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Drachmann J, Jeppesen SK, Bek T. Increased Oxygen Saturation in Retinal Venules During Isometric Exercise Is Accompanied With Increased Peripheral Blood Flow in Normal Persons. Invest Ophthalmol Vis Sci 2023; 64:25. [PMID: 37847224 PMCID: PMC10593131 DOI: 10.1167/iovs.64.13.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023] Open
Abstract
Purpose A recent study has shown that an increase in the arterial blood pressure of approximately 10 mm Hg in healthy persons can increase the oxygen saturation in venules from the retinal periphery but not from the macular area. The purpose of the present study was to investigate whether a higher increase in blood pressure has further effects on oxygen saturations and whether this is accompanied with changes in retinal blood flow. Methods In 30 healthy persons, oxygen saturation, diameter, and blood flow were measured in arterioles to and venules from the retinal periphery and the macular area. The experiments were performed before and during an experimental increase in arterial blood pressure of (mean ± SD) 18.3 ± 6.2 mm Hg. Results A higher number of venules than arterioles branching from the temporal vascular arcades to the macular area was balanced by a smaller diameter of the venules. Isometric exercise induced significant contraction of both peripheral and macular arterioles (P < 0.01 for both comparisons) and significant increase in oxygen saturation in both peripheral and macular venules (P < 0.001 for both comparisons). This was accompanied with a significant increase in the blood flow in the peripheral arterioles and venules (P = 0.4 for both comparisons), but not in their macular counterparts (P > 0.06 for both comparisons). Conclusions Increased systemic blood pressure leading to arterial contraction and increased venous oxygen saturation in the retina in normal persons can increase peripheral blood flow without significant effects on macular blood flow. This may contribute to explaining regional differences in the response pattern of retinal vascular disease.
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Affiliation(s)
- Jacob Drachmann
- Department of Ophthalmology, Aarhus University Hospital, Aarhus N, Aarhus, Denmark
| | | | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus N, Aarhus, Denmark
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Zhao G, Xu X, Yu X, Sun F, Yang A, Jin Y, Huang J, Wei J, Gao B. Comprehensive retinal vascular measurements: time in range is associated with peripheral retinal venular calibers in type 2 diabetes in China. Acta Diabetol 2023; 60:1267-1277. [PMID: 37277658 DOI: 10.1007/s00592-023-02120-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/14/2023] [Indexed: 06/07/2023]
Abstract
AIM Retinal vascular parameters are biomarkers of diabetic microangiopathy. We aimed to investigate the relationship between time in range (TIR) assessed by continuous glucose monitoring (CGM) and retinal vascular parameters in patients with type 2 diabetes in China. METHODS The TIR assessed by CGM and retinal photographs were obtained at the same time from adults with type 2 diabetes who were recruited. Retinal vascular parameters were extracted from retinal photographs by a validated fully automated computer program, and TIR was defined as between 3.9-7.8 mmol/L over a 24-h period. The association between TIR and caliber of retinal vessels distributed in different zones were analyzed using multivariable linear regression analyses. RESULTS For retinal vascular parameters measurements, the peripheral arteriovenous and middle venular calibers widen with decreasing TIR quartiles (P < 0.05). Lower TIR was associated with wider peripheral venule after adjusting for potential confounders. Even after further correction for GV, there was still a significant correlation between TIR and peripheral vascular calibers (CV: β = - 0.015 [- 0.027, - 0.003], P = 0.013; MAGE: β = - 0.013 [- 0.025, - 0.001], P = 0.038) and SD: β = - 0.013 [- 0.026, - 0.001], P = 0.004). Similar findings were not found for the middle and central venular calibers or arterial calibers located in different zones. CONCLUSIONS The TIR was associated with adverse changes to peripheral retinal venules but not central and middle vessels in patients with type 2 diabetes, suggesting that peripheral retinal vascular calibers may be affected by glycemic fluctuations earlier.
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Affiliation(s)
- Guohong Zhao
- Department of Endocrinology, Shaanxi Province, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, People's Republic of China
| | - Xiayu Xu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
- Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
| | - Xinwen Yu
- Department of Endocrinology, Shaanxi Province, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, People's Republic of China
| | - Fei Sun
- Department of Endocrinology, Shaanxi Province, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, People's Republic of China
| | - Aili Yang
- Department of Endocrinology, Shaanxi Province, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, People's Republic of China
| | - Yuxin Jin
- Department of Endocrinology, Shaanxi Province, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, People's Republic of China
| | - Jing Huang
- Department of Health Management, Shaanxi Province, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, People's Republic of China
| | - Jing Wei
- Department of Endocrinology, Shaanxi Province, Xi'an Gaoxin Hospital, Xi'an, 710100, People's Republic of China.
| | - Bin Gao
- Department of Endocrinology, Shaanxi Province, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, People's Republic of China.
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Petersen L, Aalkjaer C, Bek T. Vasomotion in Retinal Arterioles Is Modified by Exercise and Flicker Stimulation. Invest Ophthalmol Vis Sci 2022; 63:7. [PMID: 36478197 PMCID: PMC9733652 DOI: 10.1167/iovs.63.13.7] [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: 12/13/2022] Open
Abstract
PURPOSE Vasomotion is spontaneous oscillations in the diameter of resistance vessels with derived effects on blood flow, and it has been proposed that disturbances in vasomotion may be involved in retinal vascular disease. The purpose of this study was to investigate whether retinal vasomotion shows regional variation and is modified by activated autoregulation. METHODS Video recordings of the diameter of retinal arterioles previously obtained from 55 normal persons were subjected to Fourier analysis to characterize the frequencies and propagation of spontaneous diameter changes in retinal arterioles. The analyses were performed on peripapillary temporal retinal arterioles, on arteriolar branches toward the macular area and the retinal periphery, and were performed during rest, during an increase in the arterial blood pressure induced by isometric exercise, and during increased retinal metabolism induced by flickering light. RESULTS There was no propagation of diameter changes along the studied vascular segments. Isometric exercise constricted the arterioles significantly by (mean ± SD) 1.76% ± 3.56% (P = 0.02) and increased the power of diameter oscillations at very low frequencies (0.1-1.4 c/min). Flicker stimulation dilated the arterioles significantly by (mean ± SD) 5.10% ± 2.91% (P < 0.0001) and reduced the power of diameter oscillations at all but the very low frequencies (P < 0.006 for all comparisons). Flicker-induced dilation and changes in hydraulic conductance were lower in peripheral than in macular arterioles. CONCLUSIONS Retinal vasomotion in normal persons increases during increased arterial blood pressure and decreases during flicker stimulation. The findings may act as a basis for the study of vasomotion in retinal vascular disease.
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Affiliation(s)
- Line Petersen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Aalkjaer
- Institute for Biomedicin (Physiology), Aarhus University, Aarhus, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
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Jeppesen SK, Bek T. Lack of predictive value of retinal oxygen saturation for visual outcome after angiostatic treatment of branch retinal vein occlusion. Acta Ophthalmol 2022; 100:e737-e742. [PMID: 34318599 DOI: 10.1111/aos.14988] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Previous studies have shown that the retinal oxygen saturation in central retinal vein occlusion treated with anti-VEGF compound has no predictive value for visual outcome after 12 months. It is of interest to evaluate whether this conclusion is similar for patients with branch retinal vein occlusion among whom only some patients are treated. METHODS Retinal oxygen saturation, visual acuity and central retinal thickness were studied at the time of referral and after six and 12 months in 111 patients successively referred to the Department of Ophthalmology, Aarhus University Hospital, with a venous occlusion affecting branches peripheral from the central retinal venule. The predictive value of the oxygen saturation at referral was investigated in treated and untreated patients. RESULTS Seventy-three patients with visual acuity between 35 and 70 ETDRS letters at referral were treated with intravitreal injection of anti-VEGF compound. Over 12 months, the venous oxygen saturation improved in parallel with central retinal thickness and visual acuity but had no predictive value for visual outcome. In 12 untreated patients with visual acuity >70 ETDRS letters, younger age and high oxygen saturation at the time of referral were positive predictors for the visual outcome after 12 months. CONCLUSION Oxygen saturation, visual acuity and central retinal thickness improve in parallel during treatment of branch retinal vein occlusion with intravitreal anti-VEGF medication. Retinal oximetry at referral cannot predict visual acuity after 12 months in treated patients but may perhaps become a tool for predicting the visual prognosis in a subgroup of patients where treatment is omitted because of a too high visual acuity at the time of diagnosis of the disease.
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Affiliation(s)
- Signe Krejberg Jeppesen
- Department of Ophthalmology Aarhus University Hospital Aarhus N Denmark
- Department of Clinical Medicine Aarhus University Aarhus N Denmark
| | - Toke Bek
- Department of Ophthalmology Aarhus University Hospital Aarhus N Denmark
- Department of Clinical Medicine Aarhus University Aarhus N Denmark
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Mlčák P, Chlup R, Kudlová P, Krystyník O, Král M, Kučerová V, Spurná J, Titzová S, Hübnerová P, Vláčil O, Šínová I, Karhanová M, Zapletalová J, Šín M. Retinal oxygen saturation is associated with HbA1c but not with short-term diabetes control, internal environment, smoking and mild retinopathy - ROXINEGLYD study. Acta Ophthalmol 2022; 100:e142-e149. [PMID: 33742561 DOI: 10.1111/aos.14853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 01/20/2021] [Accepted: 02/27/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Purpose of this prospective uncontrolled single-centre pilot study was to find an association of retinal oxygen saturation (SatO2 ) with acid-base balance (ABB), carboxyhaemoglobin concentration, current plasma glucose concentration (PG), mean PG and PG variability over the last 72 hr, haemoglobin A1c (HbA1c), and other conditions. METHODS Forty-one adults (17 men) with type 1 (N = 14) or type 2 (N = 27) diabetes mellitus, age 48.6 ± 13.5 years, diabetes duration 9 (0.1-36) years, BMI 29.4 ± 6.3 kg/m2 , and HbA1c 52 ± 12.7 mmol/mol completed the study. The 4-day study comprised two visits (Day l, Day 4) including 72 hr of continuous glucose monitoring (CGM) by iPro® 2 Professional CGM (Medtronic, MiniMed, Inc., Northridge, CA, USA). Retinal oximeter Oxymap T1 (Oxymap ehf., Reykjavik, Iceland) was used to assess SatO2 . RESULTS Wilcoxon signed-rank test showed no SatO2 difference between eyes and visits. Spearman's correlation analysis revealed a significant correlation between arterial SatO2 and PG variability in type 2 diabetes mellitus, a positive correlation of venous SatO2 with HbA1c and with finger pulse oximetry. However, no correlation of SatO2 with ABB, carboxyhaemoglobin, current PG, mean PG over the 72 hr, age, diabetes duration, BMI, lipoproteinaemia, body temperature, systolic and diastolic blood pressure, heart rate, central retinal thickness and retinal nerve fibre layer thickness was found. CONCLUSION This study confirmed the association of venous SatO2 with long-term but not with short-term diabetes control, ABB and other conditions. The increased SatO2 and questionable impact of PG variability on retinal SatO2 is a research challenge.
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Affiliation(s)
- Petr Mlčák
- Department of Ophthalmology University Hospital Olomouc Faculty of Medicine and Dentistry Palacký University Olomouc Olomouc Czech Republic
- Department of Physiology Faculty of Medicine and Dentistry Palacký University Olomouc Olomouc Czech Republic
| | - Rudolf Chlup
- Department of Physiology Faculty of Medicine and Dentistry Palacký University Olomouc Olomouc Czech Republic
- Department of Internal Medicine II – Gastroenterology and Hepatology University Hospital Olomouc Faculty of Medicine and Dentistry Palacký University Olomouc Olomouc Czech Republic
| | - Pavla Kudlová
- Department of Health Sciences Faculty of Humanities Tomáš Baťa University Zlín Zlín Czech Republic
| | - Ondřej Krystyník
- Department of Internal Medicine III – Nephrology, Rheumatology and Endocrinology University Hospital Olomouc Faculty of Medicine and Dentistry Palacký University Olomouc Olomouc Czech Republic
| | - Michal Král
- Department of Neurology University Hospital Olomouc Faculty of Medicine and Dentistry Palacký University Olomouc Olomouc Czech Republic
| | - Veronika Kučerová
- Department of Clinical Biochemistry University Hospital Olomouc Olomouc Czech Republic
| | - Jaromíra Spurná
- Department of Internal Medicine III – Nephrology, Rheumatology and Endocrinology University Hospital Olomouc Faculty of Medicine and Dentistry Palacký University Olomouc Olomouc Czech Republic
| | - Simona Titzová
- Department of Physiology Faculty of Medicine and Dentistry Palacký University Olomouc Olomouc Czech Republic
| | - Petra Hübnerová
- Department of Ophthalmology University Hospital Olomouc Faculty of Medicine and Dentistry Palacký University Olomouc Olomouc Czech Republic
- Department of Physiology Faculty of Medicine and Dentistry Palacký University Olomouc Olomouc Czech Republic
| | - Ondřej Vláčil
- Department of Ophthalmology University Hospital Olomouc Faculty of Medicine and Dentistry Palacký University Olomouc Olomouc Czech Republic
| | - Irena Šínová
- Department of Ophthalmology University Hospital Olomouc Faculty of Medicine and Dentistry Palacký University Olomouc Olomouc Czech Republic
| | - Marta Karhanová
- Department of Ophthalmology University Hospital Olomouc Faculty of Medicine and Dentistry Palacký University Olomouc Olomouc Czech Republic
| | - Jana Zapletalová
- Department of Medical Biophysics Faculty of Medicine and Dentistry Palacký University Olomouc Olomouc Czech Republic
| | - Martin Šín
- Department of Ophthalmology University Hospital Olomouc Faculty of Medicine and Dentistry Palacký University Olomouc Olomouc Czech Republic
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Bek T, Jeppesen SK. Reduced Oxygen Extraction in the Retinal Periphery When the Arterial Blood Pressure Is Increased by Isometric Exercise in Normal Persons. Invest Ophthalmol Vis Sci 2021; 62:11. [PMID: 33683296 PMCID: PMC7960864 DOI: 10.1167/iovs.62.3.11] [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] [Indexed: 01/23/2023] Open
Abstract
Purpose Recent evidence suggests that the smaller retinal vessels are significantly involved in the regulation of retinal blood flow and that this regulation may differ among the macular area and the retinal periphery. An alternative to studying blood flow regulation in smaller retinal vessels that are difficult to resolve is to assess the metabolic consequences of changes in the microcirculation using oximetry. Methods In 20 normal persons aged (mean ± SD, range) 30.1 ± 3.8 (24–37) years, the oxygen saturation and diameter of retinal arterioles and venules to the macular area and the retinal periphery were studied before and during an increase in the arterial blood pressure induced by isometric exercise. Results The isometric exercise increased the mean arterial blood pressure by (mean ± SEM) 10.0 ± 1.1 mm Hg but induced no significant changes in the diameter of the arterioles (P = 0.83). The isometric exercise had no significant effect on the oxygen saturation in the arterioles supplying the macular area and the retinal periphery (P > 0.42 for both comparisons). However, there was a significant increase in the oxygen saturation in venules draining the retinal periphery to reduce the oxygen extraction from (mean ± SEM) 36.0% ± 2.3% to 30.6% ± 2.1% (P = 0.002) but no significant change in the preexisting low oxygen extraction in the macular area that changed from (mean ± SEM) 18.2% ± 3.0% to 16.2% ± 1.9% (P = 0.37). Conclusions Minor changes in the arterial blood pressure can induce changes in retinal rheology with significant regional variation. The finding may help explain regional variations in manifestations of retinal vascular disease such as hyperpermeability in the macular area and capillary occlusion in the retinal periphery.
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Affiliation(s)
- Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
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Yang MC, Zhu XB, Wang YX, Wu SL, Wang Q, Yan YN, Yang X, Yang JY, Chen MX, Lei YH, Wei WB. Influencing factors for peripheral and posterior lesions in mild non-proliferative diabetic retinopathy-the Kailuan Eye Study. Int J Ophthalmol 2020; 13:1467-1476. [PMID: 32953588 DOI: 10.18240/ijo.2020.09.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/18/2020] [Indexed: 02/08/2023] Open
Abstract
AIM To explore the influencing factors of diabetes type 2 patients with mild non-proliferative diabetic retinopathy (NPDR) in the Kailuan area of Tangshan, Hebei Province, China. METHODS In this non-interventional, retrospective study, 683 patients with type 2 diabetes were included in the Kailuan Diabetic Retinopathy Study involving participants with diabetes in the community-based longitudinal Kailuan Study. Based on the undilated ultra-wide field (200°; UWF) images and partial dilated digital fundus images, the diabetic retinopathy (DR) of the surveyed population was graded. Interobserver agreement was estimated by using Cohen's Kappa statistics. The main outcome indicators included gender, age, weight, height, body mass index, blood pressure, circumferences of neck, waist and hip, current smoking, levels of fasting plasma glucose (FPG), hypersensitive C-reactive protein, creatinine, and cholesterol, etc. According to different lesions' locations of patients with mild NPDR, logistic regression models were used to estimate the odds ratios (ORs) and their 95%CIs of each risk factor. RESULTS The study group of 683 patients included 570 males and 113 females. The mean age of the patients was 62.18±9.41y. Compared with dilated fundus examinations, there was fair agreement with the level of DR identified on UWF images in 63.91% of eyes (k=0.369, 95%CI, 0.00-0.00). Detected by UWF images, there were 98 patients with mild NPDR having peripheral retinal lesions, 35 patients with mild NPDR having posterior lesions, 44 patients with mild NPDR whose lesions were detected both in and out the standard two fields area, and 336 patients with non obvious DR. Parameters that conferred a statistically significant increased risks for mild NPDR with having peripheral retinal lesions were neck circumstance (OR, 1.124; 95%CI, 1.044-1.211), and with posterior lesions were FPG (OR, 1.052; 95%CI, 1.007-1.099). CONCLUSION UWF is an effectiveness means of DR screening. Moreover, it is necessary to evaluate peripheral diabetic retinal lesions which can help to estimate the severity of DR. The phenomenon that nonuniform and inhomogeneous distribution of DR lesions has been found. And the influencing factors in mild NPDR are differing by different lesions' locations.
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Affiliation(s)
- Mo-Chi Yang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.,Department of Ophthalmology, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
| | - Xiao-Bo Zhu
- Dongfang Hospital Beijing University of Chinese Medicine, Beijing 100078, China
| | - Ya-Xing Wang
- Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Shou-Ling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan 063000, Hebei Province, China
| | - Qian Wang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yan-Ni Yan
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Xuan Yang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Jing-Yan Yang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Meng-Xi Chen
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Ya-Hui Lei
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Wen-Bin Wei
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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Munuera‐Gifre E, Saez M, Juvinyà‐Canals D, Rodríguez‐Poncelas A, Barrot‐de‐la–Puente J, Franch‐Nadal J, Romero‐Aroca P, Barceló MA, Coll‐de‐Tuero G. Analysis of the location of retinal lesions in central retinographies of patients with Type 2 diabetes. Acta Ophthalmol 2020; 98:e13-e21. [PMID: 31469507 DOI: 10.1111/aos.14223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 07/25/2019] [Indexed: 01/17/2023]
Abstract
PURPOSE To describe the distribution of Type 2 DM retinal lesions and determine whether it is symmetrical between the two eyes, is random or follows a certain pattern. METHODS Cross-sectional study of Type 2 DM patients who had been referred for an outpatients' ophthalmology visit for diabetic retinopathy screening in primary health care. Retinal photographic images were taken using central projection non-mydriatic retinography. The lesions under study were microaneurysms/haemorrhages, and hard and soft exudates. The lesions were placed numerically along the x- and y-axes obtained, with the fovea as the origin. RESULTS From among the 94 patients included in the study, 4770 lesions were identified. The retinal lesions were not distributed randomly, but rather followed a determined pattern. The left eye exhibited more microaneurysms/haemorrhages and hard exudates of a greater density in the central retina than was found in the right eye. Furthermore, more cells containing lesions were found in the upper temporal quadrants, (especially in the left eye), and tended to be more central in the left eye than in the right, while the hard exudates were more central than the microaneurysms/haemorrhages. CONCLUSION The distribution of DR lesions is neither homogeneous nor random but rather follows a determined pattern for both microaneurysms/haemorrhages and hard exudates. This distribution means that the areas of the retina most vulnerable to metabolic alteration can be identified. The results may be useful for automated DR detection algorithms and for determining the underlying vascular and non-vascular physiopathological mechanisms that can explain these differences.
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Affiliation(s)
| | - Marc Saez
- METHARISC Group USR Girona IdIAP Gol i Gorina Girona Spain
- Research Group on Statistics, Econometrics and Health (GRECS) University of Girona Girona Spain
- CIBER of Epidemiology and Public Health (CIBERESP) Madrid Spain
| | | | | | | | | | - Pere Romero‐Aroca
- Ophthalmology Service University Hospital Sant Joan Institut d'Investigació Sanitària Pere Virgili (IISPV) University Rovira i Virgili Reus Spain
| | - Maria Antonia Barceló
- METHARISC Group USR Girona IdIAP Gol i Gorina Girona Spain
- Research Group on Statistics, Econometrics and Health (GRECS) University of Girona Girona Spain
- CIBER of Epidemiology and Public Health (CIBERESP) Madrid Spain
| | - Gabriel Coll‐de‐Tuero
- METHARISC Group USR Girona IdIAP Gol i Gorina Girona Spain
- CIBER of Epidemiology and Public Health (CIBERESP) Madrid Spain
- Department of Medical Sciences University of Girona Girona Spain
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Harris A, Guidoboni G, Siesky B, Mathew S, Verticchio Vercellin AC, Rowe L, Arciero J. Ocular blood flow as a clinical observation: Value, limitations and data analysis. Prog Retin Eye Res 2020; 78:100841. [PMID: 31987983 PMCID: PMC8908549 DOI: 10.1016/j.preteyeres.2020.100841] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 12/24/2022]
Abstract
Alterations in ocular blood flow have been identified as important risk factors for the onset and progression of numerous diseases of the eye. In particular, several population-based and longitudinal-based studies have provided compelling evidence of hemodynamic biomarkers as independent risk factors for ocular disease throughout several different geographic regions. Despite this evidence, the relative contribution of blood flow to ocular physiology and pathology in synergy with other risk factors and comorbidities (e.g., age, gender, race, diabetes and hypertension) remains uncertain. There is currently no gold standard for assessing all relevant vascular beds in the eye, and the heterogeneous vascular biomarkers derived from multiple ocular imaging technologies are non-interchangeable and difficult to interpret as a whole. As a result of these disease complexities and imaging limitations, standard statistical methods often yield inconsistent results across studies and are unable to quantify or explain a patient's overall risk for ocular disease. Combining mathematical modeling with artificial intelligence holds great promise for advancing data analysis in ophthalmology and enabling individualized risk assessment from diverse, multi-input clinical and demographic biomarkers. Mechanism-driven mathematical modeling makes virtual laboratories available to investigate pathogenic mechanisms, advance diagnostic ability and improve disease management. Artificial intelligence provides a novel method for utilizing a vast amount of data from a wide range of patient types to diagnose and monitor ocular disease. This article reviews the state of the art and major unanswered questions related to ocular vascular anatomy and physiology, ocular imaging techniques, clinical findings in glaucoma and other eye diseases, and mechanistic modeling predictions, while laying a path for integrating clinical observations with mathematical models and artificial intelligence. Viable alternatives for integrated data analysis are proposed that aim to overcome the limitations of standard statistical approaches and enable individually tailored precision medicine in ophthalmology.
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Affiliation(s)
- Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | | | - Brent Siesky
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Sunu Mathew
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alice C Verticchio Vercellin
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA; University of Pavia, Pavia, Italy; IRCCS - Fondazione Bietti, Rome, Italy
| | - Lucas Rowe
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Julia Arciero
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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Tilma K, Bek T. Dilatation of Retinal Arterioles Induced by Topical Dorzolamide for One Week Is Impaired in Patients with Type 1 Diabetes and Mild Retinopathy. Ophthalmologica 2019; 243:236-242. [DOI: 10.1159/000504178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022]
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11
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Petersen L, Bek T. The Oxygen Saturation in Vascular Abnormalities Depends on the Extent of Arteriovenous Shunting in Diabetic Retinopathy. ACTA ACUST UNITED AC 2019; 60:3762-3767. [DOI: 10.1167/iovs.19-27472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Line Petersen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
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12
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Bek T. Translational research in retinal vascular disease. An approach. Acta Ophthalmol 2019; 97:441-450. [PMID: 30801973 DOI: 10.1111/aos.14045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/12/2019] [Indexed: 12/24/2022]
Abstract
The clinical presentation of the most frequent vision threatening retinal diseases is dominated by lesions indicating that disturbances in retinal blood flow are involved in the pathogenesis of these diseases. The present review describes the experience from a translational strategy pursued to investigate retinal vascular diseases with diabetic retinopathy as the main object. The normal regulation of retinal blood flow is investigated in porcine retinal vessels in vitro and ex vivo. Subsequently, the in vitro findings are translated to clinical studies in normal persons in vivo, and it is investigated whether the mechanisms are disturbed in retinal vascular disease. This is followed by clinical intervention studies on these diseases. The approach has been used to investigate pressure autoregulation, metabolic autoregulation and vasomotion in retinal vessels. The investigations have shown that retinal vascular tone can be regulated by receptor-specific agonists and antagonists to vasoactive compounds such as purines, prostaglandins and nitric oxide synthesis and that the vasoactive effects can be modulated by the concentration and the mode of administration of these compounds. Additionally, it has been shown that retinal precapillary arterioles and capillaries not visible by ophthalmoscopy may play an important role for the pathophysiology of retinal vascular disease and its treatment. Future studies should focus on investigating normal and pathological regulation of retinal blood flow in these smaller vessels.
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Affiliation(s)
- Toke Bek
- Department of Ophthalmology Aarhus University Hospital Aarhus C DK‐8000 Denmark
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13
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El Dabagh Y, Petersen L, Pedersen M, Bek T. Reduced baseline diameter and contraction of peripheral retinal arterioles immediately after remote ischemia in diabetic patients. Graefes Arch Clin Exp Ophthalmol 2019; 257:2095-2101. [PMID: 31273510 DOI: 10.1007/s00417-019-04407-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Remote ischemic conditioning (RIC) implies that transient ischemia in one organ can affect blood flow and protect from ischemia in another remote organ such as the retina. The purpose of the present study was to investigate the effect of RIC on the diameter of retinal arterioles in patients with diabetic retinopathy and whether this effect differs among peripheral and macular vessels. METHODS In twenty type 1 diabetes patients aged 20-31 years, the Dynamic Vessel Analyzer (DVA) was used to measure diameters of peripheral and macular arterioles during rest, isometric exercise, and flicker stimulation. Measurements were obtained before, immediately after, and 1 h after RIC, and were compared to responses obtained from normal persons. RESULTS The reduced baseline diameter (p < 0.009) and contraction of peripheral retinal arterioles during isometric exercise (p = 0.025) observed immediately after RIC in normal persons were absent in the studied diabetic patients. CONCLUSIONS RIC affects the diameter of peripheral but not macular arterioles in normal persons, but the response is abolished in diabetic patients. TRIAL REGISTRATION NCT03906383.
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Affiliation(s)
- Yasmin El Dabagh
- Department of Ophthalmology, Aarhus University Hospital, 8200, Aarhus N, Denmark.
- Comparative Medicine Laboratory, Department of Clinical Medicine, Aarhus University Hospital, 8200, Aarhus N, Denmark.
| | - Line Petersen
- Department of Ophthalmology, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | - Michael Pedersen
- Comparative Medicine Laboratory, Department of Clinical Medicine, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, 8200, Aarhus N, Denmark
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14
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Nicholson L, Vazquez-Alfageme C, Hykin PG, Bainbridge JW, Sivaprasad S. The Relationship Between Retinal Vessel Oxygenation and Spatial Distribution of Retinal Nonperfusion in Retinal Vascular Diseases. Invest Ophthalmol Vis Sci 2019; 60:2083-2087. [PMID: 31091315 DOI: 10.1167/iovs.18-24917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We study the relationship between retinal vessel oxygenation and the spatial distribution of retinal nonperfusion using ultrawide field angiography in eyes with retinal vascular diseases. Methods This prospective single center study recruited 57 eligible eyes from 44 patients with retinal vascular diseases. Retinal oximetry measurements were obtained using the Oxymap T1 device to determine the arteriovenous (AV) difference. Retinal nonperfusion was measured from ultrawide field angiography images taken with the Optos 200TX system and superimposing the images with the concentric rings template to determine the area and distribution of retinal nonperfusion. Results Seven (12.3%) eyes had a diagnosis of a branch or hemiretinal vein occlusion, 24 (42.1%) with central retinal vein occlusion and 26 (45.6%) with diabetic retinopathy (11 [19.3%] nonproliferative and 15 [26.3%] proliferative diabetic retinopathy). The correlation between the total area of retinal nonperfusion with the AV difference controlling for age was not statistically significant (R = -0.103, P = 0.449). However, when analyzing the correlation of AV difference with the area of retinal nonperfusion in the posterior pole controlling for age and peripheral nonperfusion, this was significant (R = -0.295, P = 0.029). This was not significant for the area of retinal nonperfusion in the periphery while controlling for posterior pole nonperfusion and age (R = 0.124, P = 0.368). Conclusions Retinal nonperfusion has a negative correlation with AV difference measured on retinal oximetry. This correlation is significant in the posterior pole, but not in the peripheral retina.
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Affiliation(s)
- Luke Nicholson
- National Institute for Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom
| | - Clara Vazquez-Alfageme
- National Institute for Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom
| | - Philip G Hykin
- National Institute for Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom
| | - James W Bainbridge
- National Institute for Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom
| | - Sobha Sivaprasad
- National Institute for Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom
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15
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Van Keer K, Van Keer J, Barbosa Breda J, Nassiri V, Van Cleemput J, Abegão Pinto L, Stalmans I, Vandewalle E. Retinal oxygen saturation as a non-invasive estimate for mixed venous oxygen saturation and cardiac output. Acta Ophthalmol 2019; 97:e308-e312. [PMID: 30280510 DOI: 10.1111/aos.13890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/18/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE To investigate the correlation between retinal vessel oxygen saturation and mixed venous oxygen saturation (SvO2-mixed ) and cardiac output (CO). METHODS Retinal arterial (SaO2-retinal ) and venous (SvO2-retinal ) oxygen saturation were measured non-invasively with dual-wavelength retinal oximetry in subjects receiving invasive measurements of SvO2-mixed and CO through right heart catheterization. Correlations were analysed using Spearman's rank correlation coefficients and linear regression models. RESULTS Fourteen patients (median age 62.7 years, range: 21-77) were included in the analysis. When adjusted for age, SvO2-retinal showed a positive correlation with SvO2-mixed (β = 0.80, p = 0.003). Retinal arteriovenous oxygen saturation difference was significantly correlated with the inverse of CO (Spearman's ρ = 0.59, p = 0.026). CONCLUSION This pilot study provides proof of concept for the use of retinal oximetry as a non-invasive tool to assess systemic cardiovascular function.
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Affiliation(s)
- Karel Van Keer
- Department of Ophthalmology University Hospitals Leuven Leuven Belgium
- Research Group Ophthalmology Department of Neurosciences KU Leuven Leuven Belgium
| | - Jan Van Keer
- Department of Cardiology University Hospitals Leuven Leuven Belgium
| | - João Barbosa Breda
- Department of Ophthalmology University Hospitals Leuven Leuven Belgium
- Research Group Ophthalmology Department of Neurosciences KU Leuven Leuven Belgium
- Department of Ophthalmology Centro Hospitalar São João Porto Portugal
| | | | | | - Luìs Abegão Pinto
- Department of Ophthalmology Lisbon North Hospital Centre Lisbon Portugal
| | - Ingeborg Stalmans
- Department of Ophthalmology University Hospitals Leuven Leuven Belgium
- Research Group Ophthalmology Department of Neurosciences KU Leuven Leuven Belgium
| | - Evelien Vandewalle
- Department of Ophthalmology University Hospitals Leuven Leuven Belgium
- Research Group Ophthalmology Department of Neurosciences KU Leuven Leuven Belgium
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16
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Retinal capillary perfusion: Spatial and temporal heterogeneity. Prog Retin Eye Res 2019; 70:23-54. [PMID: 30769149 DOI: 10.1016/j.preteyeres.2019.01.001] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/18/2019] [Accepted: 01/19/2019] [Indexed: 01/17/2023]
Abstract
The central role of the cardiovascular system is to maintain adequate capillary perfusion. The spatially and temporally heterogeneous nature of capillary perfusion has been reported in some organs. However, such heterogeneous perfusion properties have not been sufficiently explored in the retina. Arguably, spatial and temporal heterogeneity of capillary perfusion could be more predominant in the retina than that in other organs. This is because the retina is one of the highest metabolic demand neural tissues yet it has a limited blood supply due to optical requirements. In addition, the unique heterogeneous distribution of retinal neural cells within different layers and regions, and the significant heterogeneity of intraretinal oxygen distribution and consumption add to the complexity. Retinal blood flow distribution must match consumption of nutrients such as oxygen and glucose within the retina at the cellular level in order to effectively maintain cell survival and function. Sophisticated local blood flow control in the microcirculation is likely required to control the retinal capillary perfusion to supply local retinal tissue and accommodate temporal and spatial variations in metabolic supply and demand. The authors would like to update the knowledge of the retinal microvessel and capillary network and retinal oxidative metabolism from their own studies and the work of others. The coupling between blood supply and energy demands in the retina is particularly interesting. We will mostly describe information regarding the retinal microvessel network and retinal oxidative metabolism relevant to the spatial and temporal heterogeneity of capillary perfusion. We believe that there is significant and necessary spatial and temporal heterogeneity and active regulation of retinal blood flow in the retina, particularly in the macular region. Recently, retinal optical coherence tomography angiography (OCTA) has been widely used in ophthalmology, both experimentally and clinically. OCTA could be a valuable tool for examining retinal microvessel and capillary network structurally and has potential for determining retinal capillary perfusion and its control. We have demonstrated spatial and temporal heterogeneity of capillary perfusion in the retina both experimentally and clinically. We have also found close relationships between the smallest arterioles and capillaries within paired arterioles and venules and determined the distribution of smooth muscle cell contraction proteins in these vessels. Spatial and temporal heterogeneity of retinal capillary perfusion could be a useful parameter to determine retinal microvessel regulatory capability as an early assay for retinal vascular diseases. This topic will be of great interest, not only for the eye but also other organs. The retina could be the best model for such investigations. Unlike cerebral vessels, retinal vessels can be seen even at the capillary level. The purpose of this manuscript is to share our current understanding with the readers and encourage more researchers and clinicians to investigate this field. We begin by reviewing the general principles of microcirculation properties and the spatial and temporal heterogeneity of the capillary perfusion in other organs, before considering the special requirements of the retina. The local heterogeneity of oxygen supply and demand in the retina and the need to have a limited and well-regulated retinal circulation to preserve the transparency of the retina is discussed. We then consider how such a delicate balance of metabolic supply and consumption is achieved. Finally we discuss how new imaging methodologies such as optical coherence tomography angiography may be able to detect the presence of spatial and temporal heterogeneity of capillary perfusion in a clinical setting. We also provide some new information of the control role of very small arterioles in the modulation of retinal capillary perfusion which could be an interesting topic for further investigation.
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ARTERIAL OXYGEN SATURATION IN NEOVASCULARIZATIONS IN PROLIFERATIVE DIABETIC RETINOPATHY. Retina 2018; 38:2301-2308. [DOI: 10.1097/iae.0000000000001870] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Bek T, Stefánsson E, Hardarson SH. Retinal oxygen saturation is an independent risk factor for the severity of diabetic retinopathy. Br J Ophthalmol 2018; 103:1167-1172. [PMID: 30337331 DOI: 10.1136/bjophthalmol-2018-312764] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/11/2018] [Accepted: 09/17/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The oxygen saturation in larger retinal vessels has been shown to increase with increasing diabetic retinopathy (DR) grade and to help predict the effect of antivascular endothelial growth factor treatment in patients with diabetic maculopathy. However, it is unknown to what extent the increased oxygen saturation co-varies with other risk factors and whether it is an independent risk factor for the severity of DR. METHODS Seven hundred and twenty-two successive patients referred for specialist evaluation of diabetic retinopathy including retinal oximetry were studied. Multiple regression analysis was used to investigate whether oxygen saturation in the larger retinal arterioles and venules contributed to the severity of diabetic retinopathy, independently of gender, age, diabetes duration, diabetes type, body mass index, blood pressure, haemoglobin A1c, visual acuity and central retinal thickness. RESULTS The included parameters could explain less than 15% of the variation in retinopathy grade. Approximately, one-third of the explained variation was related to the retinal oxygen saturation. CONCLUSIONS Prospective studies are needed to evaluate whether retinal oxygen saturation is predictive for the development of diabetic retinopathy and how it interacts with other biomarkers and risk factors over time.
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Affiliation(s)
- Toke Bek
- Departments of Ophthalmology, University of Iceland, Reykjavik, Iceland
| | - Einar Stefánsson
- Departments of Physiology, University of Iceland, Reykjavik, Iceland.,Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Sveinn Hákon Hardarson
- Departments of Physiology, University of Iceland, Reykjavik, Iceland.,Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
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Jeppesen SK, Bek T. The Retinal Oxygen Saturation Measured by Dual Wavelength Oximetry in Larger Retinal Vessels is Influenced by the Linear Velocity of the Blood. Curr Eye Res 2018; 44:46-52. [DOI: 10.1080/02713683.2018.1524015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus C, Denmark
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20
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Torp TL, Kawasaki R, Wong TY, Peto T, Grauslund J. Peripheral capillary non-perfusion in treatment-naïve proliferative diabetic retinopathy associates with postoperative disease activity 6 months after panretinal photocoagulation. Br J Ophthalmol 2018; 103:816-820. [PMID: 30068515 PMCID: PMC6582729 DOI: 10.1136/bjophthalmol-2018-312195] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/06/2018] [Accepted: 07/02/2018] [Indexed: 11/17/2022]
Abstract
Background/aims With the perspective to provide individualised panretinal laser photocoagulation (PRP) for proliferative diabetic retinopathy (PDR), we evaluated if retinal peripheral capillary non-perfusion (PCNP) and oximetry, as non-invasive markers of retinal metabolism and function, could predict disease activity 6 months after PRP. Methods We performed a prospective, interventional study of patients with treatment-naïve PDR. Retinal oximetry and ultra-widefield fluorescein angiography were performed at baseline (BL) and three (3M) and 6 months (6M) after PRP by a navigated laser system. At 6M follow-up, patients were divided according to disease activity: active or inactive. Results We included 33 eyes, and 69.6% were men. At BL, the median age and duration of diabetes (with IQRs) were 51.6±23.4 and 20.0±15.0 years. Haemoglobin A1c was 63.0±17.0 mmol/mol and blood pressure was 152±37/82±24 mm Hg. At BL and M6, patients with postoperative disease activity (30.3.%, n=10) had a larger area with PCNP than those with inactive PDR (BL: 51%–75% vs 26%–50%, p=0.03; 6M: 51%–75% vs 26%–50%, p=0.03). The area of PCNP did not change from BL to 6M in either group (inactive PDR: p=0.38, active PDR: p=0.87). Changes in retinal oxygen saturation were not found to be clinical relevant. Conclusion We found the area of PCNP at all timepoints to be statistically larger in patients with active PDR 6 months after PRP treatment. Therefore, the area of PCNP, at baseline, may serve as a potential predictive marker for PDR activity after treatment.
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Affiliation(s)
- Thomas Lee Torp
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ryo Kawasaki
- Department of Vision Informatics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tien Yin Wong
- Singapore National Eye Centre, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tunde Peto
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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21
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Bittner AK, Seger K, Salveson R, Kayser S, Morrison N, Vargas P, Mendelsohn D, Han J, Bi H, Dagnelie G, Benavente A, Ramella-Roman J. Randomized controlled trial of electro-stimulation therapies to modulate retinal blood flow and visual function in retinitis pigmentosa. Acta Ophthalmol 2018; 96:e366-e376. [PMID: 29130647 DOI: 10.1111/aos.13581] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 08/05/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE We examined changes in visual function and ocular and retinal blood flow (RBF) among retinitis pigmentosa (RP) participants in a randomized controlled trial of electro-stimulation therapies. METHODS Twenty-one RP participants were randomized (1:1:1) to transcorneal electrical stimulation (TES) at 6 weekly half-hour sessions, electro-acupuncture or inactive laser acupuncture (sham control) at 10 half-hour sessions over 2 weeks. Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity (VA), quick contrast sensitivity function, Goldmann visual fields, AdaptDx scotopic sensitivity, spectral flow and colour Doppler imaging of the central retinal artery (CRA), and RBF in macular capillaries were measured twice pre-treatment, after 2 TES sessions, within a week and a month after intervention completion. RESULTS We measured a significant improvement in retrobulbar CRA mean flow velocity for both the TES (p = 0.038) and electro-acupuncture groups (p = 0.001) on average after 2 weeks of treatment when compared to sham controls. Transcorneal electrical simulation (TES) and electro-acupuncture subjects had significant 55% and 34% greater increases, respectively, in RBF in the macular vessels when compared to sham controls (p < 0.001; p = 0.008) within a week of completing six TES sessions or a month after electro-acupuncture. There was a significant difference in the proportion of eyes that had improved visual function when comparing the three intervention groups (p = 0.038): four of seven TES subjects (57%), two of seven electro-acupuncture subjects (29%) and none of the seven control subjects (0%) had a significant visual improvement outside of typical test-retest variability at two consecutive post-treatment visits. CONCLUSION Increased blood flow following electro-stimulation therapies is an objective, physiological change that occurred in addition to visual function improvements in some RP patients.
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Affiliation(s)
- Ava K. Bittner
- College of Optometry; Nova Southeastern University; Fort Lauderdale FL USA
| | - Kenneth Seger
- College of Optometry; Nova Southeastern University; Fort Lauderdale FL USA
| | - Rachel Salveson
- College of Osteopathic Medicine; Nova Southeastern University; Fort Lauderdale FL USA
| | - Samantha Kayser
- College of Optometry; Nova Southeastern University; Fort Lauderdale FL USA
| | - Natalia Morrison
- Healing Blossom - Acupuncture and Holistic Medicine; Miami FL USA
| | - Patricia Vargas
- Medical Sonography Program; College of Health Care Sciences; Nova Southeastern University; Fort Lauderdale FL USA
| | - Deborah Mendelsohn
- Medical Sonography Program; College of Health Care Sciences; Nova Southeastern University; Fort Lauderdale FL USA
| | - Jorge Han
- Medical Sonography Program; College of Health Care Sciences; Nova Southeastern University; Fort Lauderdale FL USA
| | - Hua Bi
- College of Optometry; Nova Southeastern University; Fort Lauderdale FL USA
| | | | | | - Jessica Ramella-Roman
- Department of Biomedical Engineering; Florida International University; Miami FL USA
- Department of Cellular Biology and Pharmacology and Ophthalmology; Herbert Wertheim College of Medicine; Miami FL USA
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Abstract
PURPOSE OF REVIEW The diameter of retinal vessels is an important source of information about retinal blood flow and metabolism. The purpose of the present study is to review how diameter changes of retinal vessels contribute to the development of diabetic retinopathy and may be a marker of the prognosis of the disease. RECENT FINDINGS The early stages of diabetic retinopathy are accompanied with dilatation of the diameter of retinal vessels and reduced autoregulation. Diabetic retinopathy also shows regional differences in the macular area and the retinal periphery and accompanying differences in vascular reactivity in these areas. These differences may potentially become an important source of insight into the pathophysiology of the disease in the future. Diabetic retinopathy is accompanied with changes in the diameter regulation of retinal vessels. The potential of newly developed techniques for assessing retinal blood flow and metabolism, such as Doppler techniques, adaptive optics, and retinal oximetry, is promising and may potentially contribute to significant advances in our understanding of diabetic retinopathy which remains a major cause of visual impairment.
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Affiliation(s)
- Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, 8000, Aarhus C, Denmark.
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Torp TL, Kawasaki R, Wong TY, Peto T, Grauslund J. Changes in retinal venular oxygen saturation predict activity of proliferative diabetic retinopathy 3 months after panretinal photocoagulation. Br J Ophthalmol 2017; 102:383-387. [PMID: 28765148 PMCID: PMC5867405 DOI: 10.1136/bjophthalmol-2017-310576] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 06/12/2017] [Accepted: 06/16/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND/AIMS Proliferative diabetic retinopathy (PDR) is a severe blinding condition. We investigated whether retinal metabolism, measured by retinal oximetry, may predict PDR activity after panretinal laser photocoagulation (PRP). METHODS We performed a prospective, interventional, clinical study of patients with treatment-naive PDR. Wide-field fluorescein angiography (OPTOS, Optomap) and global and focal retinal oximetry (Oxymap T1) were performed at baseline (BL), and 3 months (3M) after PRP. Angiographic findings were used to divide patients according to progression or non-progression of PDR after PRP. We evaluated differences in global and focal retinal oxygen saturation between patients with and without progression of PDR after PRP treatment. RESULTS We included 45 eyes of 37 patients (median age and duration of diabetes were 51.6 and 20 years). Eyes with progression of PDR developed a higher retinal venous oxygen saturation than eyes with non-progression at 3M (global: +5.9% (95% CI -1.5 to 12.9), focal: +5.4%, (95% CI -4.1 to 14.8)). Likewise, progression of PDR was associated with a lower arteriovenular (AV) oxygen difference between BL and 3M (global: -6.1%, (95% CI -13.4 to -1.4), focal: -4.5% (95% CI -12.1 to 3.2)). In a multiple logistic regression model, increment in global retinal venular oxygen saturation (OR 1.30 per 1%-point increment, p=0.017) and decrement in AV oxygen saturation difference (OR 0.72 per 1%-point increment, p=0.016) at 3M independently predicted progression of PDR. CONCLUSION Development of higher retinal venular and lower AV global oxygen saturation independently predicts progression of PDR despite standard PRP and might be a potential non-invasive marker of angiogenic disease activity.
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Affiliation(s)
- Thomas Lee Torp
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ryo Kawasaki
- Department of Public Health, Yamagata University Graduate School of Medical Science, Yamagata, Japan
| | - Tien Yin Wong
- Singapore National Eye Centre, Duke NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Tunde Peto
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Ophthalmology, Queen's University Belfast, Belfast, UK
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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