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Klyscz P, Ihl T, Laumeier I, Steinicke M, Endres M, Michelson G, Audebert HJ. Retinal microvascular signs and recurrent vascular events in patients with TIA or minor stroke. Stroke Vasc Neurol 2023; 8:379-386. [PMID: 36858463 PMCID: PMC10647888 DOI: 10.1136/svn-2022-001784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/05/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND AND PURPOSE Retinal pathologies are an independent risk factor for ischaemic stroke, but research on the predictive value of retinal abnormalities for recurrent vascular events in patients with prior stroke is inconclusive. We investigated the association of retinal pathologies with subsequent vascular events. METHODS In a substudy of the Intensified secondary prevention intending a reduction of recurrent events in TIA and minor stroke patients (INSPiRE-TMS) trial, we enrolled patients with recent transient ischaemic attack (TIA) or minor stroke with at least one modifiable risk factor. Primary outcome was the composite of subsequent vascular events. Retinal photographs were taken at baseline and categorised into three different fundus groups by a telemedically linked ophthalmologist. RESULTS 722 patients participated in the current study and 109 major vascular events occurred. After multivariable adjustments, we did not find a significant association between fundus categories and risk for subsequent vascular events (HRs for moderate vascular retinopathy and vascular retinopathy with vessel rarefaction in comparison to no vascular retinopathy 1.03 (95% CI 0.64 to 1.67), p=0.905 and 1.17 (95% CI 0.62 to 2.20), p=0.626). In a selective post hoc analysis in patients with diabetes mellitus and hypertension, patients with vascular retinopathy with vessel rarefaction had a higher risk for recurrent stroke (HR 24.14 (95% CI 2.74 to 212.50), p=0.004). CONCLUSIONS Retinal changes did not predict major subsequent vascular events in patients with recent TIA or minor stroke. Further studies are needed to examine the utility of fundus photography in assessing the risk of stroke recurrence in patients with diabetes mellitus and hypertension.
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Affiliation(s)
- Philipp Klyscz
- Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Ihl
- Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Inga Laumeier
- Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Matthias Endres
- Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Excellence Cluster NeuroCure, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases, partner site Berlin, Germany
- German Center for Cardiovascular Research, partner site Berlin, Germany
| | - Georg Michelson
- Ophthalmology, Friedrich-Alexander-Universität Erlangen-Nürnberg Medizinische Fakultät, Erlangen, Germany
- Talkingeyes & More GmbH, Erlangen, Germany
| | - Heinrich J Audebert
- Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Sprödhuber A, Wolz J, Budai A, Laumeier I, Audebert HJ, Michelson G. The Role of Retinal Vascular Density as a Screening Tool for Ageing and Stroke. Ophthalmic Res 2018; 60:1-8. [PMID: 29874669 DOI: 10.1159/000488491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 03/14/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To measure the density of retinal vessels from digitized fundus photographs in patients with recent stroke and age-matched controls. To investigate whether the parameter retinal vascular density (RVD) served as a quantitative marker for cerebrovascular events. METHODS Digitized fundus photographs of n = 158 subjects with stroke or transient ischemic attack within 1 year at the time of examination and n = 1,250 age-matched controls without any remarkable medical history were examined. Sex, hypertension, and diabetes were considered to be cofactors. Measurement of RVD was performed with a computer-aided image-analyzing program by segmenting automatically all visible retinal vessels and measuring areas of vessels in distinct circles around the optic disk. RESULTS In controls RVD dwindles with increasing distance from the optic disk. RVD decreased significantly with age (p = 0.000). Stroke patients showed significantly lower values of RVD of -15% in comparison to age-matched controls. In old subjects, stroke in combination with hypertension is associated with a significant decreased RVD, and in middle-aged subjects diabetes and stroke are associated with a significant decreased RVD (p = 0.01). CONCLUSION Age and stroke are significant risk factors for decreased RVD. Diabetes and arterial hypertension are additional significant risk factors in patients with stroke with respect to RVD.
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Affiliation(s)
- Andrea Sprödhuber
- Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Johannes Wolz
- Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Attila Budai
- Pattern Recognition Lab and Graduate School in Advanced Optical Technologies, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Inga Laumeier
- Center for Stroke Research Berlin, Department of Neurology, Charité Berlin, Berlin, Germany
| | - Heinrich J Audebert
- Center for Stroke Research Berlin, Department of Neurology, Charité Berlin, Berlin, Germany
| | - Georg Michelson
- Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Interdisciplinary Center of Ophthalmic Preventive Medicine and Imaging, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Talkingeyes & More GmbH, Medical Valley Center, Erlangen, Germany
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Wolz J, Audebert H, Laumeier I, Ahmadi M, Steinicke M, Ferse C, Michelson G. Telemedical assessment of optic nerve head and retina in patients after recent minor stroke or TIA. Int Ophthalmol 2016; 37:39-46. [PMID: 27016938 DOI: 10.1007/s10792-016-0222-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 03/16/2016] [Indexed: 11/26/2022]
Abstract
The aim of the study is to telemedically assess the prevalence of simple optic nerve atrophy and retinal arteriolar anomalies in subjects who have had a minor stroke or TIA within 14 days, and to compare these results with an age-matched control group. By using a mobile examination unit, retinal photographs were taken with a 45° non-mydriatic colour fundus camera (KOWA NM-45, non-mydriatic-alpha) in patients who had suffered from a minor stroke or TIA within 14 days of the time of the examination. Retinal photographs were focused on the optic nerve head region. Pupils were not dilated. The documented medical history and the retinal images were stored on a server using browser independent web-based software running on PCs, tablets and smartphones. After completing the upload of the medical interview and the retinal images into the electronic patient chart, all retinal images were evaluated via telemedicine by an experienced senior consultant ophthalmologist. Age-matched normotensive, non-diabetic subjects (aged 40-89 years) who reported no systemic or ocular diseases were used as the control group. Both study groups were divided into five decades of life (40-49; 50-59; 60-69; 70-79; 80-89 years). We calculated the prevalences and the ratios of prevalences of optic nerve atrophy and retinal arteriolar anomalies between the stroke and the control group per decades of life. 139 minor stroke or TIA subjects (aged 40-89 years) and 1611 age-matched control subjects were examined. In the stroke group, we found significantly increased prevalences of optic nerve atrophy and retinal arteriolar anomalies throughout the 5th-8th decade of life when compared to age-matched controls. The prevalence of optic nerve atrophy in stroke subjects outranged the prevalence in the controls depending on age-class by a factor of 3-21. Simple optic nerve atrophy is frequent in patients who have suffered from an ischemic stroke or TIA, and it seems to indicate vascular damage, indicating the necessity for telemedically assisted assessment of the optic nerve.
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Affiliation(s)
- Johannes Wolz
- Department of Ophthalmology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Heinrich Audebert
- Department of Neurology, Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Inga Laumeier
- Department of Neurology, Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Michael Ahmadi
- Department of Neurology, Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Maureen Steinicke
- Department of Neurology, Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Caroline Ferse
- Department of Neurology, Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Georg Michelson
- Department of Ophthalmology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Interdisciplinary Centre of Ophthalmic Preventive Medicine and Imaging, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Measurement of retinal wall-to-lumen ratio by adaptive optics retinal camera: a clinical research. Graefes Arch Clin Exp Ophthalmol 2015; 253:1985-95. [DOI: 10.1007/s00417-015-3115-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 04/21/2015] [Accepted: 07/18/2015] [Indexed: 10/23/2022] Open
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Jürgens C, Völzke H, Tost F. [Study of health in Pomerania (SHIP-Trend): : Important aspects for healthcare research in ophthalmology]. Ophthalmologe 2015; 111:443-7. [PMID: 24838865 DOI: 10.1007/s00347-013-2924-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epidemiological studies continue to receive growing attention in health services research. OBJECTIVES How can ophthalmological health services research benefit from the Study of Health in Pomerania (SHIP)? METHODS The SHIP is a population-based, epidemiological project conducted in the northeast of Germany. In 1997 a random sample of 6,265 eligible subjects was enrolled for the first SHIP cohort. Between 1997 and 2001 baseline examinations were performed, followed by 5-year follow-up from 2002 to 2006, from 2008 to 2012 and from 2014. A second independent sample of 8,016 eligible subjects was enrolled in 2008. Baseline examinations of this new cohort (SHIP-Trend) were conducted between 2008 and 2012 and the first follow-up is scheduled for 2015. Included in SHIP are a large variety of different assessments including eye examinations. All participants are subjected to non-mydriatic funduscopy and static vessel analysis (SVA). RESULTS A total number of 4,420 subjects participated in the interdisciplinary baseline examinations of SHIP-Trend. Standardized fundus photography was performed with a non-mydriatic camera in 3,934 subjects. CONCLUSION Estimations of the prevalence of major eye diseases may provide valid indicators for healthcare provision within healthcare research. New concepts of prevention with a strengthened integration of ophthalmological diagnostics can be identified from the widespread spectrum of different healthcare examinations. Regional differences in the efficiency of healthcare provision can be evaluated with comparative studies between different German populations.
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Affiliation(s)
- C Jürgens
- Institut für Community Medicine, Study of Health in Pomerania (SHIP), Universitätsmedizin Greifswald, Walter Rathenau Str. 48, 17475, Greifswald, Deutschland,
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Jürgens C, Ittermann T, Völzke H, Tost F. Comparison of Two Non-mydriatic Fundus Cameras to Obtain Retinal Arterio-venous Ratio. Ophthalmic Epidemiol 2014; 21:333-8. [DOI: 10.3109/09286586.2014.949352] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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[Electronic patient records and teleophthalmology. Part 2: concrete projects in ophthalmology]. Ophthalmologe 2011; 108:687-95; quiz 696. [PMID: 21796511 DOI: 10.1007/s00347-011-2353-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Electronic storage of patient-related data will replace paper-based patient records in the near future. Because of the high visualization needed in ophthalmology integrated electronic data storage and usage will be very useful. Chronic diseases like glaucoma, macular degeneration and diabetic retinopathy would benefit from long-term data storage and analysis. Unfortunately there are nearly no widely accepted systems available providing these options. Another important point is the simplification of existing diagnostic procedures and nomenclature on an international level. Increasing mobility of patients requires a better portability of existing medical examination data between different physicians. This is the only way to provide continuously high levels of quality in patient care and to simultaneously reduce costs and prevent unnecessary secondary examinations.
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Schargus M, Michelson G, Grehn F. [Electronic patient records and teleophthalmology : part 1: introduction to the various systems and standards]. Ophthalmologe 2011; 108:473-84. [PMID: 21590353 DOI: 10.1007/s00347-010-2314-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Electronic storage of patient-related data will replace paper-based patient records in the near future. Some steps in medical practice can even now not be achieved without electronic data processing. Both systems, conventional paper-based and electronic-based records, have advantages and disadvantages which have to be taken into consideration. The advantages of electronic-based records are e.g. good availability of data, structured storage of data, scientific analysis of long-term data and possible data exchange with colleagues in the context of teleconsultation systems. Problems have to be solved in the field of data security, initial high investment costs and time consumption in learning to use the system as well as in incompatibility of existing IT systems.
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Affiliation(s)
- M Schargus
- Universitäts Augenklinik Würzburg, Deutschland.
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