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Torm MEW, Pircher M, Bonnin S, Johannesen J, Klefter ON, Schmidt MF, Frederiksen JL, Lefaudeux N, Andilla J, Valdes C, Loza-Alvarez P, Brea LS, De Jesus DA, Grieve K, Paques M, Larsen M, Gocho K. Detection of capillary abnormalities in early diabetic retinopathy using scanning laser ophthalmoscopy and optical coherence tomography combined with adaptive optics. Sci Rep 2024; 14:13450. [PMID: 38862584 PMCID: PMC11166634 DOI: 10.1038/s41598-024-63749-7] [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: 02/01/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024] Open
Abstract
This study tested if a high-resolution, multi-modal, multi-scale retinal imaging instrument can provide novel information about structural abnormalities in vivo. The study examined 11 patients with very mild to moderate non-proliferative diabetic retinopathy (NPDR) and 10 healthy subjects using fundus photography, optical coherence tomography (OCT), OCT angiography (OCTA), adaptive optics scanning laser ophthalmoscopy (AO-SLO), adaptive optics OCT and OCTA (AO-OCT(A)). Of 21 eyes of 11 patients, 11 had very mild NPDR, 8 had mild NPDR, 2 had moderate NPDR, and 1 had no retinopathy. Using AO-SLO, capillary looping, inflections and dilations were detected in 8 patients with very mild or mild NPDR, and microaneurysms containing hyperreflective granular elements were visible in 9 patients with mild or moderate NPDR. Most of the abnormalities were seen to be perfused in the corresponding OCTA scans while a few capillary loops appeared to be occluded or perfused at a non-detectable flow rate, possibly because of hypoperfusion. In one patient with moderate NPDR, non-perfused capillaries, also called ghost vessels, were identified by alignment of corresponding en face AO-OCT and AO-OCTA images. The combination of multiple non-invasive imaging methods could identify prominent microscopic abnormalities in diabetic retinopathy earlier and more detailed than conventional fundus imaging devices.
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Affiliation(s)
- Marie Elise Wistrup Torm
- Department of Ophthalmology, Center for Research in Eye Diseases, Rigshospitalet, Section 37, Valdemar Hansens Vej 13, 2600, Glostrup, Denmark.
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N, Denmark.
| | - Michael Pircher
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Sophie Bonnin
- INSERM-DGOS CIC 1423, CHNO des Quinze-Vingts, 28 Rue de Charenton, 75012, Paris, France
- INSERM, CNRS, Institut de La Vision, Sorbonne Université, 17 Rue Moreau, 75012, Paris, France
- Foundation Rothschild Hospital, 25-29, Rue Manin, 75019, Paris, France
| | - Jesper Johannesen
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N, Denmark
- Department of Pediatrics, Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 25C, Herlev, Denmark
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, Herlev, Denmark
| | - Oliver Niels Klefter
- Department of Ophthalmology, Center for Research in Eye Diseases, Rigshospitalet, Section 37, Valdemar Hansens Vej 13, 2600, Glostrup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N, Denmark
| | - Mathias Falck Schmidt
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N, Denmark
- Department of Neurology, Clinic of Optic Neuritis, The Danish Multiple Sclerosis Center (DMSC), Rigshospitalet, Valdemar Hansens Vej 13, Glostrup, Denmark
| | - Jette Lautrup Frederiksen
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N, Denmark
- Department of Neurology, Clinic of Optic Neuritis, The Danish Multiple Sclerosis Center (DMSC), Rigshospitalet, Valdemar Hansens Vej 13, Glostrup, Denmark
| | | | - Jordi Andilla
- The Barcelona Institute of Science and Technology, ICFO-Institut de Ciencies Fotoniques, 08860, Castelldefels, Barcelona, Spain
| | - Claudia Valdes
- The Barcelona Institute of Science and Technology, ICFO-Institut de Ciencies Fotoniques, 08860, Castelldefels, Barcelona, Spain
| | - Pablo Loza-Alvarez
- The Barcelona Institute of Science and Technology, ICFO-Institut de Ciencies Fotoniques, 08860, Castelldefels, Barcelona, Spain
| | - Luisa Sanchez Brea
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Dr. Molewaterplein 40, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus Medical Center, Dr. Molewaterplein 40, Rotterdam, The Netherlands
- The Rotterdam Eye Hospital, The Rotterdam Ophthalmic Institute, Schiedamse Vest 160, Rotterdam, The Netherlands
| | - Danilo Andrade De Jesus
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Dr. Molewaterplein 40, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus Medical Center, Dr. Molewaterplein 40, Rotterdam, The Netherlands
- The Rotterdam Eye Hospital, The Rotterdam Ophthalmic Institute, Schiedamse Vest 160, Rotterdam, The Netherlands
| | - Kate Grieve
- INSERM-DGOS CIC 1423, CHNO des Quinze-Vingts, 28 Rue de Charenton, 75012, Paris, France
- INSERM, CNRS, Institut de La Vision, Sorbonne Université, 17 Rue Moreau, 75012, Paris, France
| | - Michel Paques
- INSERM-DGOS CIC 1423, CHNO des Quinze-Vingts, 28 Rue de Charenton, 75012, Paris, France
- INSERM, CNRS, Institut de La Vision, Sorbonne Université, 17 Rue Moreau, 75012, Paris, France
| | - Michael Larsen
- Department of Ophthalmology, Center for Research in Eye Diseases, Rigshospitalet, Section 37, Valdemar Hansens Vej 13, 2600, Glostrup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N, Denmark
| | - Kiyoko Gocho
- INSERM-DGOS CIC 1423, CHNO des Quinze-Vingts, 28 Rue de Charenton, 75012, Paris, France
- INSERM, CNRS, Institut de La Vision, Sorbonne Université, 17 Rue Moreau, 75012, Paris, France
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Ahn J, Baik JW, Kim D, Choi K, Lee S, Park SM, Kim JY, Nam SH, Kim C. In vivo photoacoustic monitoring of vasoconstriction induced by acute hyperglycemia. PHOTOACOUSTICS 2023; 30:100485. [PMID: 37082618 PMCID: PMC10112177 DOI: 10.1016/j.pacs.2023.100485] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/19/2023] [Accepted: 03/29/2023] [Indexed: 05/03/2023]
Abstract
Postprandial hyperglycemia, blood glucose spikes, induces endothelial dysfunction, increasing cardiovascular risks. Endothelial dysfunction leads to vasoconstriction, and observation of this phenomenon is important for understanding acute hyperglycemia. However, high-resolution imaging of microvessels during acute hyperglycemia has not been fully developed. Here, we demonstrate that photoacoustic microscopy can noninvasively monitor morphological changes in blood vessels of live animals' extremities when blood glucose rises rapidly. As blood glucose level rose from 100 to 400 mg/dL following intraperitoneal glucose injection, heart/breath rate, and body temperature remained constant, but arterioles constricted by approximately -5.7 ± 1.1% within 20 min, and gradually recovered for another 40 min. In contrast, venular diameters remained within about 0.6 ± 1.5% during arteriolar constriction. Our results experimentally and statistically demonstrate that acute hyperglycemia produces transitory vasoconstriction in arterioles, with an opposite trend of change in blood glucose. These findings could help understanding vascular glucose homeostasis and the relationship between diabetes and cardiovascular diseases.
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Affiliation(s)
- Joongho Ahn
- Departments of Electrical Engineering, Convergence IT Engineering, Mechanical Engineering, and Medical Science and Engineering, and Medical Device Innovation Center, Pohang University of Science and Technology, Pohang 37673, Republic of Korea
| | - Jin Woo Baik
- Departments of Electrical Engineering, Convergence IT Engineering, Mechanical Engineering, and Medical Science and Engineering, and Medical Device Innovation Center, Pohang University of Science and Technology, Pohang 37673, Republic of Korea
| | - Donggyu Kim
- Departments of Electrical Engineering, Convergence IT Engineering, Mechanical Engineering, and Medical Science and Engineering, and Medical Device Innovation Center, Pohang University of Science and Technology, Pohang 37673, Republic of Korea
| | - Karam Choi
- Samsung Advanced Institute of Technology, Samsung Electronics Co. Ltd., Suwon 16678, Republic of Korea
| | - Seunghyun Lee
- Departments of Electrical Engineering, Convergence IT Engineering, Mechanical Engineering, and Medical Science and Engineering, and Medical Device Innovation Center, Pohang University of Science and Technology, Pohang 37673, Republic of Korea
| | - Sung-Min Park
- Departments of Electrical Engineering, Convergence IT Engineering, Mechanical Engineering, and Medical Science and Engineering, and Medical Device Innovation Center, Pohang University of Science and Technology, Pohang 37673, Republic of Korea
| | - Jin Young Kim
- Departments of Electrical Engineering, Convergence IT Engineering, Mechanical Engineering, and Medical Science and Engineering, and Medical Device Innovation Center, Pohang University of Science and Technology, Pohang 37673, Republic of Korea
| | - Sung Hyun Nam
- Samsung Advanced Institute of Technology, Samsung Electronics Co. Ltd., Suwon 16678, Republic of Korea
- Corresponding authors.
| | - Chulhong Kim
- Departments of Electrical Engineering, Convergence IT Engineering, Mechanical Engineering, and Medical Science and Engineering, and Medical Device Innovation Center, Pohang University of Science and Technology, Pohang 37673, Republic of Korea
- Corresponding authors.
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Ong JX, Fawzi AA. Perspectives on diabetic retinopathy from advanced retinal vascular imaging. Eye (Lond) 2022; 36:319-327. [PMID: 34987198 PMCID: PMC8807653 DOI: 10.1038/s41433-021-01825-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/05/2021] [Accepted: 10/14/2021] [Indexed: 02/03/2023] Open
Abstract
Diabetic retinopathy (DR) is a microvascular complication of diabetes and the most common cause of acquired vision loss in adults worldwide. DR is associated with long-term chronic hyperglycaemia and its detrimental effects on the neurovascular structure and function of the retina. Direct imaging of the retinal vasculature and staging of DR has been traditionally based on fundoscopy and fluorescein angiography, which provide only 2D views of the retina, and in the case of fluorescein angiography, requires an invasive dye injection. In contrast, advanced retinal imaging modalities like optical coherence tomography angiography (OCTA) and adaptive optics (AO) are non-invasive and provide depth-resolved, 3D visualization of retinal vessel structure as well as blood flow. Recent studies utilizing these imaging techniques have shown promise in evaluating quantitative vascular parameters that correlate tightly to clinical DR staging, elucidating functional changes in early diabetes, and monitoring DR treatment response. In this article, we discuss and synthesize the results of advanced retinal imaging studies in DR and their implications for our clinical and pathophysiologic understanding of the disease. Based on the recent literature, we also propose a model to describe the differential changes in vascular structure and flow that have been described on advanced retinal imaging as DR progresses. Future studies of these imaging modalities in larger and more diverse populations, as well as corroboration with histological and functional studies, will be important to further our understanding of DR.
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Affiliation(s)
- Janice X Ong
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amani A Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Yang JY, Zhou WJ, Wang Q, Li Y, Yan YN, Wang YX, Wu SL, Wei WB. Retinal nerve fiber layer thickness and retinal vascular caliber alterations in coal miners in northern China: a community-based observational study. Int J Ophthalmol 2022; 15:135-140. [PMID: 35047368 DOI: 10.18240/ijo.2022.01.20] [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: 04/23/2020] [Accepted: 03/24/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate retinal nerve fiber layer thickness and retinal vascular caliber alterations in coal mine workers. METHODS The community-based observational cross-sectional study included 4004 participants of a sub-population of the Kailuan Study. All the study participants underwent structured interviews with a standardized questionnaire, fundus photography and spectral-domain optical coherence tomography (OCT) examinations performed by trained doctors. RESULTS The retinal nerve fiber layer thickness was significantly higher (P=0.006) and the central macular thickness was lower in coal miners (n=659, 51.0±7.8y) as compared to the control (working above the ground; n=477, 51.8±7.5y; P=0.032). Additionally, the downhole workers showed a significantly thicker retinal artery (P=0.012) and vein diameters (P<0.001). In multivariable regression, a thicker retinal nerve fiber layer was associated with a higher cumulative silica dust exposure (P=0.005) after adjusting for younger age and larger spherical equivalent. In a reverse pattern, a higher cumulative silica dust exposure (P=0.004) was significantly associated with a thicker retinal nerve fiber layer after adjusting for age, high-density lipoproteins and uric acid. Wider retinal vein diameters were associated with higher cumulative silica dust exposure (P=0.036) after adjusting for younger age and larger spherical equivalent. CONCLUSION The retinal vessels diameters and retinal nerve fiber layer thickness are significantly thicker in long term of coal mining. The results of our study indicate that underground working environment may lead to retinal vessel dilation and inflammation. Thus, ocular examination might be needed within coal miners in order to monitor the occupational eye health as well as the incidence and progression of eye diseases.
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Affiliation(s)
- Jing-Yan Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing 100730, China
| | - Wen-Jia Zhou
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing 100730, China
| | - Qian Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing 100730, China
| | - Yang Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing 100730, China
| | - Yan-Ni Yan
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing 100730, China
| | - Ya-Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100730, China
| | - Shou-Ling Wu
- Cardiology Department, Kailuan General Hospital, Tangshan 063000, Hebei Province, China
| | - Wen-Bin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing 100730, China
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Han W, Wei H, Kong W, Wang J, Yang L, Wu H. Association between retinol binding protein 4 and diabetic retinopathy among type 2 diabetic patients: a meta-analysis. Acta Diabetol 2020; 57:1203-1218. [PMID: 32405713 DOI: 10.1007/s00592-020-01535-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/07/2020] [Indexed: 12/23/2022]
Abstract
AIMS The aim of this study was to investigate the association between retinol-binding protein 4 (RBP4) and diabetic retinopathy (DR) among patients with type 2 diabetes mellitus (T2DM). METHODS Databases PubMed, Embase, Web of Science, Chinese National Knowledge Infrastructure, VIP, and Wangfang were searched to July 30, 2019. The Newcastle-Ottawa Scale was applied to assess the quality of all identified studies, and those qualified were included in the meta-analysis. The Chi squared Q test and I2 statistics were conducted to evaluate heterogeneity. Standardized mean differences (SMD) and 95% confidence intervals (CI) among RBP4 within the DR and T2DM without retinopathy (DWR) groups were pooled using the random effects model depending on the heterogeneity. Subgroup analyses were conducted among the groups having different diabetes duration, detection methods, body mass index, and total cholesterol and triglyceride levels. The funnel plot was used to assess publication bias. RESULTS Nineteen observational studies were included in our meta-analysis. RBP4 was significantly higher in both nonproliferative DR (SMD: 0.72, 95% CI 0.48-0.95, P < 0.00001) and proliferative DR (SMD: 2.68, 95% CI 1.69-3.67, P < 0.00001) groups despite high heterogeneity (I2 = 87 and 97% in DR and PDR groups, respectively). Significant differences were noted among most subgroups (P < 0.05). Among those accompanied by hypercholesterolemia, the association between RBP4 and DR were unclear (P = 0.09). CONCLUSIONS Elevated RBP4 is strongly associated with DR and may play an essential role in its progression. Additional large-scale controlled studies are needed to confirm these findings.
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Affiliation(s)
- Wentao Han
- Department of Medical Informatics, Medical School of Nantong University, Nantong, 226001, People's Republic of China
| | - Huagen Wei
- Department of Medical Informatics, Medical School of Nantong University, Nantong, 226001, People's Republic of China
| | - Weizheng Kong
- Department of Medical Informatics, Medical School of Nantong University, Nantong, 226001, People's Republic of China
| | - Jing Wang
- Department of Medical Informatics, Medical School of Nantong University, Nantong, 226001, People's Republic of China
| | - Luqian Yang
- Department of Medical Informatics, Medical School of Nantong University, Nantong, 226001, People's Republic of China
| | - Huiqun Wu
- Department of Medical Informatics, Medical School of Nantong University, Nantong, 226001, People's Republic of China.
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Kwan CC, Lee HE, Schwartz G, Fawzi AA. Acute Hyperglycemia Reverses Neurovascular Coupling During Dark to Light Adaptation in Healthy Subjects on Optical Coherence Tomography Angiography. Invest Ophthalmol Vis Sci 2020; 61:38. [PMID: 32340033 PMCID: PMC7401911 DOI: 10.1167/iovs.61.4.38] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Purpose To test the hypothesis that hyperglycemia perturbs neurovascular\ coupling and compromises retinal vascular response during transition from dark to light in healthy subjects using optical coherence tomography angiography (OCTA). Methods Ten eyes of 10 healthy subjects were tested, first during fasting and then after receiving a 75-g oral glucose solution. In both sessions, OCTA imaging was done in the dark-adapted state and at 50 seconds, 2 minutes, 5 minutes, and 15 minutes of ambient light. Parafoveal vessel density (VD) and adjusted flow index (AFI) were calculated for the superficial capillary plexus (SCP), middle capillary plexus (MCP), and deep capillary plexus (DCP), and vessel length density was calculated for the SCP. These measurements were compared among conditions after adjusting for age, refractive error, and OCTA scan quality. Results Hyperglycemia leads to a complete reversal of dark/light adaptation trends in VD and AFI in all layers of the inner retina. In the dark, there is significantly decreased VD in the DCP in hyperglycemia. With a transition to light in hyperglycemia, we observed decreased VD in the SCP, increased vessel density in the MCP and DCP, and decreased AFI in all three layers. Conclusions Our results show that hyperglycemia significantly disrupts neurovascular coupling in healthy eyes, with potential metabolic deficits affecting photoreceptor oxygen demands during dark adaptation and the inner retina during light exposure. In pathological states, such as diabetic retinopathy, where the vasculature is already attenuated, retinal neurons may be exquisitely vulnerable to intermittent hyperglycemic challenge, which should be the focus of future studies.
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