal arteriolar (small arteries) and venular (small veins) diameters in 55 frequent cannabis users and 51 comparison individuals with a mean age of 19.25 years (SD = 2.43). Results indicated that mean arteriolar diameter was statistically significantly wider for cannabis users (M = 157.98, SE = 1.42) than for comparison individuals (M = 153.56, SE = 1.46; F(1,103) = 4.67, p = .033), even after controlling for a variety of covariates and after excluding from analyses cannabis users who had used cannabis in the past 24 h. There was no statistically significant difference in retinal venular diameter between cannabis users and comparison individuals. Findings suggest that frequent cannabis use is associated with wider retinal arterioles, which might represent a residual vasodilatory effect of recent cannabis use or impaired autoregulation resulting from chronic cannabis use. Retinal imaging is a non-invasive, cost-effective tool for visualizing the microvasculature in living individuals and can be combined, in future research, with neuroimaging and other measures of retinal vascular function to better understand the acute and longer-term effects of cannabis use on the microvasculature.
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16
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Robertson G, Fleming A, Williams MC, Trucco E, Quinn N, Hogg R, McKay GJ, Kee F, Young I, Pellegrini E, Newby DE, van Beek EJR, Peto T, Dhillon B, van Hemert J, MacGillivray TJ. Association between hypertension and retinal vascular features in ultra-widefield fundus imaging. Open Heart 2020; 7:e001124. [PMID: 32076560 PMCID: PMC6999694 DOI: 10.1136/openhrt-2019-001124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/27/2019] [Accepted: 12/17/2019] [Indexed: 01/14/2023] Open
Abstract
Objective Changes to the retinal vasculature are known to be associated with hypertension independently of traditional risk factors. We investigated whether measurements of retinal vascular calibre from ultra-widefield fundus imaging were associated with hypertensive status. Methods We retrospectively collected and semiautomatically measured ultra-widefield retinal fundus images from a subset of participants enrolled in an ongoing population study of ageing, categorised as normotensive or hypertensive according to thresholds on systolic/diastolic blood pressure (140/90 mm Hg) measured in a clinical setting. Vascular calibre in the peripheral retina was measured to calculate the nasal–annular arteriole:venule ratio (NA-AVR), a novel combined parameter. Results Left and right eyes were analysed from 440 participants (aged 50–59 years, mean age of 54.6±2.9 years, 247, 56.1% women), including 151 (34.3%) categorised as hypertensive. Arterioles were thinner and the NA-AVR was smaller in people with hypertension. The area under the receiver operating characteristic curve of NA-AVR for hypertensive status was 0.73 (95% CI 0.68 to 0.78) using measurements from left eyes, while for right eyes, it was 0.64 (95% CI 0.59 to 0.70), representing evidence of a statistically significant difference between the eyes (p=0.020). Conclusions Semiautomated measurements of NA-AVR in ultra-widefield fundus imaging were associated with hypertension. With further development, this may help screen people attending routine eye health check-ups for high blood pressure. These individuals may then follow a care pathway for suspected hypertension. Our results showed differences between left and right eyes, highlighting the importance of investigating both eyes of a patient.
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Affiliation(s)
| | | | | | - Emanuele Trucco
- The VAMPIRE Project, Computer Vision and Image Processing Group, School of Science and Engineering, University of Dundee, Dundee, Dundee, UK
| | - Nicola Quinn
- Centre for Public Health, Queen's University Belfast, Belfast, Belfast, UK
| | - Ruth Hogg
- Centre for Public Health, Queen's University Belfast, Belfast, Belfast, UK
| | - Gareth J McKay
- Centre for Public Health, Queen's University Belfast, Belfast, Belfast, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, Belfast, UK
| | - Ian Young
- Centre for Public Health, Queen's University Belfast, Belfast, Belfast, UK
| | | | - David E Newby
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, Lothian, UK
| | - Edwin J R van Beek
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, Lothian, UK.,Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, Belfast, UK
| | - Baljean Dhillon
- The VAMPIRE Project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Thomas J MacGillivray
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK.,The VAMPIRE Project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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17
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McGrory S, Ballerini L, Okely JA, Ritchie SJ, Doubal FN, Doney ASF, Dhillon B, Starr JM, MacGillivray TJ, Trucco E, Wardlaw JM, Deary IJ. Retinal microvascular features and cognitive change in the Lothian-Birth Cohort 1936. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2019; 11:500-509. [PMID: 31338413 PMCID: PMC6625967 DOI: 10.1016/j.dadm.2019.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction We test whether measures of the retinal vasculature are associated with cognitive functioning and cognitive change. Methods Retinal images from a narrow-age cohort were analyzed using Vessel Assessment and Measurement Platform for Images of the Retina, producing a comprehensive range of quantitative measurements of the retinal vasculature, at mean age 72.5 years (SD = 0.7). Cognitive ability and change were measured using a battery of multiple measures of memory, visuospatial, processing speed, and crystallized cognitive abilities at mean ages 73, 76, and 79 years. We applied multivariate growth curve models to test the association between retinal vascular measurements with cognitive abilities and their changes. Results Almost all associations were nonsignificant. In our most parsimonious model, venular asymmetry factor was associated with speed at age 73. Discussion Our null findings suggest that the quantitative retinal parameters applied in this study are not significantly associated with cognitive functioning or cognitive change.
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Affiliation(s)
- Sarah McGrory
- VAMPIRE project, Center for Clinical Brain Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK.,Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Lucia Ballerini
- VAMPIRE project, Center for Clinical Brain Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Judith A Okely
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Center for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Stuart J Ritchie
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Fergus N Doubal
- VAMPIRE project, Center for Clinical Brain Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Alex S F Doney
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, Ninewells Hospital and Medical School, Dundee, UK
| | - Baljean Dhillon
- VAMPIRE project, Center for Clinical Brain Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - John M Starr
- Center for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Thomas J MacGillivray
- VAMPIRE project, Center for Clinical Brain Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Emanuele Trucco
- VAMPIRE Project, Computing, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Joanna M Wardlaw
- Center for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK.,Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK.,UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Center for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK
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18
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Zhu X, He W, Du Y, Zhang K, Lu Y. Interocular Symmetry of Fixation, Optic Disc, and Corneal Astigmatism in Bilateral High Myopia: The Shanghai High Myopia Study. Transl Vis Sci Technol 2019; 8:22. [PMID: 30783557 PMCID: PMC6375117 DOI: 10.1167/tvst.8.1.22] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/12/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose We investigate the interocular symmetry of fixation, optic disc, and corneal astigmatism in bilateral high myopia, and evaluate the predictive relationships between them. Methods We enrolled 202 cases with bilateral high myopia. Fixation, in terms of the bivariate contour ellipse area (BCEA), was evaluated with the Macular Integrity Assessment microperimetry. Optic disc features, including orientation, tilt, and rotation, were evaluated with ultrawide-field retinal photographs. Corneal topography was performed with Pentacam. Interocular symmetry of fixation, optic disc, and corneal astigmatism was assessed, and the predictive relationships between these parameters were investigated. Results Axial length differences between the two eyes were: ≥0 to ≤1 mm, 67.8%; 1 to ≤2 mm, 20.3%; 2 to ≤3 mm, 9.4%; and >3 mm, 2.5%. Axial length, 95% BCEA, and magnitude of corneal astigmatism showed good interocular symmetry, whereas the optic disc tilt, rotation, and axis of corneal astigmatism (mirror axes) showed less symmetry (all P < 0.05). No interocular symmetry was observed in the direction of the fixation ellipse. In both eyes, the corneal steep meridian more often was consistent with the optic disc orientation than inconsistent (right eye [OD], P < 0.001; left eye [OS], P = 0.029). Conclusions As different parameters presented different degrees of symmetry, cautions are needed when including both eyes or only one lateral eye in cases of bilateral high myopia for clinical investigations. The optic disc orientation, to some extent, may indicate the steep meridian of the cornea. Translational Relevance Our study provided evidences for selection of eye laterality in clinical investigations of highly myopic eyes.
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Affiliation(s)
- Xiangjia Zhu
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital, Funan University, Shanghai, China
| | - Wenwen He
- Eye Institute, Eye and Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, People's Republic of China
| | - Yu Du
- NHC Key Laboratory of Myopia, Fudan University, 83 Fenyang Road, Shanghai, People's Republic of China
| | - Keke Zhang
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, People's Republic of China
| | - Yi Lu
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China
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Retinal micro-vascular and aortic macro-vascular changes in postmenopausal women with primary hyperparathyroidism. Sci Rep 2018; 8:16521. [PMID: 30410012 PMCID: PMC6224616 DOI: 10.1038/s41598-018-35017-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 10/25/2018] [Indexed: 01/23/2023] Open
Abstract
Aim of the study was to evaluate the micro and macro-vascular changes in patients with primary hyperparathyroidism (PHPT) compared to controls. 30 postmenopausal PHPT women (15 hypertensive and 15 normotensive) and 30 normotensive controls underwent biochemical evaluation of mineral metabolism and measurements of arterial stiffness by 24 hour ambulatory blood pressure monitoring. Retinal microcirculation was imaged by a Retinal Vessel Analyzer. PHPT patients also underwent bone mineral density measurements and kidney ultrasound. PHPT patients had higher mean calcium and parathyroid hormone values compared to controls. Evaluating macro-vascular compartment, we found higher values of 24 hours-systolic, diastolic blood pressure, aortic pulse wave velocity (aPWV) and aortic augmentation index (Aix) in hypertensive PHPT, but not in normotensive PHPT compared to controls. The eye examination showed narrowing arterial and venular diameters of retinal vessels in both hypertensive and normotensive PHPT compared to controls. In hypertensive PHPT, 24 hours systolic blood pressure was associated only with parathyroid hormone (PTH) levels (beta = 0.36, p = 0.04). aPWV was associated with retinal diameter (beta = -0.69, p = 0.003), but not with PTH. Retinal artery diameter was associated with PTH (beta = -0.6, p = 0.008). In the normotensive PHPT, only PTH was associated with retinal artery diameter (beta = -0.60, p = 0.01) and aortic AIx (beta = 0.65, p = 0.02). In conclusion, we found macro-vascular impairment in PHPT and that micro-vascular impairment is negatively associated with PTH, regardless of hypertension in PHPT.
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20
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Soma-Pillay P, Pillay R, Wong TY, Makin JD, Pattinson RC. The effect of pre-eclampsia on retinal microvascular caliber at delivery and post-partum. Obstet Med 2018; 11:116-120. [PMID: 30214476 DOI: 10.1177/1753495x17745727] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/25/2017] [Indexed: 12/21/2022] Open
Abstract
Background The retinal microcirculation provides a unique view of microvessel structure by means of non-invasive, retinal image analysis. The aim of the study was to compare the retinal vessel caliber at delivery and one-year post-partum between women who have had pre-eclampsia during pregnancy to a normotensive control group. Methods Digital photos of the eye were taken at delivery and one-year post-partum. Retinal vessels were analysed and summarised as the corrected central retinal arteriolar equivalent and corrected central retinal venular equivalent. Results The corrected central retinal arteriolar equivalent and corrected central retinal venular equivalent were significantly lower in the pre-eclamptic group compared to the control group both at delivery and one-year post-partum (p < 0.001). Conclusion Retinal artery and venular caliber changes that occur during pregnancies affected by pre-eclampsia persist for up to one-year post-partum. These changes may reflect a permanent, long-term microvascular dysfunction and may be useful as a biomarker of future vascular risk.
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Affiliation(s)
- P Soma-Pillay
- Department of Obstetrics and Gynaecology, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa.,South African Medical Research Council Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - R Pillay
- Netcare Waterfall Hospital, Midrand, South Africa.,Sunninghill Hospital, Sandton, South Africa
| | - T Y Wong
- Singapore Eye Research Institute, Singapore, Singapore
| | - J D Makin
- South African Medical Research Council Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - R C Pattinson
- South African Medical Research Council Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
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Daien V, Granados L, Kawasaki R, Villain M, Ribstein J, Du Cailar G, Mimran A, Fesler P. Retinal vascular caliber associated with cardiac and renal target organ damage in never-treated hypertensive patients. Microcirculation 2018; 24. [PMID: 27987377 DOI: 10.1111/micc.12344] [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: 07/25/2016] [Accepted: 12/12/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to assess the relationship between retinal vascular caliber and target organ damage in HT patients. METHODS Data were collected on cardiac, renal, vascular, and retinal variables in 88 consecutive never-treated HT subjects. Retinal vascular calibers were measured from fundus photographs by using a semi-automated computer-assisted program and summarized as CRAE and CRVE. RESULTS Mean CRAE and CRVE were significantly lower in patients with left ventricular hypertrophy (left ventricular mass ≥110 g/m² for women, 125 g/m² for men) than in those with normal left ventricular (CRAE: 129.4±3.7 vs 138.2±2.3 μm; P=.04; CRVE: 195.6±4.4 vs 209.8±2.7 μm; P=.008). CRAE and CRVE were negatively correlated with urinary albumin excretion (β±SE=-15.4±3.2, P<.0001 and β±SE=-11.9±4.4, P=.001, respectively) but were not correlated with estimated glomerular filtration rate (P=.21 and P=.75, respectively), carotid-to-femoral pulse wave velocity (P=.24 and P=.14), or carotid augmentation index (P=.43 and P=.16). CONCLUSION In never-treated HT patients, reduced CRAE and CRVE were associated with cardiac and renal preclinical damage, ie, left ventricular hypertrophy and albuminuria, but not estimated glomerular filtration rate or vascular stiffness.
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Affiliation(s)
- Vincent Daien
- Department of Opthalmology, Hôpital Gui de Chauliac, Montpellier, France.,Université Montpellier 1, Montpellier, France.,National Institute for Health and Medical Research (INSERM), U1061, Montpellier, France
| | - Loic Granados
- Department of Opthalmology, Hôpital Gui de Chauliac, Montpellier, France.,Université Montpellier 1, Montpellier, France
| | - Ryo Kawasaki
- Department of Public Health, Yamagata University Graduate School of Medical Science, Yamagata, Japan
| | - Max Villain
- Department of Opthalmology, Hôpital Gui de Chauliac, Montpellier, France.,Université Montpellier 1, Montpellier, France
| | - Jean Ribstein
- Université Montpellier 1, Montpellier, France.,Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France
| | - Guilhem Du Cailar
- Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France
| | - Albert Mimran
- Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France
| | - Pierre Fesler
- Université Montpellier 1, Montpellier, France.,Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France.,PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier 34295 Montpellier Cedex 5, France
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Comparisons of retinal vessel diameter and glaucomatous parameters between both eyes of subjects with clinically unilateral pseudoexfoliation syndrome. PLoS One 2017. [PMID: 28644852 PMCID: PMC5482447 DOI: 10.1371/journal.pone.0179663] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose Pseudoexfoliation syndrome (PEX), the most common identifiable cause of open-angle glaucoma, might affect the retinal hemodynamics. To test this, we compared retinal vessel diameter and glaucoma-related parameters between eyes with pseudoexfoliation material (PE+) and fellow unaffected (PE-) eyes of patients with clinically unilateral PEX. Methods The medical records of 30 consecutive Japanese subjects were reviewed retrospectively. The retinal vessel diameters were measured and expressed as the central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) using standardized software. During the chart review, we recorded glaucoma-related parameters including intraocular pressure (IOP), visual field mean deviation (MD) value, planimetrically measured vertical cup-to-disc (C/D) ratio, circumpapillary retinal nerve fiber layer thickness (cpRNFLT) and macular inner retinal thickness (mIRT) measured by spectral-domain optical coherence tomography, anterior chamber flare (ACF), corneal endothelial cell density (CECD), and number of antiglaucoma medications. Results Compared with PE- eyes, the CRAE, CRVE, MD, cpRNFLT and mIRT, and CECD were significantly lower in PE+ eyes; the IOP, vertical C/D ratio, number of antiglaucoma medications, and ACF were significantly higher in PE+ eyes (P<0.0001 for all comparisons). The CRAE, cpRNFLT, and MD were correlated positively with each other (ρ = 0.456–0.499, P<0.0001–0.0002) and negatively with the IOP (ρ = -0.562- —0.432, P<0.0001–0.0006). The vertical C/D ratio was correlated positively with the IOP (ρ = 0.483, P<0.0001) and negatively with the CRAE, cpRNFLT, and MD (ρ = -0.745–-0.479, P<0.0001–0.0001). Conclusions Deposition of PE can cause retinal vessel narrowing in arterioles and venules. The roles and mechanisms of retinal vessel narrowing in glaucoma pathogenesis need clarification.
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Comparisons of microvascular and macrovascular changes in aldosteronism-related hypertension and essential hypertension. Sci Rep 2017; 7:2666. [PMID: 28572599 PMCID: PMC5453943 DOI: 10.1038/s41598-017-02622-2] [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: 05/16/2016] [Accepted: 04/13/2017] [Indexed: 12/21/2022] Open
Abstract
Case-control observational study to evaluate the microvascular and macrovascular changes in patients with hypertension secondary to primary aldosteronism (PA), essential hypertension (EH) and healthy subjects. Measurements of arterial stiffness including augmentation index (AIx) and pulse wave velocity (PWV) were assessed using a TensioClinic arteriograph system. Retinal microcirculation was imaged by a Retinal Vessel Analyzer (RVA) and a non-midriatic camera (Topcon-TRC-NV2000). IMEDOS software analyzed the retinal artery diameter (RAD), retinal vein diameters (RVD) and arteriole-to-venule ratio (AVR) of the vessels coming off the optic disc. Thirty, 39 and 35 patients were included in the PA, EH and control group, respectively. The PA group showed higher PWV values compared only with the control group. The mean brachial and aortic AIx values did not show significant difference between groups. In the PA group, the mean RVD and AVR values were significantly lower than in the EH and control groups, whereas the parameters did not differ between the EH and control groups. In conclusion, AVR appears significantly modified in the PA group compared with the EH group and could represent an early and more reliable indicator of microvascular remodeling.
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24
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Lateral thinking - Interocular symmetry and asymmetry in neurovascular patterning, in health and disease. Prog Retin Eye Res 2017; 59:131-157. [PMID: 28457789 DOI: 10.1016/j.preteyeres.2017.04.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/24/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023]
Abstract
No biological system or structure is likely to be perfectly symmetrical, or have identical right and left forms. This review explores the evidence for eye and visual pathway asymmetry, in health and in disease, and attempts to provide guidance for those studying the structure and function of the visual system, where recognition of symmetry or asymmetry may be essential. The principal question with regards to asymmetry is not 'are the eyes the same?', for some degree of asymmetry is pervasive, but 'when are they importantly different?'. Knowing if right and left eyes are 'importantly different' could have significant consequences for deciding whether right or left eyes are included in an analysis or for examining the association between a phenotype and ocular parameter. The presence of significant asymmetry would also have important implications for the design of normative databases of retinal and optic nerve metrics. In this review, we highlight not only the universal presence of asymmetry, but provide evidence that some elements of the visual system are inherently more asymmetric than others, pointing to the need for improved normative data to explain sources of asymmetry and their impact on determining associations with genetic, environmental or health-related factors and ultimately in clinical practice.
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25
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Retinal Vessel Diameters and Their Relationship with Cardiovascular Risk and All-Cause Mortality in the Inter99 Eye Study: A 15-Year Follow-Up. J Ophthalmol 2016; 2016:6138659. [PMID: 28053777 PMCID: PMC5174182 DOI: 10.1155/2016/6138659] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/13/2016] [Accepted: 10/25/2016] [Indexed: 11/29/2022] Open
Abstract
Purpose. To describe associations between retinal vessel diameters and cardiovascular risk markers and mortality. Methods. The present study included 908 persons aged 30 to 60 years. Vessel diameters were expressed as central retinal venular equivalent (CRVE) and central retinal arteriolar equivalent (CRAE). Multiple linear regression analyses and Cox regression models were used. Results. Multiple linear regression analyses showed that narrower CRAE was associated with higher systolic blood pressure, age, and higher HDL cholesterol, whereas wider CRAE and CRVE were associated with smoking. Narrower CRVE was associated with higher HDL cholesterol. In an age-adjusted model, associations between wider CRVE and risk of ischemic heart disease were found (P < 0.001). Wider CRVE was associated with all-cause mortality (HR = 2.02, P = 0.033) in a model adjusted for age, gender, and blood pressure. However, the association was not statistically significant after additional adjustment for smoking. Conclusions. The associations between retinal vessel diameters and known cardiovascular risk factors were confirmed. All-cause mortality was not associated with retinal vessel diameters when adjusting for relevant confounders.
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26
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McGrory S, Taylor AM, Kirin M, Corley J, Pattie A, Cox SR, Dhillon B, Wardlaw JM, Doubal FN, Starr JM, Trucco E, MacGillivray TJ, Deary IJ. Retinal microvascular network geometry and cognitive abilities in community-dwelling older people: The Lothian Birth Cohort 1936 study. Br J Ophthalmol 2016; 101:993-998. [PMID: 28400371 PMCID: PMC5530803 DOI: 10.1136/bjophthalmol-2016-309017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/21/2016] [Accepted: 09/26/2016] [Indexed: 11/05/2022]
Abstract
Aim To examine the relationship between retinal vascular morphology and cognitive abilities in a narrow-age cohort of community-dwelling older people. Methods Digital retinal images taken at age ∼73 years from 683 participants of the Lothian Birth Cohort 1936 (LBC1936) were analysed with Singapore I Vessel Assessment (SIVA) software. Multiple regression models were applied to determine cross-sectional associations between retinal vascular parameters and general cognitive ability (g), memory, processing speed, visuospatial ability, crystallised cognitive ability and change in IQ from childhood to older age. Results After adjustment for cognitive ability at age 11 years and cardiovascular risk factors, venular length-to-diameter ratio was nominally significantly associated with processing speed (β=−0.116, p=0.01) and g (β=−0.079, p=0.04). Arteriolar length-to-diameter ratio was associated with visuospatial ability (β=0.092, p=0.04). Decreased arteriolar junctional exponent deviation and increased arteriolar branching coefficient values were associated with less relative decline in IQ between childhood and older age (arteriolar junctional exponent deviation: β=−0.101, p=0.02; arteriolar branching coefficient: β=0.089, p=0.04). Data are presented as standardised β coefficients (β) reflecting change in cognitive domain score associated with an increase of 1 SD unit in retinal parameter. None of these nominally significant associations remained significant after correction for multiple statistical testing. Conclusions Retinal parameters contributed <1% of the variance in the majority of associations observed. Whereas retinal analysis may have potential for early detection of some types of age-related cognitive decline and dementia, our results present little evidence that retinal vascular features are associated with non-pathological cognitive ageing.
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Affiliation(s)
- Sarah McGrory
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Adele M Taylor
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Mirna Kirin
- Faculty of Medicine, University of Split, Split, Croatia
| | - Janie Corley
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Alison Pattie
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Simon R Cox
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Scottish Imaging Network: A Platform for Scientific Excellence Collaboration, Edinburgh, UK
| | - Baljean Dhillon
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Scottish Imaging Network: A Platform for Scientific Excellence Collaboration, Edinburgh, UK
| | - Fergus N Doubal
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - John M Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Emanuele Trucco
- VAMPIRE project, Computing, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Thomas J MacGillivray
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Edinburgh Clinical Research Facility, University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
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Neumann T, Baertschi M, Vilser W, Drinda S, Franz M, Brückmann A, Wolf G, Jung C. Retinal vessel regulation at high altitudes1. Clin Hemorheol Microcirc 2016; 63:281-92. [DOI: 10.3233/ch-162041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Thomas Neumann
- Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - Michael Baertschi
- Department of Ophthalmology, University of Basel, Switzerland
- Eyeness AG, Bern, Switzerland
| | | | | | - Marcus Franz
- Department of Internal Medicine I, Jena University Hospital, Jena, Germany
| | | | - Gunter Wolf
- Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - Christian Jung
- University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
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28
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Pedersen KB, Broe R, Grauslund J. Inter-Eye Agreement in Measurement of Retinal Vascular Fractal Dimension in Patients with Type 1 Diabetes Mellitus. Ophthalmic Epidemiol 2016; 23:131-5. [PMID: 26950285 DOI: 10.3109/09286586.2016.1145241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate inter-eye agreement in retinal vascular fractal dimension (FD) in patients with type 1 diabetes. METHODS In a cross-sectional study, both eyes were exained in 178 patients with type 1 diabetes. All vessels in a zone 0.5-2.0 disc diameters from the optic disc were traced and FD calculated with the box-counting method using SIVA-Fractal semiautomatic software. The modified Early Treatment Diabetic Retinopathy Study (ETDRS) scale was used to grade diabetic retinopathy (DR). Pitman's test of difference in variance was used to calculated inter-eye agreement in FD according to level of DR. RESULTS Mean age and duration of diabetes was 37.0 years and 29.5 years, respectively, and 49.4% of participants were male. Mean FD of right and left eyes was 1.4540 and 1.4472, respectively. FD did not differ between eyes in patients with no or non-proliferative DR (NPDR) in both eyes. This was true for patients with the same level of DR in both eyes (n = 74, p = 0.73), as well as for patients in which the ETDRS level of DR between the eyes differed by 1 (n = 43, p = 0.99) or more (n = 9, p = 0.53). In patients treated for proliferative DR in one eye, FD was significantly lower in this eye compared to the other (n = 10, p = 0.03). CONCLUSION FD did not differ significantly between the two eyes of patients with no DR or NPDR, despite differences in severity of DR.
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Affiliation(s)
- Knud B Pedersen
- a Research Unit of Ophthalmology , Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Rebecca Broe
- a Research Unit of Ophthalmology , Institute of Clinical Research, University of Southern Denmark , Odense , Denmark.,b Department of Ophthalmology , Odense University Hospital , Odense , Denmark
| | - Jakob Grauslund
- a Research Unit of Ophthalmology , Institute of Clinical Research, University of Southern Denmark , Odense , Denmark.,b Department of Ophthalmology , Odense University Hospital , Odense , Denmark
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29
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Guo VY, Chan JCN, Chung H, Ozaki R, So W, Luk A, Lam A, Lee J, Zee BCY. Retinal Information is Independently Associated with Cardiovascular Disease in Patients with Type 2 diabetes. Sci Rep 2016; 6:19053. [PMID: 26754623 PMCID: PMC4709555 DOI: 10.1038/srep19053] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 12/04/2015] [Indexed: 11/30/2022] Open
Abstract
To evaluate the association between a series of retinal information and cardiovascular disease (CVD) and to evaluate whether this association is independent of traditional CVD risk factors in type 2 diabetes patients, we undertook an age-sex matched case-control study with 79 CVD cases and 150 non-CVD controls. All the participants underwent standardized physical examinations and retinal imaging. Retinal information was extracted from the retinal images using a semi-automatic computer program. Three stepwise logistic regression models were evaluated: model 1 with cardiovascular risk factors only; model 2 with retinal information only and model 3 with both cardiovascular risk factors and retinal information. The areas under the receiver operating characteristic curves (AUCs) were used to compare the performances of different models. Results showed that the AUCs were 0.692 (95%CI: 0.622−0.761) and 0.661 (95%CI: 0.588−0.735) for model 1 and model 2, respectively. In addition, model 3 had an AUC of 0.775 (95%CI: 0.716−0.834). Compared to the previous two models, the AUC of model 3 increased significantly (p < 0.05 in both comparisons). In conclusion, retinal information is independently associated with CVD in type 2 diabetes. Further work is needed to validate the translational value of applying retinal imaging analysis into clinical practice.
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Affiliation(s)
- Vivian Yawei Guo
- Division of Biostatistics, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.,Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Juliana Chung Ngor Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, China.,Asia Diabetes Foundation, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, China
| | - Harriet Chung
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, China
| | - Risa Ozaki
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, China
| | - Wingyee So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, China
| | - Andrea Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, China
| | - Augustine Lam
- Department of Family Medicine, New Territories East Cluster, Hospital Authority (Ma On Shan Family Medicine Centre), Hong Kong, China
| | - Jack Lee
- Division of Biostatistics, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Benny Chung-Ying Zee
- Division of Biostatistics, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.,Clinical Trials and Biostatistics Lab, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
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30
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Jeong KD, Kim JS. Association between Metabolic Syndrome and Retinal Vascular Changes in Koreans based on Health Check-ups. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.7.1102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kyeong Do Jeong
- Department of Ophthalmology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Jae Suk Kim
- Department of Ophthalmology, Inje University Sanggye Paik Hospital, Seoul, Korea
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31
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Gishti O, Jaddoe VWV, Duijts L, Franco OH, Hofman A, Ikram MK, Gaillard R. Influence of breastfeeding on retinal vessel calibers in school-age children. The Generation R Study. Eur J Clin Nutr 2015; 70:72-7. [DOI: 10.1038/ejcn.2015.113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/26/2015] [Accepted: 04/24/2015] [Indexed: 11/10/2022]
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Dashtbozorg B, Mendonça AM, Penas S, Campilho A. RetinaCAD, a system for the assessment of retinal vascular changes. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:6328-31. [PMID: 25571444 DOI: 10.1109/embc.2014.6945076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper introduces RetinaCAD, a system, for the fast, reliable and automatic measurement of the Central Retinal Arteriolar Equivalent (CRAE), the Central Retinal Venular Equivalent (CRVE), and the Arteriolar-to-Venular Ratio (AVR) values, as well as several geometrical features of the retinal vasculature. RetinaCAD identifies important landmarks in the retina, such as the blood vessels and optic disc, and performs artery/vein classification and vessel width measurement. The estimation of the CRAE, CRVE and AVR values on 480 images from 120 subjects has shown a significant correlation between right and left eyes and also between images of same eye acquired with different camera fields of view. AVR estimation in retinal images of 54 subjects showed the lowest values in people with diabetes or high blood pressure thus demonstrating the potential of the system as a CAD tool for early detection and follow-up of diabetes, hypertension or cardiovascular pathologies.
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Schuster AKG, Fischer JE, Vossmerbaeumer U. Semi-automated retinal vessel analysis in nonmydriatic fundus photography. Acta Ophthalmol 2014; 92:e42-9. [PMID: 23879386 DOI: 10.1111/aos.12242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 06/12/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Funduscopic assessment of the retinal vessels may be used to assess the health status of microcirculation and as a component in the evaluation of cardiovascular risk factors. Typically, the evaluation is restricted to morphological appreciation without strict quantification. Our purpose was to develop and validate a software tool for semi-automated quantitative analysis of retinal vasculature in nonmydriatic fundus photography. METHODS matlab software was used to develop a semi-automated image recognition and analysis tool for the determination of the arterial-venous (A/V) ratio in the central vessel equivalent on 45° digital fundus photographs. Validity and reproducibility of the results were ascertained using nonmydriatic photographs of 50 eyes from 25 subjects recorded from a 3DOCT device (Topcon Corp.). Two hundred and thirty-three eyes of 121 healthy subjects were evaluated to define normative values. RESULTS A software tool was developed using image thresholds for vessel recognition and vessel width calculation in a semi-automated three-step procedure: vessel recognition on the photograph and artery/vein designation, width measurement and calculation of central retinal vessel equivalents. Mean vessel recognition rate was 78%, vessel class designation rate 75% and reproducibility between 0.78 and 0.91. Mean A/V ratio was 0.84. Application on a healthy norm cohort showed high congruence with prior published manual methods. Processing time per image was one minute. CONCLUSIONS Quantitative geometrical assessment of the retinal vasculature may be performed in a semi-automated manner using dedicated software tools. Yielding reproducible numerical data within a short time leap, this may contribute additional value to mere morphological estimates in the clinical evaluation of fundus photographs.
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Affiliation(s)
- Alexander Karl-Georg Schuster
- Mannheim Institute of Public Health, Social and Preventive Medicine; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - Joachim Ernst Fischer
- Mannheim Institute of Public Health, Social and Preventive Medicine; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - Urs Vossmerbaeumer
- Mannheim Institute of Public Health, Social and Preventive Medicine; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
- Department of Ophthalmology; University of Mainz; Mainz Germany
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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.
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35
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Im JC, Shin JP, Kim IT, Park DH. Analysis of Factors Associated with Retinal Vascular Caliber in Normal Korean Subjects. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.4.548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jong Chan Im
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jae Pil Shin
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
| | - In Taek Kim
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Dong Ho Park
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
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Bertelsen G, Erke MG, von Hanno T, Mathiesen EB, Peto T, Sjølie AK, Njølstad I. The Tromsø Eye Study: study design, methodology and results on visual acuity and refractive errors. Acta Ophthalmol 2013; 91:635-42. [PMID: 22963377 DOI: 10.1111/j.1755-3768.2012.02511.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the study design and methodology of the Tromsø Eye Study (TES), and to describe visual acuity and refractive error in the study population. METHODS The Tromsø Eye Study is a sub-study of the Tromsø Study, a population-based multipurpose longitudinal study in the municipality of Tromsø, Norway. The Tromsø Eye Study was a part of the sixth survey of the Tromsø Study, conducted from October 2007 through December 2008. The eye examination included information on self-reported eye diseases, assessment of visual acuity and refractive errors, retinal photography and optical coherence tomography. Retinal images were graded for diabetic retinopathy and age-related macular degeneration, and with computer-assisted measurements of arteriolar and venular diameters. In addition, TES researchers have access to the large comprehensive Tromsø Study database including physical examination results, carotid artery ultrasound, electrocardiogram, bone densitometry, cognitive tests, questionnaires, DNA, blood and urine samples and more from the present and the five previous surveys. RESULTS Visual acuity was assessed in 6459 subjects and refraction in 6566 subjects aged 38-87 years. Snellen visual acuity <20/60 was found in 1.2% (95% CI 0.95-1.5) of the participants and there was no gender difference. Visual impairment increased with age, and in the age group 80-87 years, the overall visual acuity <20/60 was 7.3% (95% CI 3.3-11.2). Spherical equivalent showed an increasing trend with age and there was no clinically relevant difference between men and women. Retinal photography was performed in 6540 subjects. CONCLUSION Prevalence of visual impairment was low but increased with age. There was a trend towards hyperopia with age and no clinically relevant difference in refraction between the sexes. TES aims to provide epidemiological research on several eye and eye-related diseases. Owing to a comprehensive data collection, it has the opportunity to explore issues related to environmental factors, cognition and their interaction with diseases in this community.
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Affiliation(s)
- Geir Bertelsen
- Department of Ophthalmology and Neurosurgery, University Hospital of North Norway, Tromsø, NorwayResearch Group of Epidemiology of Chronic Diseases, Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, NorwayBrain and Circulation Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, NorwayDepartment of Ophthalmology, Nordland Hospital, Bodø, NorwayDepartment of Neurology and Neurophysiology, University Hospital of North Norway, Tromsø, NorwayNIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, NHS Foundation Trust, London, UKUCL Institute of Ophthalmology, Head of Reading Centre, London, UKDepartment of Ophthalmology, Odense University Hospital, Odense, Denmark
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Lupton SJ, Chiu CL, Hodgson LAB, Tooher J, Ogle R, Wong TY, Hennessy A, Lind JM. Changes in retinal microvascular caliber precede the clinical onset of preeclampsia. Hypertension 2013; 62:899-904. [PMID: 24019405 DOI: 10.1161/hypertensionaha.113.01890] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preeclampsia is a leading cause of maternal morbidity and mortality. The degree of maternal cardiovascular dysfunction that precedes the onset of preeclampsia is largely unknown. This prospective cohort study aimed to characterize differences in vivo in retinal microvascular caliber and blood pressure throughout pregnancy in relation to preeclampsia development. Women were recruited from Royal Prince Alfred Hospital, Sydney, Australia, of which 92 women were included in the study. Retinal images and blood pressures were collected at 13, 19, 29, and 38 weeks of gestation. Retinal vessels were analyzed as the central retinal arteriolar equivalent corrected for mean arterial blood pressure and the central retinal venular equivalent corrected for mean arterial blood pressure, using generalized linear models adjusted for age and body mass index. The preeclampsia group were significantly older (P=0.002) and had a significantly higher mean body mass index (P=0.005). The central retinal arteriolar equivalent corrected for mean arterial blood pressure was significantly reduced at 13 (P=0.03), 19 (P=0.007), and 38 (P=0.03) weeks of gestation in the preeclampsia group. The central retinal venular equivalent corrected for mean arterial blood pressure was also significantly lower at 13 (P=0.04) and 19 (P=0.001) weeks of gestation in the women who progressed to preeclampsia. This study directly documents increased peripheral resistance in vivo, observed as the combination of constricted retinal arterioles or venules and elevated blood pressure, in women who later developed preeclampsia. This difference preceded the clinical signs of preeclampsia.
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Affiliation(s)
- Samantha J Lupton
- University of Western Sydney, School of Medicine, Locked Bag 1797, Penrith, NSW 2751, Australia.
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Daien V, Carriere I, Kawasaki R, Cristol JP, Villain M, Fesler P, Ritchie K, Delcourt C. Retinal vascular caliber is associated with cardiovascular biomarkers of oxidative stress and inflammation: the POLA study. PLoS One 2013; 8:e71089. [PMID: 23923054 PMCID: PMC3724806 DOI: 10.1371/journal.pone.0071089] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/24/2013] [Indexed: 12/30/2022] Open
Abstract
Purpose Retinal vascular caliber has been linked with increased cardiovascular risk and is predictive of cardiovascular pathology, including stroke and coronary heart disease. Oxidative stress, as well as inflammatory mechanisms, plays a major role in the pathogenesis and progression of atherosclerosis, plaque rupture and vascular thrombotic propensity. The purpose of this study is to explore the relationship between retinal vascular calibers and biomarkers of oxidative stress and inflammation, in subjects free of cardiovascular pathology. Patients and Methods Cross-sectional analysis from a community-dwelling cohort comprising 1224 individuals aged 60 years and over, without a history of coronary or peripheral artery disease or stroke. Retinal vascular caliber was measured from fundus photographs using semi-automated standardized imaging software. Oxidative stress was evaluated using plasma superoxide dismutase 2 and glutathione peroxidase (GPx-3) activities, and inflammatory state was assessed using plasma high sensitivity C-reactive protein (hsCRP) and orosomucoid. Results In a multivariate model controlling for cardiovascular risk factors, larger retinal arteriolar caliber was independently related to higher level of GPx-3 activity (p = 0.003) whereas larger venular caliber was associated with higher levels of hsCRP (p = 0.0001) and orosomucoid (p = 0.01). Conclusion In the present study, biomarkers of oxidative stress regulation and inflammation were independently associated with retinal vascular calibers. This suggests that an assessment of retinal vessels may offer early and non-invasive detection of subclinical vascular pathology.
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Affiliation(s)
- Vincent Daien
- Inserm, U1061, Montpellier, France
- Université Montpellier 1, U1061, Montpellier, France
- Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France
| | - Isabelle Carriere
- Inserm, U1061, Montpellier, France
- Université Montpellier 1, U1061, Montpellier, France
| | - Ryo Kawasaki
- Department of Public Health, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Jean-Paul Cristol
- Department of Biochemistry, Lapeyronie Hospital, Montpellier, France
| | - Max Villain
- Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France
| | - Pierre Fesler
- Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France
| | - Karen Ritchie
- Inserm, U1061, Montpellier, France
- Université Montpellier 1, U1061, Montpellier, France
- Faculty of Medicine, Imperial College, St Mary's Hospital, London, United Kingdom
| | - Cecile Delcourt
- Inserm, Centre Inserm U897-Epidemiologie-Biostatistique, Bordeaux, France
- Université Bordeaux, ISPED, Bordeaux, France
- * E-mail:
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Daien V, Kawasaki R, Villain M, Ribstein J, Du Cailar G, Mimran A, Fesler P. Retinal vascular caliber is associated with renal function in apparently healthy subjects. Acta Ophthalmol 2013; 91:e283-8. [PMID: 23406335 DOI: 10.1111/aos.12094] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To assess the relation between retinal vascular caliber and renal function. PATIENTS AND METHODS Eighty apparently healthy subjects screened for cardiovascular risk factors (mean age 47 years, 51% female, 36% hypertensive, without diabetes or renal dysfunction) were recruited. Retinal vascular calibers were measured from fundus photographs and expressed as central retinal artery and venular equivalent. Renal function was assessed by measurement of glomerular filtration rate (urinary clearance of 99mTc-DTPA) and urinary albumin/creatinine ratio. RESULTS Mean glomerular filtration rate was 117 ml/min/1.73m(2). Overall, central retinal artery and venular equivalent were positively correlated with glomerular filtration rate (r = +0.31, p = 0.005 and r = +0.30, p = 0.006, respectively). In addition, central retinal artery equivalent was negatively correlated with urinary albumin/creatinine ratio (r = -0.34, p = 0.002). No significant relationship was found between central retinal venular equivalent and urinary albumin/creatinine ratio (r = +0.12, p = 0.32). The observed relations between retinal vascular calibers and renal function parameters remained significant after adjusting for potential confounding factors. CONCLUSION In apparently healthy subjects with normal renal function, retinal arteriolar and venular calibers were negatively correlated with kidney function, suggesting common determinants of these preclinical target organ damages.
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Affiliation(s)
- Vincent Daien
- Department of Opthalmology, Hôpital Gui de Chauliac, Montpellier, France.
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Lupton SJ, Chiu CL, Hodgson LA, Tooher J, Lujic S, Ogle R, Wong TY, Hennessy A, Lind JM. Temporal Changes in Retinal Microvascular Caliber and Blood Pressure During Pregnancy. Hypertension 2013; 61:880-5. [DOI: 10.1161/hypertensionaha.111.00698] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The microvasculature plays an important role in regulating cardiovascular changes in pregnancy, but changes in microvasculature have been difficult to document in vivo. This study objectively quantifies changes in the maternal retinal arteriolar and venular caliber over the course of healthy pregnancy. Healthy pregnant women (n=53) were recruited from Royal Prince Alfred Hospital, Sydney, Australia. Retinal images and mean arterial blood pressures (MAP) were collected at 13, 19, 29, and 38 weeks of gestation and at 6-month postpartum. Retinal vessels were analyzed and summarized as the central retinal arteriolar equivalent and central retinal venular equivalent. Central retinal arteriolar equivalent and central retinal venular equivalent were corrected for MAP. Paired
t
tests were performed comparing consecutive time points, with a significance level of
P
<0.01. There was a decrease in MAP between 13- and 19-week gestation (
P
=0.001) followed by a return to baseline from 19 weeks to delivery. This was correlated by an increase in vessel caliber between 13- and 19-week gestation (central retinal arteriolar equivalent:
P
<0.001, central retinal venular equivalent:
P
=0.007) and a return to baseline from 19 weeks to delivery. There were no differences in the central retinal arteriolar equivalent or central retinal venular equivalent (both uncorrected and corrected for MAP) between nulliparous and parous women. The pattern of dilatation and constriction in the microvasculature mirrored the changes in MAP throughout pregnancy, reflecting changes in peripheral resistance. This study provides insights into physiological changes in the microvasculature throughout a healthy pregnancy. These results can be used as a baseline with which to compare the changes observed in pathological conditions of pregnancy.
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Affiliation(s)
- Samantha J. Lupton
- From the University of Western Sydney, School of Medicine, NSW, Australia (S.J.L., C.L.C., S.L., A.H., J.M.L.); Centre for Eye Research Australia, University of Melbourne, VIC, Australia (L.A.B.H., T.Y.W.); Royal Prince Alfred Hospital, NSW, Australia (J.T., R.O.); and Singapore Eye Research Institute, National University of Singapore, Singapore (T.Y.W.)
| | - Christine L. Chiu
- From the University of Western Sydney, School of Medicine, NSW, Australia (S.J.L., C.L.C., S.L., A.H., J.M.L.); Centre for Eye Research Australia, University of Melbourne, VIC, Australia (L.A.B.H., T.Y.W.); Royal Prince Alfred Hospital, NSW, Australia (J.T., R.O.); and Singapore Eye Research Institute, National University of Singapore, Singapore (T.Y.W.)
| | - Lauren A.B. Hodgson
- From the University of Western Sydney, School of Medicine, NSW, Australia (S.J.L., C.L.C., S.L., A.H., J.M.L.); Centre for Eye Research Australia, University of Melbourne, VIC, Australia (L.A.B.H., T.Y.W.); Royal Prince Alfred Hospital, NSW, Australia (J.T., R.O.); and Singapore Eye Research Institute, National University of Singapore, Singapore (T.Y.W.)
| | - Jane Tooher
- From the University of Western Sydney, School of Medicine, NSW, Australia (S.J.L., C.L.C., S.L., A.H., J.M.L.); Centre for Eye Research Australia, University of Melbourne, VIC, Australia (L.A.B.H., T.Y.W.); Royal Prince Alfred Hospital, NSW, Australia (J.T., R.O.); and Singapore Eye Research Institute, National University of Singapore, Singapore (T.Y.W.)
| | - Sanja Lujic
- From the University of Western Sydney, School of Medicine, NSW, Australia (S.J.L., C.L.C., S.L., A.H., J.M.L.); Centre for Eye Research Australia, University of Melbourne, VIC, Australia (L.A.B.H., T.Y.W.); Royal Prince Alfred Hospital, NSW, Australia (J.T., R.O.); and Singapore Eye Research Institute, National University of Singapore, Singapore (T.Y.W.)
| | - Robert Ogle
- From the University of Western Sydney, School of Medicine, NSW, Australia (S.J.L., C.L.C., S.L., A.H., J.M.L.); Centre for Eye Research Australia, University of Melbourne, VIC, Australia (L.A.B.H., T.Y.W.); Royal Prince Alfred Hospital, NSW, Australia (J.T., R.O.); and Singapore Eye Research Institute, National University of Singapore, Singapore (T.Y.W.)
| | - Tien Yin Wong
- From the University of Western Sydney, School of Medicine, NSW, Australia (S.J.L., C.L.C., S.L., A.H., J.M.L.); Centre for Eye Research Australia, University of Melbourne, VIC, Australia (L.A.B.H., T.Y.W.); Royal Prince Alfred Hospital, NSW, Australia (J.T., R.O.); and Singapore Eye Research Institute, National University of Singapore, Singapore (T.Y.W.)
| | - Annemarie Hennessy
- From the University of Western Sydney, School of Medicine, NSW, Australia (S.J.L., C.L.C., S.L., A.H., J.M.L.); Centre for Eye Research Australia, University of Melbourne, VIC, Australia (L.A.B.H., T.Y.W.); Royal Prince Alfred Hospital, NSW, Australia (J.T., R.O.); and Singapore Eye Research Institute, National University of Singapore, Singapore (T.Y.W.)
| | - Joanne M. Lind
- From the University of Western Sydney, School of Medicine, NSW, Australia (S.J.L., C.L.C., S.L., A.H., J.M.L.); Centre for Eye Research Australia, University of Melbourne, VIC, Australia (L.A.B.H., T.Y.W.); Royal Prince Alfred Hospital, NSW, Australia (J.T., R.O.); and Singapore Eye Research Institute, National University of Singapore, Singapore (T.Y.W.)
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Influence of blood pressure and body mass index on retinal vascular caliber in preschool-aged children. J Hum Hypertens 2013; 27:523-8. [PMID: 23448844 DOI: 10.1038/jhh.2013.15] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 01/06/2013] [Accepted: 01/16/2013] [Indexed: 11/08/2022]
Abstract
We assessed the associations between body mass index (BMI) and blood pressure (BP) with the retinal microvasculature among preschool-aged children. Three hundred and seventy-nine children aged 3-<6 years old had gradable retinal photographs, and quantifiable retinal vascular caliber using validated computer-based methods. Weight, height, BMI, waist circumference and BP were obtained using standardized protocols. Mean (±s.d.) BMI and systolic BP in preschool-aged children were 16.0 (±1.8) kg m(-2) and 93.2 (±9.9) mm Hg, respectively. After multivariable adjustment, each kg m(-2) increase in BMI was associated with a 1.06 μm narrowing of retinal arteriolar caliber (P=0.01) and 1.12 μm widening of retinal venular caliber (P=0.02). Children in the 95th percentile (obese) compared with those in the <85th percentile (healthy weight) had narrower retinal arteriolar caliber (∼6.1 μm, Ptrend=0.01) and wider retinal venular caliber (∼6.4 μm, Ptrend=0.01). Each 10 mm Hg increase in systolic BP was associated with a 1.70 μm narrower retinal arteriolar caliber (multivariable-adjusted P=0.02). We show that BMI and systolic BP have inverse linear associations with retinal arteriolar caliber, and BMI has a positive linear association with retinal venular caliber during early childhood. These findings suggests that the influence of BP and BMI on small vessels are continuous and commence early in life.
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Burgansky-Eliash Z, Lowenstein A, Neuderfer M, Kesler A, Barash H, Nelson DA, Grinvald A, Barak A. The Correlation Between Retinal Blood Flow Velocity Measured by the Retinal Function Imager and Various Physiological Parameters. Ophthalmic Surg Lasers Imaging Retina 2013; 44:51-8. [DOI: 10.3928/23258160-20121221-13] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Accepted: 05/23/2012] [Indexed: 12/19/2022]
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Associations between metabolic syndrome and syndrome components and retinal microvascular signs in a rural Chinese population: the Handan Eye Study. Graefes Arch Clin Exp Ophthalmol 2012; 250:1755-63. [PMID: 22948948 DOI: 10.1007/s00417-012-2109-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 06/14/2012] [Accepted: 07/01/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Our purpose was to determine the relationship of metabolic syndrome (MetS) and its components with retinal microvascular abnormalities in a rural Chinese population. METHODS The Handan Eye Study, a population-based survey, recruited 6,830 (90.4 % of eligible) rural Chinese ≥30 years of age. A diagnosis of metabolic syndrome was based on the International Diabetes Federation definition. Retinal microvascular signs and arteriolar and venular diameters were assessed from fundus photographs by graders who were trained at the Retinal Vascular Imaging Centre, University of Melbourne. RESULTS After adjusting for age, gender, and smoking status, 5,519 participants with MetS, or with the specific components of large waist circumference, elevated blood pressure (BP), or elevated fasting blood glucose (FG), were more likely to have retinopathy, arteriovenous nicking, focal arteriolar narrowing, enhanced arteriolar wall reflex, and generalized retinal arteriolar narrowing than those without MetS or the corresponding component. Individuals with elevated triglycerides were significantly more likely to have arteriovenous nicking and retinopathy. CONCLUSION These results show that individual components of MetS are associated with different retinal microvascular signs and with changes in retinal arteriolar and venular diameters.
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Association of dilated retinal arteriolar caliber with early age-related macular degeneration: the Handan Eye Study. Graefes Arch Clin Exp Ophthalmol 2011; 250:741-9. [DOI: 10.1007/s00417-011-1824-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 08/17/2011] [Accepted: 09/06/2011] [Indexed: 10/17/2022] Open
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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.
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Affiliation(s)
- Jakob Grauslund
- Faculty of Health Science, University of Southern Denmark, Odense, Denmark.
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TANABE YUSUKE, KAWASAKI RYO, WANG JIEJIN, WONG TIENYIN, MITCHELL PAUL, DAIMON MAKOTO, OIZUMI TOSHIHIDE, KATO TAKEO, KAWATA SUMIO, KAYAMA TAKAMASA, YAMASHITA HIDETOSHI. Retinal Arteriolar Narrowing Predicts 5-Year Risk of Hypertension in Japanese People: The Funagata Study. Microcirculation 2010; 17:94-102. [DOI: 10.1111/j.1549-8719.2009.00006.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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.
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Affiliation(s)
- J Grauslund
- Department of Ophthalmology, Odense University Hospital, Denmark.
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Wang JJ, Rochtchina E, Liew G, Tan AG, Wong TY, Leeder SR, Smith W, Shankar A, Mitchell P. The long-term relation among retinal arteriolar narrowing, blood pressure, and incident severe hypertension. Am J Epidemiol 2008; 168:80-8. [PMID: 18469315 DOI: 10.1093/aje/kwn100] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The authors assessed associations between retinal vascular signs and incident severe hypertension in an older population-based cohort. At baseline (1992-1994), 3,654 residents aged 49-97 years living in the Blue Mountains area west of Sydney, Australia, were examined; respectively, 2,335 (75.1%) and 1,952 (76%) survivors were reexamined 5 and 10 years later. Retinal arteriolar and venular calibers were measured, and average central retinal artery and central retinal vein equivalents for that eye were estimated. Severe hypertension was defined by previous diagnosis of hypertension plus antihypertensive medication use or by systolic blood pressure > or =160 mmHg and/or diastolic blood pressure > or =100 mmHg at examinations. Of the 1,424 participants at risk, 618 developed severe hypertension over 10 years (cumulative incidence = 47.7%, 95% confidence interval: 44.9, 50.5). Participants who subsequently developed severe hypertension had significantly narrower mean central retinal artery equivalents than those who did not (187.0 vs. 191.9 mum, p < 0.0001). After adjusting for age, sex, body mass index, smoking, mean arterial blood pressure, and plasma glucose and triglyceride levels, baseline narrowing central retinal artery equivalent was associated with increased risk of severe hypertension (per standard deviation reduction, odds ratio = 1.1, 95% confidence interval: 1.1, 1.2; narrowest vs. widest quintile, odds ratio = 1.6, 95% confidence interval: 1.2, 2.1). These findings support structural narrowing in small arteries and arterioles antecedent to clinical onset of severe hypertension.
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Affiliation(s)
- Jie Jin Wang
- Centre for Vision Research, Department of Ophthalmology and the Westmead Millennium Institute, University of Sydney, Sydney, Australia.
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Wang JJ, Liew G, Klein R, Rochtchina E, Knudtson MD, Klein BEK, Wong TY, Burlutsky G, Mitchell P. Retinal vessel diameter and cardiovascular mortality: pooled data analysis from two older populations. Eur Heart J 2007; 28:1984-92. [PMID: 17626032 DOI: 10.1093/eurheartj/ehm221] [Citation(s) in RCA: 230] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
AIMS The retinal microvasculature may reflect pre-clinical changes in the cerebral and coronary microcirculations. We assessed whether smaller retinal arterioles and larger venules predicted coronary heart disease (CHD)- and stroke-mortality. METHODS AND RESULTS We pooled data from the Beaver Dam Eye Study (n = 4926, aged 43-86) and the Blue Mountains Eye Study (n = 3654, aged 49-97). Retinal vessel diameters were measured from digitized retinal photographs. Change point models were used to assess and document the existence of threshold effects. We defined smaller arterioles as diameters within the narrowest quintile and larger venules as diameters within the widest quintile, with other quintiles as the reference. Of 8550 participants, 7494 (88%) with complete data were included, of whom 653 died from CHD and 299 from stroke over 10-12 years follow-up. After multivariable adjustment, each standard deviation (SD) increase in arteriolar diameter, or SD decrease in venular diameter, was not found to be significantly associated with either CHD-mortality or stroke-mortality. However, smaller arterioles [hazard ratio (HR) 1.34, 95% confidence interval (CI) 1.11-1.62] and larger venules (HR 1.24, CI 1.02-1.52), predicted increased risk of CHD-mortality. These associations were mainly evident among persons aged 43-69 (smaller arterioles: HR 1.70, CI 1.27-2.28; larger venules: HR 1.41, CI 1.06-1.89). Smaller arterioles (HR 1.64, CI 1.00-2.67) and larger venules (HR 1.53, CI 0.94-2.47) were also associated with an increased risk of stroke-mortality among persons aged 43-69. CONCLUSION Retinal vessel diameter may predict risk of CHD and stroke deaths in middle-aged persons.
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Affiliation(s)
- Jie Jin Wang
- Centre for Vision Research, Department of Ophthalmology, Westmead Hospital, and The Westmead Millennium Institute, University of Sydney, Australia.
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Cheung N, Saw SM, Islam FMA, Rogers SL, Shankar A, de Haseth K, Mitchell P, Wong TY. BMI and retinal vascular caliber in children. Obesity (Silver Spring) 2007; 15:209-15. [PMID: 17228049 DOI: 10.1038/oby.2007.576] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE In adult populations, changes in retinal vascular caliber have been linked with obesity and metabolic syndrome. We examined the association of BMI and weight with retinal vascular caliber in children. RESEARCH METHODS AND PROCEDURES This was a school-based, cross-sectional study of 768 children, 7 to 9 years old, randomly sampled from the Singapore Cohort Study of the Risk Factors for Myopia. Participants had digital retinal photographs. Retinal vascular caliber was measured using a computer-based program and combined to provide average calibers of arterioles and venules in that eye. Weight and height were measured using standardized protocol. These data were used to calculate BMI. RESULTS In this population, the mean retinal arteriolar and venular calibers were 156.40 microm [95% confidence interval (CI), 155.44 to 157.36] and 225.43 microm (95% CI, 224.10 to 226.74) respectively. After controlling for age, gender, race, parental monthly income, axial length, birth weight, and birth length, each 3.1 kg/m2 (standard deviation) increase in BMI was associated with a 2.55-microm (95% CI, 1.21 to 3.89; p < 0.001) larger retinal venular caliber. In multivariable analysis, greater weight was also significantly associated with larger retinal venular caliber. BMI and weight were not associated with retinal arteriolar caliber. Height was not significantly associated with retinal arteriolar or venular caliber. DISCUSSION Greater BMI and weight are associated with larger retinal venular caliber in healthy children.
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Affiliation(s)
- Ning Cheung
- Centre for Eye Research Australia, University of Melbourne, 32 Gisborne Street, Victoria 3002, Australia
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