1
|
Girach Z, Sarian A, Maldonado-García C, Ravikumar N, Sergouniotis PI, Rothwell PM, Frangi AF, Julian TH. Retinal imaging for the assessment of stroke risk: a systematic review. J Neurol 2024; 271:2285-2297. [PMID: 38430271 PMCID: PMC11055692 DOI: 10.1007/s00415-023-12171-6] [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: 10/15/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 03/03/2024]
Abstract
BACKGROUND Stroke is a leading cause of morbidity and mortality. Retinal imaging allows non-invasive assessment of the microvasculature. Consequently, retinal imaging is a technology which is garnering increasing attention as a means of assessing cardiovascular health and stroke risk. METHODS A biomedical literature search was performed to identify prospective studies that assess the role of retinal imaging derived biomarkers as indicators of stroke risk. RESULTS Twenty-four studies were included in this systematic review. The available evidence suggests that wider retinal venules, lower fractal dimension, increased arteriolar tortuosity, presence of retinopathy, and presence of retinal emboli are associated with increased likelihood of stroke. There is weaker evidence to suggest that narrower arterioles and the presence of individual retinopathy traits such as microaneurysms and arteriovenous nicking indicate increased stroke risk. Our review identified three models utilizing artificial intelligence algorithms for the analysis of retinal images to predict stroke. Two of these focused on fundus photographs, whilst one also utilized optical coherence tomography (OCT) technology images. The constructed models performed similarly to conventional risk scores but did not significantly exceed their performance. Only two studies identified in this review used OCT imaging, despite the higher dimensionality of this data. CONCLUSION Whilst there is strong evidence that retinal imaging features can be used to indicate stroke risk, there is currently no predictive model which significantly outperforms conventional risk scores. To develop clinically useful tools, future research should focus on utilization of deep learning algorithms, validation in external cohorts, and analysis of OCT images.
Collapse
Affiliation(s)
- Zain Girach
- Sheffield Medical School, University of Sheffield, Beech Hill Rd, Broomhall, Sheffield, UK
| | - Arni Sarian
- Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, UK
| | - Cynthia Maldonado-García
- Centre for Computational Imaging and Simulation Technologies in Biomedicine, School of Computing, University of Leeds, Leeds, UK
| | - Nishant Ravikumar
- Centre for Computational Imaging and Simulation Technologies in Biomedicine, School of Computing, University of Leeds, Leeds, UK
| | - Panagiotis I Sergouniotis
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, UK
- Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, UK
| | - Peter M Rothwell
- Wolfson Centre for the Prevention of Stroke and Dementia, University of Oxford, Oxford, UK
| | - Alejandro F Frangi
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- School of Computer Science, Faculty of Science and Engineering, University of Manchester, Kilburn Building, Manchester, UK
- Christabel Pankhurst Institute, The University of Manchester, Manchester, UK
| | - Thomas H Julian
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, UK.
- Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, UK.
| |
Collapse
|
2
|
Gao Y, Xu L, He N, Ding Y, Zhao W, Meng T, Li M, Wu J, Haddad Y, Zhang X, Ji X. A narrative review of retinal vascular parameters and the applications (Part II): Diagnosis in stroke. Brain Circ 2023; 9:129-134. [PMID: 38020952 PMCID: PMC10679631 DOI: 10.4103/bc.bc_9_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/27/2023] [Accepted: 04/12/2023] [Indexed: 12/01/2023] Open
Abstract
The retina, as an external extension of the diencephalon, can be directly, noninvasively observed by ocular fundus photography. Therefore, it offers a convenient and feasible mode to study nervous system diseases. Caliber, tortuosity, and fractal dimension, as three commonly used retinal vascular parameters, are not only the reflection of structural changes in the retinal microcirculation but also capture the branching pattern or density changes of the retinal microvascular network. Therefore, it contributes to better reflecting the subclinical pathological changes (e.g., lacunar stroke and small cerebral vascular disease) and predicting the risk of incident stroke and recurrent stroke.
Collapse
Affiliation(s)
- Yuan Gao
- Department of Biomedical Engineering, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Department of Ophthalmology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lijun Xu
- Department of School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China
| | - Ning He
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Wenbo Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tingting Meng
- Department of Ophthalmology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiaqi Wu
- Department of Biomedical Engineering, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yazeed Haddad
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Xuxiang Zhang
- Department of Ophthalmology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Biomedical Engineering, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
3
|
Liu J, Wan J, Kwapong WR, Tao W, Ye C, Liu M, Wu B. Retinal microvasculature and cerebral hemodynamics in patients with internal carotid artery stenosis. BMC Neurol 2022; 22:386. [PMID: 36229769 PMCID: PMC9559035 DOI: 10.1186/s12883-022-02908-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/30/2022] [Indexed: 11/15/2022] Open
Abstract
Purpose To investigate the relationship between retinal microvasculature and cerebral hemodynamics in patients with internal carotid artery (ICA) stenosis. Methods Patients with unilateral moderate or severe ICA stenosis(≥50%) from West China hospital, Sichuan university were consecutively and prospectively recruited enrolled in the current study. En face angiograms of the superficial vascular complex (SVC), deep vascular complex (DVC), superficial vascular plexus (SVP), intermediate capillary plexus (ICP), and deep capillary plexus (DCP) were generated by automatic segmentation using swept-source optical coherence tomography angiography (SS-OCTA) to assess the retinal microvascular perfusion. The cerebral blood flow perfusion on bilateral middle cerebral artery territories measured at the basal ganglia level was assessed by brain computed tomography perfusion (CTP). CTP data were postprocessed to generate maps of different perfusion parameters including cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), mean transit time (MTT) and permeability surface(PS). Relative perfusion parameters (rPS, rCBF, etc.) were calculated as the ratio of the value on the contralateral side to that on the ipsilateral side. Results In the final analysis, 31 patients were included, of whom 11 patients had a moderate ICA stenosis (50–69%) and 20 with a severe ICA stenosis(≥70%). A total of 55 eyes were analyzed in the study, 27 eyes from the ipsilateral side (ie, side with stenosis) and 28 eyes from the contralateral side. In the patients with ICA stenosis, there was a strong correlation between the retinal microvascular perfusion of SVC with rCBV(B = 0.45, p = 0.03), rCBF(B = 0.26, p = 0.02) and rPS(B = 0.45, p < 0.001) after adjustment for age, sex and vascular risk factors. Similar correlations were also found between microvasculature in SVP and cerebral perfusion changes. There were no any significant associations of microvascular perfusion in both DVC and DCP with CTP parameters(all p > 0.05). Conclusions Retinal perfusion changes in superficial vascular layer (SVC and SVP) were correlated with brain hemodynamic compromise in patients with unilateral moderate or severe ICA stenosis(≥50%). Given the limited size of our study, future studies with larger sample size are needed to confirm our findings.
Collapse
Affiliation(s)
- Junfeng Liu
- Department of Neurology, West China Hospital, Sichuan University, No. 37, GuoXue Xiang, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Jincheng Wan
- Department of Neurology, West China Hospital, Sichuan University, No. 37, GuoXue Xiang, Chengdu, Sichuan Province, 610041, People's Republic of China.,Department of Neurology, Minda Hospital of Hubei Minzu University, Enshi, 445000, Hubei Province, China
| | - William Robert Kwapong
- Department of Neurology, West China Hospital, Sichuan University, No. 37, GuoXue Xiang, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Wendan Tao
- Department of Neurology, West China Hospital, Sichuan University, No. 37, GuoXue Xiang, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Chen Ye
- Department of Neurology, West China Hospital, Sichuan University, No. 37, GuoXue Xiang, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Ming Liu
- Department of Neurology, West China Hospital, Sichuan University, No. 37, GuoXue Xiang, Chengdu, Sichuan Province, 610041, People's Republic of China.
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, No. 37, GuoXue Xiang, Chengdu, Sichuan Province, 610041, People's Republic of China.
| |
Collapse
|
4
|
Wong DYL, Lam MC, Ran A, Cheung CY. Artificial intelligence in retinal imaging for cardiovascular disease prediction: current trends and future directions. Curr Opin Ophthalmol 2022; 33:440-446. [PMID: 35916571 DOI: 10.1097/icu.0000000000000886] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Retinal microvasculature assessment has shown promise to enhance cardiovascular disease (CVD) risk stratification. Integrating artificial intelligence into retinal microvasculature analysis may increase the screening capacity of CVD risks compared with risk score calculation through blood-taking. This review summarizes recent advancements in artificial intelligence based retinal photograph analysis for CVD prediction, and suggests challenges and future prospects for translation into a clinical setting. RECENT FINDINGS Artificial intelligence based retinal microvasculature analyses potentially predict CVD risk factors (e.g. blood pressure, diabetes), direct CVD events (e.g. CVD mortality), retinal features (e.g. retinal vessel calibre) and CVD biomarkers (e.g. coronary artery calcium score). However, challenges such as handling photographs with concurrent retinal diseases, limited diverse data from other populations or clinical settings, insufficient interpretability and generalizability, concerns on cost-effectiveness and social acceptance may impede the dissemination of these artificial intelligence algorithms into clinical practice. SUMMARY Artificial intelligence based retinal microvasculature analysis may supplement existing CVD risk stratification approach. Although technical and socioeconomic challenges remain, we envision artificial intelligence based microvasculature analysis to have major clinical and research impacts in the future, through screening for high-risk individuals especially in less-developed areas and identifying new retinal biomarkers for CVD research.
Collapse
Affiliation(s)
- Dragon Y L Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | | | | | | |
Collapse
|
5
|
Triantafyllou GA, Triantafyllou A, Zafeiridis AS, Koletsos N, Zafeiridis A, Gkaliagkousi E, Douma S, Dipla K. Association of Cerebral Oxygenation During Exercise With Target Organ Damage in Middle-Aged Hypertensive and Normotensive Individuals. Am J Hypertens 2022; 35:664-671. [PMID: 35325928 PMCID: PMC11024639 DOI: 10.1093/ajh/hpac040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/20/2022] [Accepted: 03/23/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The brain is one of the main target organs affected by hypertension. Impaired cerebral oxygenation during exercise is an indicator of cerebral dysfunction. We aimed to investigate whether cerebral oxygenation during exercise correlates with subclinical markers of early target organ damage in a population of middle-aged, newly diagnosed hypertensive and healthy individuals. METHODS Carotid intima-media thickness (cIMT) was measured using ultrasound, arterial stiffness was estimated measuring the augmentation index and pulse wave velocity, and retinal vessel diameter was assessed via the central retinal-arteriolar and vein equivalent and retinal-arteriovenous ratio. Participants (n = 93) performed a 3-minute isometric handgrip exercise. Cerebral prefrontal oxygenation was measured continuously using near infrared spectroscopy. The average exercise responses in oxygenated hemoglobin (O2Hb), deoxygenated hemoglobin (HHb), and total hemoglobin (tHb) were assessed. Univariate analyses were performed; partial correlation was used to account for traditional cardiovascular risk factors to identify independent associations between cerebral-oxygenation indices and early markers of target organ damage. RESULTS Mean cIMT was negatively correlated with the average exercise response in cerebral oxygenation (rhoO2Hb = -0.348, PO2Hb = 0.001; rhotHb = -0.253, Pthb = 0.02). Augmentation index was negatively correlated with cerebral oxygenation during exercise (rhoO2Hb = -0.374, P < 0.001; rhotHb = -0.332, P = 0.02), whereas no significant correlation was observed between pulse wave velocity and cerebral-oxygenation indices. In the adjusted analysis, cerebral oxygenation was correlated with central retinal arteriolar diameter (CRAE r = 0.233, P = 0.043). CONCLUSIONS Our novel findings suggest that indices of lower cerebral oxygenation during a submaximal physical task are associated with markers of early, subclinical target organ damage, namely increased cIMT, arterial stiffness, and arteriolar retinal narrowing in newly diagnosed, untreated, hypertensive individuals.
Collapse
Affiliation(s)
- Georgios A Triantafyllou
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Areti Triantafyllou
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandros Savvas Zafeiridis
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Koletsos
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Zafeiridis
- Exercise Physiology and Biochemistry Laboratory, Department of Sports Science at Serres, Agios Ioannis 62110, Aristotle University of Thessaloniki, Serres, Greece
| | - Eugenia Gkaliagkousi
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Douma
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantina Dipla
- Exercise Physiology and Biochemistry Laboratory, Department of Sports Science at Serres, Agios Ioannis 62110, Aristotle University of Thessaloniki, Serres, Greece
| |
Collapse
|
6
|
Characterization of Macular Structural and Microvascular Changes in Thalamic Infarction Patients: A Swept-Source Optical Coherence Tomography-Angiography Study. Brain Sci 2022; 12:brainsci12050518. [PMID: 35624906 PMCID: PMC9139152 DOI: 10.3390/brainsci12050518] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/02/2022] [Accepted: 04/17/2022] [Indexed: 02/05/2023] Open
Abstract
Background: The retina and brain share similar neuronal and microvascular features. We aimed to investigate the retinal thickness and microvasculature in patients with thalamic infarcts compared with control participants. Material and methods: Swept-source optical coherence tomography (SS-OCT) was used to image the macular thickness (retinal nerve fiber layer, RNFL; ganglion cell-inner plexiform layer, GCIP), while OCT angiography was used to image the microvasculature (superficial vascular plexus, SVP; intermediate capillary plexus, ICP; deep capillary plexus, DCP). Inbuilt software was used to measure the macular thickness (µm) and microvascular density (%). Lesion volumes were quantitively assessed based on structural magnetic resonance images. Results: A total of 35 patients with unilateral thalamic infarction and 31 age−sex-matched controls were enrolled. Compared with control participants, thalamic infarction patients showed a significantly thinner thickness of RNFL (p < 0.01) and GCIP (p = 0.02), and a lower density of SVP (p = 0.001) and ICP (p = 0.022). In the group of patients, ipsilateral eyes showed significant reductions in SVP (p = 0.033), RNFL (p = 0.01) and GCIP (p = 0.043). When divided into three groups based on disease duration (<1 month, 1−6 months, and >6 months), no significant differences were found among these groups. After adjusting for confounders, SVP, ICP, DCP, RNFL, and GCIP were significantly correlated with lesion volume in patients. Conclusions: Thalamic infarction patients showed significant macular structure and microvasculature changes. Lesion size was significantly correlated with these alterations. These findings may be useful for further research into the clinical utility of retinal imaging in stroke patients, especially those with damage to the visual pathway.
Collapse
|
7
|
Cheung CY, Biousse V, Keane PA, Schiffrin EL, Wong TY. Hypertensive eye disease. Nat Rev Dis Primers 2022; 8:14. [PMID: 35273180 DOI: 10.1038/s41572-022-00342-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 02/07/2023]
Abstract
Hypertensive eye disease includes a spectrum of pathological changes, the most well known being hypertensive retinopathy. Other commonly involved parts of the eye in hypertension include the choroid and optic nerve, sometimes referred to as hypertensive choroidopathy and hypertensive optic neuropathy. Together, hypertensive eye disease develops in response to acute and/or chronic elevation of blood pressure. Major advances in research over the past three decades have greatly enhanced our understanding of the epidemiology, systemic associations and clinical implications of hypertensive eye disease, particularly hypertensive retinopathy. Traditionally diagnosed via a clinical funduscopic examination, but increasingly documented on digital retinal fundus photographs, hypertensive retinopathy has long been considered a marker of systemic target organ damage (for example, kidney disease) elsewhere in the body. Epidemiological studies indicate that hypertensive retinopathy signs are commonly seen in the general adult population, are associated with subclinical measures of vascular disease and predict risk of incident clinical cardiovascular events. New technologies, including development of non-invasive optical coherence tomography angiography, artificial intelligence and mobile ocular imaging instruments, have allowed further assessment and understanding of the ocular manifestations of hypertension and increase the potential that ocular imaging could be used for hypertension management and cardiovascular risk stratification.
Collapse
Affiliation(s)
- Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Valérie Biousse
- Departments of Ophthalmology and Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Ernesto L Schiffrin
- Hypertension and Vascular Research Unit, Lady Davis Institute for Medical Research, and Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore. .,Tsinghua Medicine, Tsinghua University, Beijing, China.
| |
Collapse
|
8
|
French C, Cubbidge RP, Heitmar R. The application of arterio-venous ratio (AVR) cut-off values in clinic to stratify cardiovascular risk in patients. Ophthalmic Physiol Opt 2022; 42:666-674. [PMID: 35257402 PMCID: PMC9310762 DOI: 10.1111/opo.12967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/30/2022] [Accepted: 02/04/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cardiovascular risk calculators are a useful tool for identifying at-risk individuals. There are standardised methods for assessing the retinal microcirculation which alters as a consequence of cardiovascular disease (CVD). This study aimed to explore if a standardised retinal vessel assessment conducted in primary optometric care reflects current cardiovascular risk, as measured using two validated CVD risk calculators (QRISK 2; Mayo Clinic). METHODS A total of 120 subjects were included in the analyses. Following a routine eye examination, participants had disc-centred retinal photographs and systemic blood pressure taken. Retinal vessel parameters (central retinal artery and vein equivalent and arterio-venous ratio (AVR)) were calculated using semi-automated software. Participants were then grouped into AVR quintiles as defined by the Atherosclerosis Risk in Communities Study (ARIC). Cardiovascular risk was calculated with the validated QRISK and Mayo Clinic health calculators. RESULTS Systolic blood pressure was significantly greater in those with an AVR value falling in the lowest quintile compared to the highest quintile (150.65 mmHg vs. 132.21 mmHg [p = 0.001]). Similarly, CVD risk was significantly higher in those with the lowest AVR compared to the highest (QRISK: 14.28% vs. 9.87% [p = 0.05]; MAYO risk: 36.35% vs. 19.21% [p = 0.01]). Chi squared analyses showed a significant difference in the number of hypertensives in the lowest AVR quintile compared to those in the highest [p = 0.02]. CONCLUSION Whilst the ARIC population is not directly comparable to the population used to develop the QRISK calculator, it has been shown that its application could help to identify at risk individuals using retinal vessel analyses.
Collapse
Affiliation(s)
- Christian French
- Department of Clinical, Biological & Pharmaceutical Science, University of Hertfordshire, Hatfield, UK.,Kettering General Hospital, Kettering, UK
| | | | - Rebekka Heitmar
- Centre for Vision across the LifeSpan (CVLS), School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| |
Collapse
|
9
|
Tan W, Yao X, Le TT, Tan B, Schmetterer L, Chua J. The New Era of Retinal Imaging in Hypertensive Patients. Asia Pac J Ophthalmol (Phila) 2022; 11:149-159. [PMID: 35533334 DOI: 10.1097/apo.0000000000000509] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
ABSTRACT Structural and functional alterations in the microcirculation by systemic hypertension can cause significant organ damage at the eye, heart, brain, and kidneys. As the retina is the only tissue in the body that allows direct imaging of small vessels, the relationship of hypertensive retinopathy signs with development of disease states in other organs have been extensively studied; large-scale epidemiological studies using fundus photography and advanced semi-automated analysis software have reported the association of retinopathy signs with hypertensive end-organ damage includes the following: stroke, dementia, and coronary heart disease. Although yielding much useful information, the vessels assessed from fundus photographs remain limited to the larger retinal arterioles and venules, and abnormalities observed may not be that of the earliest changes. Newer imaging modalities such as optical coherence tomography angiography and adaptive optics technology, which allow a greater precision in the structural quantification of retinal vessels, including capillaries, may facilitate the assessment and management of these patients. The advent of deep learning technology has also augmented the utility of fundus photographs to help create diagnostic and risk stratification systems. Particularly, deep learning systems have been shown in several large studies to be able to predict multiple cardiovascular risk factors, major adverse cardiovascular events within 5 years, and presence of coronary artery calcium, from fundus photographs alone. In the future, combining deep learning systems with the imaging precision offered by optical coherence tomography angiography and adaptive optics could pave way for systems that are able to predict adverse clinical outcomes even more accurately.
Collapse
Affiliation(s)
- Wilson Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Xinwen Yao
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
| | - Thu-Thao Le
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
| |
Collapse
|
10
|
French C, Heitmar R. Comparison of Static Retinal Vessel Caliber Measurements by Different Commercially Available Platforms. Optom Vis Sci 2021; 98:1104-1112. [PMID: 34570034 DOI: 10.1097/opx.0000000000001774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Commercially available platforms show good agreement in clinical outcomes for retinal vessel caliber measurements, despite differing absolute values. Tighter agreement is observed when right and left eye data are averaged, suggesting an approach suitable for clinical practice. PURPOSE The purpose of this study was to compare the retinal vessel caliber measurements generated by different commercially available platforms and their associations with systemic blood pressure and age. METHODS A total of 209 participants were recruited from a UK optometric practice. After a routine eye examination, participants had disc-centered retinal photographs and systemic blood pressure taken. Retinal vessel calibers (central retinal artery equivalent, central retinal vein equivalent, and arteriovenous ratio) were calculated using both MONA REVA and VesselMap. RESULTS An inverse Pearson correlation was observed between central retinal artery equivalent and mean arterial blood pressure on both platforms (r = -0.275 [P ≤ .001] and r = -0.388 [P ≤ .001] for MONA REVA and VesselMap, respectively); this correlation was also observed with arteriovenous ratio and blood pressure. An inverse correlation was observed between central retinal artery equivalent and age (r = -0.362 [P ≤ .001] and r = -0.404 [P ≤ .001] for MONA REVA and VesselMap, respectively); this was also seen between central retinal vein equivalent and age (r = -0.322 [P ≤ .001] and r = -0.369 [P ≤ .001]). Arteriovenous ratio remained independent from age for both platforms. Bland-Altman plots demonstrated good agreement between the platforms for all three variables. CONCLUSIONS Although absolute caliber measurements differed between the platforms, the correlations observed were of similar magnitudes, with good agreement between the two platforms. Tighter spaced limits of agreement were observed when right and left eye data were averaged for each subject. In the absence of localized ocular pathology, this approach should be used.
Collapse
|
11
|
Jung S, Kolwelter J, Bosch A, Cífková R, Harazny JM, Ott C, Achenbach S, Schmieder RE. Hypertrophic remodelling of retinal arterioles in patients with congestive heart failure. ESC Heart Fail 2021; 8:1892-1900. [PMID: 33787089 PMCID: PMC8120369 DOI: 10.1002/ehf2.13334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/13/2021] [Accepted: 03/19/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS Analysis of microvascular parameters in the retinal circulation-known to reflect those in the systemic circulation-allows us to differentiate between eutrophic and hypertrophic remodelling of small arteries. This study aimed to examine microvascular changes in patients with congestive heart failure (CHF) and reduced as well as mid-range ejection fraction. METHODS AND RESULTS Forty subjects with CHF underwent measurement of retinal capillary flow (RCF), wall-to-lumen ratio (WLR), vessel and lumen diameter, wall thickness, and wall cross-sectional area (WCSA) of retinal arterioles of the right eye by scanning laser Doppler flowmetry (SLDF). Applying a matched pair approach, we compared this group with reference values of age-matched controls from a random sample in the population of Pilsen, Czech Republic. There was no significant difference in RCF and WLR between the groups (RCF: P = 0.513; WLR: P = 0.106). In contrast, wall thickness and WCSA, indicators of hypertrophic remodelling, were higher in CHF subjects (WT: 15.0 ± 4.2 vs. 12.7 ± 4.2 μm, P = 0.021; WCSA: 4437.6 ± 1314.5 vs. 3615.9 ± 1567.8 μm2 , P = 0.014). Similarly, vessel (109.4 ± 11.1 vs. 100.5 ± 14.4 μm, P = 0.002) and lumen diameter (79.0 ± 7.9 vs. 75.2 ± 8.5 μm, P = 0.009) were increased in CHF. CONCLUSIONS In CHF subjects, we observed hypertrophic remodelling of retinal arterioles indicative of similar changes of small resistance arteries in the systemic circulation. Microvascular structure and function assessed by SLDF may thereby represent a useful, non-invasive method for monitoring of microvascular damage in patients with CHF and may offer innovative treatment targets for new CHF therapies.
Collapse
Affiliation(s)
- Susanne Jung
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Ulmenweg 18, Erlangen, 91054, Germany.,Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Julie Kolwelter
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Ulmenweg 18, Erlangen, 91054, Germany.,Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Agnes Bosch
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Ulmenweg 18, Erlangen, 91054, Germany
| | - Renata Cífková
- Center for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic.,Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | - Joanna M Harazny
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Ulmenweg 18, Erlangen, 91054, Germany.,Department of Human Physiology and Pathophysiology, University of Warmia and Mazury, Olsztyn, Poland
| | - Christian Ott
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Ulmenweg 18, Erlangen, 91054, Germany.,Department of Nephrology and Hypertension, Paracelsus Medical School, Nuremberg, Germany
| | - Stephan Achenbach
- Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Ulmenweg 18, Erlangen, 91054, Germany
| |
Collapse
|
12
|
Lin GM, Colangelo LA, Klein BEK, Cotch MF, Wong TY, Cheung CY, Heckbert SR, Alonso A, Kwon Y, Kronmal RA, Lloyd-Jones DM, Liu K. Association of Retinal Microvascular Signs with Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis. Ophthalmol Retina 2020; 5:78-85. [PMID: 32565383 DOI: 10.1016/j.oret.2020.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/28/2020] [Accepted: 06/10/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Microvascular diseases may contribute to the occurrence of atrial fibrillation (AF). Retinal microvascular signs that are similar to other microvasculature in the body and can be visualized directly via ophthalmoscopy may provide insights into such a relationship. DESIGN Prospective, longitudinal, multiethnic study. PARTICIPANTS We examined the association between retinal microvascular signs and incident AF in 4994 participants 47 to 86 years of age and free of prior AF who underwent fundus photography from 2002 through 2004 and were followed up through 2015 in the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS Retinal microvascular signs evaluated include central retinal arteriolar equivalent and central retinal venular equivalent (CRVE) and presence of any retinopathy signs (e.g., retinal microaneurysms or hemorrhages). A multivariate Cox regression analysis was used to determine the relationship while adjusting for traditional risk factors, alcohol intake, body mass index, diabetes status, chronic kidney disease status, hemoglobin A1c level, C-reactive protein level, medications, and prevalent cardiovascular diseases or heart failure. MAIN OUTCOME AND MEASURES Incident AF events were identified using 12-lead electrocardiographic findings, hospital discharge records, and Medicare claims data. RESULTS During a median follow-up of 14.1 years, 643 AF events were identified. No association was found between any retinal microvascular signs and incident AF except for retinal focal arteriolar narrowing (hazard ratio, 1.75; 95% confidence interval, 1.06-2.87) in the overall population. However, in the subgroup analyses by gender, wider CRVE was associated with a higher risk of incident AF in women, but not in men (hazard ratio for every 10-μm increase in CRVE, 1.08 [95% confidence interval, 1.01-1.15] and 0.97 [95% confidence interval, 0.92-1.03], respectively; P = 0.041 for interaction). CONCLUSIONS No consistent pattern of association was found between retinal microvascular signs and incident AF. We observed an association in women, but not in men, of wider retinal venular calibers with incidence of AF. The reasons for a possible interaction are incompletely understood.
Collapse
Affiliation(s)
- Gen-Min Lin
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois; Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Laura A Colangelo
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Mary Frances Cotch
- Division of Epidemiology and Clinical Applications, NIH Intramural Research Program, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Younghoon Kwon
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Richard A Kronmal
- Department of Biostatistics, University of Washington, Seattle, Washington
| | | | - Kiang Liu
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
13
|
Association Between Caliber of Retinal Vessels and Cardiovascular Disease: a Systematic Review and Meta-Analysis. Curr Atheroscler Rep 2020; 22:16. [PMID: 32440852 DOI: 10.1007/s11883-020-0834-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
14
|
Affiliation(s)
- Santosh Kumar
- Francois M Abboud Cardiovascular Research Center, Division of Cardiovascular Medicine, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
15
|
|
16
|
|
17
|
Dumitrescu AG, Voinea L, Badarau IA, Paun VA, Schowe M, Ciuluvica R. Update on retinal vascular caliber. Rom J Ophthalmol 2018; 61:171-180. [PMID: 29450394 PMCID: PMC5710034 DOI: 10.22336/rjo.2017.32] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Retinal vessels are the only blood vessels that can be viewed directly, in vivo, repetitively and non-invasively. Retinal vessel caliber is influenced by physiological (age, sex, race, blood pressure, blood glucose, body mass index) and pathological (atherosclerosis, dyslipidemia, smoking) determinants. There are studies on large population groups that demonstrate the associations between retinal vasculature and subclinical or clinical changes in systemic diseases (hypertension, diabetes, stroke, renal or cardiac diseases). The assessment of retinal vessels can provide information about the pathophysiology of many diseases, but it also has a direct applicability in clinic, being used as a screening method that predicts the risk of their occurrence.
Collapse
Affiliation(s)
- Alina Gabriela Dumitrescu
- Coltea Clinical Hospital, Bucharest, Romania.,Physiology Department I, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Liliana Voinea
- Ophthalmology Department, University Emergency Hospital; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ioana Anca Badarau
- Physiology Department I, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Vanessa Andrada Paun
- Ophthalmology Department, University Emergency Hospital; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Radu Ciuluvica
- Anatomy Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| |
Collapse
|
18
|
Association of retinal vessel calibers and longitudinal changes in arterial stiffness. J Hypertens 2018; 36:587-593. [DOI: 10.1097/hjh.0000000000001602] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
19
|
Abstract
Supplemental Digital Content is available in the text Objectives: To examine factors influencing retinal vasculature in two environmentally contrasted, cross-sectional studies of adult participants of European descent and to estimate the extent and specificity of genetic contributions to each retinal vasculature feature. Methods: Retinal images from 1088 participants in the Orkney Complex Disease Study and 387 in the CROATIA-Korčula study, taken using the same nonmydriatic camera system and graded by the same person, were evaluated. Using general linear models, we estimated the influence of an extensive range of systemic risk factors, calculated retinal traits heritabilities and genetic correlations. Main results: Systemic covariates explained little (<4%) of the variation in vessel tortuosity, substantially more (>10%, up to 31.7%) of the variation in vessel width and monofractal dimension. Suggestive not well trodden associations of biological interest included that of urate, tissue plasminogen activator and cardiac PR interval with arteriolar narrowing, that of carotid intima–media thickness with less-tortuous arterioles and of cardiac QT interval with more tortuous venules. The genetic underpinning of tortuosity is largely distinct from that of the other retinal vascular features, whereas that of fractal dimension and vessel width greatly overlaps. The previously recognized influence of ocular axial length on vessel widths was high and can be expected to lead to artefactual genetic associations [genetic correlation with central retinal arteriolar equivalent: −0.53 (standard error 0.11)]. The significant genetic correlation between SBP and central retinal arteriolar equivalent, −0.53 (standard error 0.22) (after adjusting for age, sex and axial length of the eye), augurs more favourably for the discovery of genetic variants relevant to vascular physiology.
Collapse
|
20
|
Cheung CYL, Ikram MK, Chen C, Wong TY. Imaging retina to study dementia and stroke. Prog Retin Eye Res 2017; 57:89-107. [PMID: 28057562 DOI: 10.1016/j.preteyeres.2017.01.001] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/07/2016] [Accepted: 01/01/2017] [Indexed: 02/07/2023]
Abstract
With increase in life expectancy, the number of persons suffering from common age-related brain diseases, including neurodegenerative (e.g., dementia) and cerebrovascular (e.g., stroke) disease is expected to rise substantially. As current neuro-imaging modalities such as magnetic resonance imaging may not be able to detect subtle subclinical changes (resolution <100-500 μm) in dementia and stroke, there is an urgent need for other complementary techniques to probe the pathophysiology of these diseases. The retina - due to its anatomical, embryological and physiological similarities with the brain - offers a unique and accessible "window" to study correlates and consequences of subclinical pathology in the brain. Retinal components such as the microvasculature and retinal ganglion cell axons can now be visualized non-invasively using different retinal imaging techniques e.g., ocular fundus photography and optical coherence tomography. Advances in retinal imaging may provide new and potentially important insights into cerebrovascular neurodegenerative processes in addition to what is currently possible with neuro-imaging. In this review, we present an overview of the current literature on the application of retinal imaging in the study of dementia and stroke. We discuss clinical implications of these studies, novel state-of-the-art retinal imaging techniques and future directions aimed at evaluating whether retinal imaging can be an additional investigation tool in the study of dementia and stroke.
Collapse
Affiliation(s)
- Carol Yim-Lui Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.
| | - M Kamran Ikram
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore; Departments of Neurology & Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Christopher Chen
- Memory Aging and Cognition Centre, National University Health System, Singapore; Department of Pharmacology, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Graduate Medical School, National University of Singapore, Singapore
| |
Collapse
|
21
|
Abstract
PURPOSE OF REVIEW Hypertension is the primary risk factor for cardiovascular disease and mortality that consists a major public health issue worldwide. Hypertension triggers a series of pathophysiological ocular modifications affecting significantly the retinal, choroidal, and optic nerve circulations that result in a range of ocular effects.The retina is the only place in the body where microvasculature can be directly inspected, providing valuable information on hypertension related systemic risks.The aim of this review is to provide an update on latest advances regarding the detection and significance of hypertension related eye signs. RECENT FINDINGS It's been shown that measurable retinal microvascular changes may precede progression of systemic microvascular disease.Last years, there are emerging advances in the field retinal imaging and computer software analysis that have enabled the objective and accurate assessment of retinal vascular caliber, while in association with latest epidemiological studies several other retinal vascular features have been recognized, such as vascular length-to-diameter ratio, and wall-to-lumen ratio that may also be associated to hypertension.Additionally, recent genetic studies have provided some insight to vascular pathophysiological processes having correlated new chromosome's loci to hypertensive retinopathy signs. SUMMARY Assessment of hypertensive retinopathy signs may convey additional prognostic information on the risk of end-organ damage and may alert for urgent systemic management or even preventive systemic therapies. Further development of retinal vascular imaging and computerized system may provide a significant tool to improve the diagnosis, prognosis, and management of hypertension in clinical practice.
Collapse
|
22
|
Abstract
The retinal circulation is a potential marker of cerebral vascular disease because it shares origin and drainage with the intracranial circulation and because it can be directly visualized using ophthalmoscopy. Cross-sectional and cohort studies have demonstrated associations between chronic retinal and cerebral vascular disease, acute retinal and cerebral vascular disease, and chronic retinal vascular disease and acute cerebral vascular disease. In particular, certain qualitative features of retinopathy, retinal artery occlusion, and increased retinal vein caliber are associated with concurrent and future cerebrovascular events. These associations persist after accounting for confounding variables known to be disease-causing in both circulations, which supports the potential use of retinal vasculature findings to stratify individuals with regards to cerebral vascular disease risk.
Collapse
|
23
|
Heitmar R, Kalitzeos AA. Reliability of retinal vessel calibre measurements using a retinal oximeter. BMC Ophthalmol 2015; 15:184. [PMID: 26705024 PMCID: PMC4690418 DOI: 10.1186/s12886-015-0174-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 12/15/2015] [Indexed: 11/30/2022] Open
Abstract
Background Summarised retinal vessel diameters are linked to systemic vascular pathology. Monochromatic images provide best contrast to measure vessel calibres. However, when obtaining images with a dual wavelength oximeter the red-free image can be extracted as the green channel information only which in turn will reduce the number of photographs taken at a given time. This will reduce patient exposure to the camera flash and could provide sufficient quality images to reliably measure vessel calibres. Methods We obtained retinal images of one eye of 45 healthy participants. Central retinal arteriolar and central retinal venular equivalents (CRAE and CRVE, respectively) were measured using semi-automated software from two monochromatic images: one taken with a red-free filter and one extracted from the green channel of a dual wavelength oximetry image. Results Participants were aged between 21 and 62 years, all were normotensive (SBP: 115 (12) mmHg; DBP: 72 (10) mmHg) and had normal intra-ocular pressures (12 (3) mmHg). Bland-Altman analysis revealed good agreement of CRAE and CRVE as obtained from both images (mean bias CRAE = 0.88; CRVE = 2.82). Conclusions Summarised retinal vessel calibre measurements obtained from oximetry images are in good agreement to those obtained using red-free photographs.
Collapse
Affiliation(s)
- Rebekka Heitmar
- Aston University, School of Life and Health Sciences, Aston Triangle, Birmingham, B4 7ET, UK.
| | - Angelos A Kalitzeos
- Aston University, School of Life and Health Sciences, Aston Triangle, Birmingham, B4 7ET, UK
| |
Collapse
|
24
|
Renal glomerular dysfunction in relation to retinal arteriolar narrowing and high pulse pressure in seniors. Hypertens Res 2015; 39:138-43. [PMID: 26559607 DOI: 10.1038/hr.2015.125] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/23/2015] [Accepted: 10/15/2015] [Indexed: 01/14/2023]
Abstract
Retinal arteriolar narrowing and high pulse pressure (PP) are associated with macrovascular complications and microvascular renal disease. Few studies addressed whether in seniors (⩾60 years) estimated glomerular filtration rate (eGFR) is independently related to central retinal arteriolar equivalent (CRAE) and PP. In 292 randomly recruited seniors (49.3% women; mean, 68.2 years), we measured PP by standard sphygmomanometry, CRAE (IVAN software), eGFR (Chronic Kidney Disease Epidemiology Collaboration equation) and stage of chronic kidney disease (CKD (Kidney Disease Outcomes Quality Initiative guideline)). Statistical methods included linear and logistic regression. PP, CRAE and eGFR averaged 59.2 mm Hg, 146.3 μm and 79.9 ml min(-1) per 1.73 m(2). Decline in eGFR (-2.27 ml min(-1) per 1.73 m(2) per 15 μm; P=0.011) occurred in parallel with CRAE narrowing. CRAE (effect size per 1-s.d. increment, -1.85 μm; P=0.032) and eGFR (-2.68 ml min(-1) per 1.73 m(2); P=0.003) both declined with higher PP. With PP increasing from 63 to 73 mm Hg (threshold for macrovascular complications), CRAE dropped by -4.70 μm (P⩽0.037). A 70-mm Hg PP threshold corresponded with a 150-μm CRAE cutoff. The risk of CKD (stage ⩾2 vs. 1; n=203 vs. 89) rose with CRAE <150 μm (odds ratio, 2.81; P<0.0001), but not with PP ⩾70 mm Hg (1.47; P=0.20). Additionally, CRAE added to PP increased the area under the curve from 0.58 to 0.64 (P=0.047) for identifying stage ⩾2 CKD. In seniors, CRAE and eGFR decline in parallel with higher PP. CRAE <150 μm identifies early decline in eGFR.
Collapse
|
25
|
Eriksen BO, Løchen ML, Arntzen KA, Bertelsen G, Winther Eilertsen BA, von Hanno T, Herder M, Jenssen TG, Mathisen UD, Melsom T, Njølstad I, Solbu MD, Mathiesen EB. Estimated and Measured GFR Associate Differently with Retinal Vasculopathy in the General Population. Nephron Clin Pract 2015; 131:175-84. [PMID: 26426198 DOI: 10.1159/000441092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/11/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND/AIMS Estimated glomerular filtration rate (eGFR) is used extensively in epidemiological research. Validations of eGFR have demonstrated acceptable performance, but the dependence of creatinine and cystatin C on non-GFR factors could confound associations with disease. Few studies have investigated this issue in direct comparison with measured GFR (mGFR). We compared the associations between eGFR and mGFR and retinal vasculopathy, a marker of systemic microvasculopathy. METHODS Iohexol clearance and retinal photography were examined in the Renal Iohexol Clearance Survey in Tromsø 6, which consists of a representative sample of middle-aged persons from the general population. A total of 1,553 persons without self-reported kidney disease, cardiovascular disease or diabetes were investigated. Three eGFR equations based on creatinine and/or cystatin C from the Chronic Kidney Disease Epidemiology Collaboration were studied. Differences between eGFR and mGFR were analyzed with seemingly unrelated regression methods. RESULTS mGFR in the lowest quartile was associated with an increased multivariable-adjusted odds ratio of retinopathy (OR 1.86, 95% CI 1.16-2.97), but not with retinal artery or vein diameters. eGFR based on cystatin C (eGFRcys) was consistently biased relative to mGFR in its associations with retinal vessel diameters across different models. eGFR based on creatinine (eGFRcrea) and eGFR based on both creatinine and cystatin C were also biased in several of these models (p < 0.05). For retinopathy, the differences between the 3 eGFR and mGFR measurements were not statistically significant. CONCLUSIONS Low mGFR is associated with retinopathy in the general population. eGFR based on creatinine and/or cystatin C are not valid substitutes for mGFR in studies of the relationship between the retina and kidney function in healthy persons.
Collapse
Affiliation(s)
- Bjørn Odvar Eriksen
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsx00F8;, Norway
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Kord Valeshabad A, Wanek J, Mukarram F, Zelkha R, Testai FD, Shahidi M. Feasibility of assessment of conjunctival microvascular hemodynamics in unilateral ischemic stroke. Microvasc Res 2015; 100:4-8. [PMID: 25917010 PMCID: PMC4461531 DOI: 10.1016/j.mvr.2015.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 04/06/2015] [Accepted: 04/20/2015] [Indexed: 11/21/2022]
Abstract
Since the internal carotid artery supplies blood to both the eye and the brain, ocular microvascular hemodynamics can be altered due to ischemic stroke. The purpose of the current study was to establish the feasibility of conjunctival microcirculation imaging for detection of inter-ocular differences in microvascular hemodynamics in subjects with unilateral ischemic stroke. Conjunctival microcirculation imaging was performed in both eyes of 15 healthy control subjects and 12 subjects following unilateral ischemic stroke. Diameter and axial blood velocity were measured in multiple conjunctival venules of each eye. A two-way repeated measures analysis of variance was performed to determine the effects of stroke (control vs. stroke) and side of stroke (ipsilateral vs. contralateral) on conjunctival diameter and axial blood velocity. There was no significant main effect of stroke on conjunctival diameter (P=0.7) or conjunctival axial blood velocity (P=0.9). There was no significant main effect of side of stroke on conjunctival diameter (P=0.8), but there was a significant main effect of side of stroke on conjunctival axial blood velocity (P=0.02). There was a significant interaction effect between stroke and side of stroke (P=0.04), indicating that conjunctival axial blood velocity was lower in ipsilateral eyes than in contralateral eyes of stroke subjects. Conjunctival axial blood velocity and internal carotid artery blood velocity were correlated in stroke subjects (r=0.75, P=0.01, N=10). Conjunctival microcirculation imaging is a feasible method to detect inter-ocular differences in microvascular hemodynamics in subjects with unilateral ischemic stroke.
Collapse
Affiliation(s)
- Ali Kord Valeshabad
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Justin Wanek
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Faisal Mukarram
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, USA
| | - Ruth Zelkha
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, USA
| | - Mahnaz Shahidi
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.
| |
Collapse
|
27
|
Wang J, Zhao M, Li SJ, Wang DZ. Retinal artery lesions and long-term outcome in Chinese patients with acute coronary syndrome. Eye (Lond) 2015; 29:643-8. [PMID: 25744444 PMCID: PMC4429279 DOI: 10.1038/eye.2015.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/07/2015] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the relationship between staging of retinal artery lesions and the prognosis of acute coronary syndrome (ACS) in a Chinese population. Methods A total of 436 Chinese patients with ACS underwent coronary angiography and the eyes fundus examinations. All the patients were divided into three groups: group 1, no retinal artery lesions (n=111); group 2, retinal artery lesions of <Stage 2 (Stage 1—a broadening of the light reflex from the artery can be seen, with minimal or no arteriovenous compression; n=135); and group 3, retinal artery lesions of ≥Stage 2 (Stage 2—the changes similar to those in Stage 1, but more prominent, Stage 3—the arteries have a ‘copper wire' appearance and this is much more arteriovenous compression, and Stage 4—the arteries have a ‘silver wire' appearance and the arteriovenous crossing changes are more severe; n=190). The endpoints were main adverse cardiovascular and cerebrovascular events (MACCE), including all-cause death, myocardial infarction (MI), and stroke after 3–6 years of follow-up. Results There was no significant differences of the baseline data among the three groups. After 3–6 years of follow-up, we found that patients of group 3 had more MACCE and death than those of the group 1 or group 2. Cox regression analysis found that factors related to the prognosis of ACS was staging of retinal artery lesions (P<0.05) in addition to traditional risk factors such as age, gender, diabetes, hypertension, and hypercholesterolemia. Conclusion Staging of retinal artery lesions plays an important role in the long-term outcome of patients with ACS.
Collapse
Affiliation(s)
- J Wang
- Department of Cardiology, Beijing Mentougou District Hospital, Beijing, China
| | - M Zhao
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - S-J Li
- Department of Cardiology, Beijing Mentougou District Hospital, Beijing, China
| | - D-Z Wang
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
28
|
Cheung CYL, Tay WT, Ikram MK, Ong YT, De Silva DA, Chow KY, Wong TY. Retinal Microvascular Changes and Risk of Stroke. Stroke 2013; 44:2402-8. [DOI: 10.1161/strokeaha.113.001738] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
To examine the relationship between retinal microvascular measures and incident stroke in an Asian Malay population.
Methods—
We conducted a prospective, population-based cohort study of Asian Malay persons 40 to 80 years at baseline. Retinal microvascular signs were assessed from baseline retinal photographs including quantitative retinal microvascular parameters (caliber, branching angle, tortuosity, and fractal dimension) and qualitative retinopathy signs. Incident stroke cases were identified during the follow-up period. Cox proportional-hazards regression and incremental usefulness analysis (calibration, discrimination, and reclassification) were performed.
Results—
A total of 3189 participants were free of prevalent stroke at baseline. During the follow-up (median, 4.41 years), 51 (1.93%) participants had an incident stroke event. In Cox proportional-hazards models adjusting for established stroke predictors (age, sex, systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, smoking, glycosylated hemoglobin, and antihypertensive medication), retinopathy (hazard ratio, 1.94; 95% confidence interval, 1.01–3.72) and larger retinal venular caliber (hazard ratio, 3.28; 95% confidence interval, 1.30–8.26, comparing fourth versus first quartiles) were associated with risk of stroke. Compared with the model with only established risk factors, the addition of retinal measures improved the prediction of stroke (C-Statistic 0.826 versus 0.792;
P
=0.017) and correctly reclassified 5.9% of participants with incident stroke and 3.4% of participants with no incident stroke.
Conclusions—
Retinal microvascular changes are related to an increased risk of stroke in Asian Malay, consistent with data from white populations. Retinal imaging improves the discrimination and stratification of stroke risk beyond that of established risk factors by a significant but small margin.
Collapse
Affiliation(s)
- Carol Yim-lui Cheung
- From the Singapore Eye Research Institute, Singapore National Eye Centre, Singapore (C.Y.C., W.T.T., M.K.I., Y.T.O., T.Y.W.); Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (C.Y.C., M.K.I., Y.T.O., T.Y.W.); Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore (C.Y.C.); Memory Aging and Cognition Centre, National University Health System, Singapore (M.K.I.); Department of Neurology, Singapore General Hospital Campus,
| | - Wan Ting Tay
- From the Singapore Eye Research Institute, Singapore National Eye Centre, Singapore (C.Y.C., W.T.T., M.K.I., Y.T.O., T.Y.W.); Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (C.Y.C., M.K.I., Y.T.O., T.Y.W.); Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore (C.Y.C.); Memory Aging and Cognition Centre, National University Health System, Singapore (M.K.I.); Department of Neurology, Singapore General Hospital Campus,
| | - M. Kamran Ikram
- From the Singapore Eye Research Institute, Singapore National Eye Centre, Singapore (C.Y.C., W.T.T., M.K.I., Y.T.O., T.Y.W.); Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (C.Y.C., M.K.I., Y.T.O., T.Y.W.); Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore (C.Y.C.); Memory Aging and Cognition Centre, National University Health System, Singapore (M.K.I.); Department of Neurology, Singapore General Hospital Campus,
| | - Yi Ting Ong
- From the Singapore Eye Research Institute, Singapore National Eye Centre, Singapore (C.Y.C., W.T.T., M.K.I., Y.T.O., T.Y.W.); Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (C.Y.C., M.K.I., Y.T.O., T.Y.W.); Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore (C.Y.C.); Memory Aging and Cognition Centre, National University Health System, Singapore (M.K.I.); Department of Neurology, Singapore General Hospital Campus,
| | - Deidre A. De Silva
- From the Singapore Eye Research Institute, Singapore National Eye Centre, Singapore (C.Y.C., W.T.T., M.K.I., Y.T.O., T.Y.W.); Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (C.Y.C., M.K.I., Y.T.O., T.Y.W.); Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore (C.Y.C.); Memory Aging and Cognition Centre, National University Health System, Singapore (M.K.I.); Department of Neurology, Singapore General Hospital Campus,
| | - Khuan Yew Chow
- From the Singapore Eye Research Institute, Singapore National Eye Centre, Singapore (C.Y.C., W.T.T., M.K.I., Y.T.O., T.Y.W.); Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (C.Y.C., M.K.I., Y.T.O., T.Y.W.); Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore (C.Y.C.); Memory Aging and Cognition Centre, National University Health System, Singapore (M.K.I.); Department of Neurology, Singapore General Hospital Campus,
| | - Tien Yin Wong
- From the Singapore Eye Research Institute, Singapore National Eye Centre, Singapore (C.Y.C., W.T.T., M.K.I., Y.T.O., T.Y.W.); Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (C.Y.C., M.K.I., Y.T.O., T.Y.W.); Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore (C.Y.C.); Memory Aging and Cognition Centre, National University Health System, Singapore (M.K.I.); Department of Neurology, Singapore General Hospital Campus,
| |
Collapse
|
29
|
|
30
|
Ikram MK, Ong YT, Cheung CY, Wong TY. Retinal Vascular Caliber Measurements: Clinical Significance, Current Knowledge and Future Perspectives. Ophthalmologica 2013; 229:125-36. [DOI: 10.1159/000342158] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 07/01/2012] [Indexed: 11/19/2022]
|
31
|
Kawasaki R, Xie J, Cheung N, Lamoureux E, Klein R, Klein BEK, Cotch MF, Sharrett AR, Shea S, Wong TY. Retinal microvascular signs and risk of stroke: the Multi-Ethnic Study of Atherosclerosis (MESA). Stroke 2012; 43:3245-51. [PMID: 23111439 PMCID: PMC3508325 DOI: 10.1161/strokeaha.112.673335] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 08/27/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Small-vessel disease contributes to the pathophysiology of stroke, and retinal microvascular signs have been linked to the risk of stroke. We examined the relationship of retinal signs with incident stroke in a multiethnic cohort. METHODS The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective cohort study that enrolled participants without clinical cardiovascular diseases from 6 US communities between 2000 and 2002. Of the participants, 4849 (71.2%) had fundus photography performed in 2002 to 2004. Retinopathy and retinal vessel caliber were assessed from retinal images. Stroke risk factors including high-sensitivity C-reactive protein, carotid artery intima-media thickness, and coronary artery calcium were measured using standardized protocols. Incident stroke was confirmed from medical record review and death certificates. RESULTS After 6 years of follow-up, there were 62 incident strokes. Narrower retinal arteriolar caliber was associated with increased risk of stroke after adjusting for conventional cardiovascular risk factors (adjusted incidence rate ratio, 2.83; 95% CI, 1.34-5.95; P=0.006; adjusted hazard ratio, 3.01; 95% CI, 1.29-6.99; P=0.011). Retinopathy in persons without diabetes was associated with increased risk of stroke (adjusted adjusted incidence rate ratio, 2.96; 95% CI, 1.50-5.84; P=0.002; adjusted hazard ratio, 3.07; 95% CI, 1.17-8.09; P=0.023). These associations remained significant after adjusting for high-sensitivity C-reactive protein, carotid intima-media thickness, or coronary artery calcium. CONCLUSIONS Narrower retinal arteriolar caliber and retinopathy in nondiabetic persons were associated with increased risk of stroke in this relatively healthy multiethnic cohort independent of traditional risk factors and measures of atherosclerosis. The association between narrower retinal arteriolar caliber and stroke warrants further investigation.
Collapse
Affiliation(s)
- Ryo Kawasaki
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, 32 Gisborne St, Melbourne, VIC3002 Australia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Cheung CYL, Ikram MK, Sabanayagam C, Wong TY. Retinal microvasculature as a model to study the manifestations of hypertension. Hypertension 2012; 60:1094-103. [PMID: 23045470 DOI: 10.1161/hypertensionaha.111.189142] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The retinal vasculature allows direct noninvasive visualization of the body's mircrovasculature. Because the retina and other end organs (brain and kidney) share similar anatomical features and physiological properties, the retinal vessels offer a unique and easily accessible window to study the health and disease of the human microcirculation. Advanced retinal vascular imaging technologies have been developed to allow a more objective and precise assessment of retinal vascular changes. The changes in the retinal vasculature associated with hypertension can be broadly divided into 3 groups: (1) classic retinal vascular changes in response to blood pressure (referred to as hypertensive retinopathy signs), (2) changes in retinal vascular caliber, and (3) changes in more global geometrical patterns of the retina. In this review, we summarize the current understanding of the relationship between retinal vascular changes and blood pressure, the evidence for the retinal vasculature as a biological model to study the manifestation and early pathogenic correlates of hypertension, the latest advances in retinal vascular imaging technologies, and the future opportunities and challenges of retinal vascular imaging. We suggest that further development of retinal vascular analyses and standardized measurement protocols, evaluation of the clinical use of retinal vascular imaging in assessing cardiovascular risk prediction, and using retinal vascular imaging to test antihypertensive treatments will allow the translation of retinal vascular imaging as a tool to improve the diagnosis, prognosis, and management of hypertension in clinical practice.
Collapse
Affiliation(s)
- Carol Yim-lui Cheung
- Singapore Eye Research Institute, 11 Third Hospital Ave, Singapore 168751, Singapore
| | | | | | | |
Collapse
|
33
|
Wickremasinghe SS, Xie J, Guymer RH, Wong TY, Kawasaki R, Qureshi S. Retinal vascular changes following intravitreal ranibizumab injections for neovascular AMD over a 1-year period. Eye (Lond) 2012; 26:958-66. [PMID: 22562186 PMCID: PMC3396172 DOI: 10.1038/eye.2012.72] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 03/13/2012] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To assess retinal vascular calibre changes in eyes with neovascular age-related macular degeneration (AMD), treated with intravitreal anti-vascular endothelial growth factor agents, over a 1-year period and compare any such changes to untreated fellow eyes. METHODS Treatment naïve patients with neovascular AMD received three consecutive intravitreal injections of ranibizumab, followed by a pro re nata dosing regimen up to 1 year, with the aim of maintaining a 'fluid-free' macula. Retinal arteriolar and venular calibre was measured from digital fundus photographs at baseline and at three monthly intervals to 1 year, and summarised as central retinal artery equivalent (CRAE) and central retinal venular equivalent (CRVE), respectively. RESULTS A total of 53 injected eyes and 41 fellow, non-injected eyes were analysed. At baseline, there were no differences in retinal vascular calibre between injected and non-injected eyes (mean CRAE (SD) 144.93 (14.07) vs 145.74 (13.10) μm, P=0.80 and mean CRVE (SD) 216.23 (25.93) vs 219.91 (22.82) μm, P=0.53). Over a 12-month period, retinal venular calibre dilatation occurred in injected eyes (mean CRVE change +5.71 (14.71) μm, P=0.007), with no change in retinal arterioles, +0.69 (14.71) μm, P=0.68. In non-injected eyes, arteriolar narrowing occurred as a whole, mean CRAE change -4.20 (7.00) μm, P=0.001, over 12 months, with a trend for narrowing in venules, -2.16 (11.56) μm, P=0.28. In injected eyes, after controlling for covariates, the changes in CRVE over 12 months mirrored improvements in macular thickness, -0.06 (-0.005, -0.11) μm, P=0.04, and visual acuity, +9.66 (-0.30, +19.32) μm, P=0.06. CONCLUSION Intravitreal ranibizumab significantly dilated retinal venules after a 1-year period.
Collapse
Affiliation(s)
- S S Wickremasinghe
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - J Xie
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - R H Guymer
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - T Y Wong
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Singapore Eye Research Institute, National University of Singapore, Singapore, Singapore
| | - R Kawasaki
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - S Qureshi
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
34
|
Heitmar R, Summers RJ. Assessing vascular function using dynamic retinal diameter measurements: a new insight on the endothelium. Thromb Haemost 2012; 107:1019-26. [PMID: 22534674 DOI: 10.1160/th11-11-0810] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 03/18/2012] [Indexed: 11/05/2022]
Affiliation(s)
- Rebekka Heitmar
- School of Life and Health Sciences, Aston University, Aston Triangle, B4 7ET, Birmingham, UK.
| | | |
Collapse
|
35
|
Kandasamy Y, Smith R, Wright IMR. Retinal microvascular changes in low-birth-weight babies have a link to future health. J Perinat Med 2012; 40:209-14. [PMID: 22150014 DOI: 10.1515/jpm.2011.116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In utero insults that result in low-birth-weight (LBW) infants are now recognized risk factors for the development of vascular-related diseases in adulthood. Microcirculatory pathologies are believed to form a mechanistic link between fetal insult and the manifestation of illness in adulthood. OBJECTIVES The challenge has been to investigate microcirculatory changes in vivo. The objective of this review is to determine whether LBW infants and individuals undergo abnormal microvascular changes and, if so, whether these changes can be objectively identified and measured by investigating retinal vessels. METHODS An online publication search was carried out using the following keywords to identify and review relevant articles: retinal microvasculature, retinal vessels, small for gestation age, growth restriction, and intrauterine growth restriction. Articles published from 1980 to 2011 were considered. CONCLUSIONS The ability of retinal imaging technology to assess and measure retinal microvasculature makes it a valuable assessment tool. The current tool is, however, unsuitable for non-invasive assessment in infants and young children. Once this hurdle has been overcome, a longitudinal study of LBW individuals from infancy to adulthood, with regular retinal microvascular assessments, would help prove the mechanistic link between LBW and cardiovascular disease in adulthood.
Collapse
|
36
|
Personalized prediction of lifetime benefits with statin therapy for asymptomatic individuals: a modeling study. PLoS Med 2012; 9:e1001361. [PMID: 23300388 PMCID: PMC3531501 DOI: 10.1371/journal.pmed.1001361] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 11/16/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Physicians need to inform asymptomatic individuals about personalized outcomes of statin therapy for primary prevention of cardiovascular disease (CVD). However, current prediction models focus on short-term outcomes and ignore the competing risk of death due to other causes. We aimed to predict the potential lifetime benefits with statin therapy, taking into account competing risks. METHODS AND FINDINGS A microsimulation model based on 5-y follow-up data from the Rotterdam Study, a population-based cohort of individuals aged 55 y and older living in the Ommoord district of Rotterdam, the Netherlands, was used to estimate lifetime outcomes with and without statin therapy. The model was validated in-sample using 10-y follow-up data. We used baseline variables and model output to construct (1) a web-based calculator for gains in total and CVD-free life expectancy and (2) color charts for comparing these gains to the Systematic Coronary Risk Evaluation (SCORE) charts. In 2,428 participants (mean age 67.7 y, 35.5% men), statin therapy increased total life expectancy by 0.3 y (SD 0.2) and CVD-free life expectancy by 0.7 y (SD 0.4). Age, sex, smoking, blood pressure, hypertension, lipids, diabetes, glucose, body mass index, waist-to-hip ratio, and creatinine were included in the calculator. Gains in total and CVD-free life expectancy increased with blood pressure, unfavorable lipid levels, and body mass index after multivariable adjustment. Gains decreased considerably with advancing age, while SCORE 10-y CVD mortality risk increased with age. Twenty-five percent of participants with a low SCORE risk achieved equal or larger gains in CVD-free life expectancy than the median gain in participants with a high SCORE risk. CONCLUSIONS We developed tools to predict personalized increases in total and CVD-free life expectancy with statin therapy. The predicted gains we found are small. If the underlying model is validated in an independent cohort, the tools may be useful in discussing with patients their individual outcomes with statin therapy.
Collapse
|
37
|
Association of dilated retinal arteriolar caliber with early age-related macular degeneration: the Handan Eye Study. Graefes Arch Clin Exp Ophthalmol 2011; 250:741-9. [DOI: 10.1007/s00417-011-1824-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 08/17/2011] [Accepted: 09/06/2011] [Indexed: 10/17/2022] Open
|
38
|
Hofman A, van Duijn CM, Franco OH, Ikram MA, Janssen HLA, Klaver CCW, Kuipers EJ, Nijsten TEC, Stricker BHC, Tiemeier H, Uitterlinden AG, Vernooij MW, Witteman JCM. The Rotterdam Study: 2012 objectives and design update. Eur J Epidemiol 2011; 26:657-86. [PMID: 21877163 PMCID: PMC3168750 DOI: 10.1007/s10654-011-9610-5] [Citation(s) in RCA: 263] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 08/08/2011] [Indexed: 01/09/2023]
Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, oncological, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over a 1,000 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
Collapse
Affiliation(s)
- Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Bokura H, Saika R, Yamaguchi T, Nagai A, Oguro H, Kobayashi S, Yamaguchi S. Microbleeds Are Associated With Subsequent Hemorrhagic and Ischemic Stroke in Healthy Elderly Individuals. Stroke 2011; 42:1867-71. [DOI: 10.1161/strokeaha.110.601922] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hirokazu Bokura
- From the Department of Neurology (H.B., R.S., T.Y., A.N., H.O., S.Y.), Faculty of Medicine, Shimane University; and Shimane University Hospital (S.K.), Izumo, Japan
| | - Reiko Saika
- From the Department of Neurology (H.B., R.S., T.Y., A.N., H.O., S.Y.), Faculty of Medicine, Shimane University; and Shimane University Hospital (S.K.), Izumo, Japan
| | - Takuya Yamaguchi
- From the Department of Neurology (H.B., R.S., T.Y., A.N., H.O., S.Y.), Faculty of Medicine, Shimane University; and Shimane University Hospital (S.K.), Izumo, Japan
| | - Atsushi Nagai
- From the Department of Neurology (H.B., R.S., T.Y., A.N., H.O., S.Y.), Faculty of Medicine, Shimane University; and Shimane University Hospital (S.K.), Izumo, Japan
| | - Hiroaki Oguro
- From the Department of Neurology (H.B., R.S., T.Y., A.N., H.O., S.Y.), Faculty of Medicine, Shimane University; and Shimane University Hospital (S.K.), Izumo, Japan
| | - Shotai Kobayashi
- From the Department of Neurology (H.B., R.S., T.Y., A.N., H.O., S.Y.), Faculty of Medicine, Shimane University; and Shimane University Hospital (S.K.), Izumo, Japan
| | - Shuhei Yamaguchi
- From the Department of Neurology (H.B., R.S., T.Y., A.N., H.O., S.Y.), Faculty of Medicine, Shimane University; and Shimane University Hospital (S.K.), Izumo, Japan
| |
Collapse
|