Are Retinal Vessels Calibers Influenced by Blood Pressure Measured at the Time of Retinography Acquisition?

Ocular manifestations of severe familial hypercholesterolemia

Background

To study ocular manifestations of patients with severe familial hypercholesterolemia (FH).

Methods

In this population-based case-control study, patients suffering from severe familial hypercholesterolemia from the Lebanese Familial Hypercholesterolemia Registry, along with age and gender-matched healthy controls were recruited. All participants underwent a comprehensive eye examination, and patients underwent fluorescein angiography as well. Logistic regression models were used to identify any association between patients with severe familial hypercholesterolemia and abnormal eye findings, while adjusting for hypertension and pack-year smoking. The main outcome measure of this study was the development of ocular vascular abnormalities.

Results

28 patients and 28 controls were recruited. Patients with severe familial hypercholesterolemia had significantly greater odds of developing corneal arcus and xanthelasmas than the control group (p < 0.001). Retinal vascular abnormalities (plaques) were exclusively and more significantly present in patients with familial hypercholesterolemia (18 %). Similarly, retinal arteriosclerosis was exclusively and significantly more prevalent in the familial hypercholesterolemia group (p < 0.001, adjusted odds ratio 6.8). Stratification by LDL levels and genotypes did not show any significant change in the prevalence of any ocular finding.

Conclusion

In addition to the well-established increase in incidence of corneal arcus and xanthelasmas, severe familial hypercholesterolemia patients have more prevalent retinal vascular abnormalities that include vascular plaques and arteriosclerosis.

Association between hypertension and retinal vascular features in ultra-widefield fundus imaging

Objective

Changes to the retinal vasculature are known to be associated with hypertension independently of traditional risk factors. We investigated whether measurements of retinal vascular calibre from ultra-widefield fundus imaging were associated with hypertensive status.

Methods

We retrospectively collected and semiautomatically measured ultra-widefield retinal fundus images from a subset of participants enrolled in an ongoing population study of ageing, categorised as normotensive or hypertensive according to thresholds on systolic/diastolic blood pressure (140/90 mm Hg) measured in a clinical setting. Vascular calibre in the peripheral retina was measured to calculate the nasal–annular arteriole:venule ratio (NA-AVR), a novel combined parameter.

Results

Left and right eyes were analysed from 440 participants (aged 50–59 years, mean age of 54.6±2.9 years, 247, 56.1% women), including 151 (34.3%) categorised as hypertensive. Arterioles were thinner and the NA-AVR was smaller in people with hypertension. The area under the receiver operating characteristic curve of NA-AVR for hypertensive status was 0.73 (95% CI 0.68 to 0.78) using measurements from left eyes, while for right eyes, it was 0.64 (95% CI 0.59 to 0.70), representing evidence of a statistically significant difference between the eyes (p=0.020).

Conclusions

Semiautomated measurements of NA-AVR in ultra-widefield fundus imaging were associated with hypertension. With further development, this may help screen people attending routine eye health check-ups for high blood pressure. These individuals may then follow a care pathway for suspected hypertension. Our results showed differences between left and right eyes, highlighting the importance of investigating both eyes of a patient.

Retinal vessel metrics: normative data and their use in systemic hypertension: results from the Gutenberg Health Study

PURPOSE OF REVIEW

In-vivo measurement of retinal vascular calibers may be used as a tool to study the pathophysiology and clinical status of the microvasculature of the retina. The aim of this study was to generate normative data for retinal vessel parameters, and to evaluate the clinical relevance in systemic hypertension.

METHODS

Fundus photographs from 4309 participants of the Gutenberg Health Study were assessed using the 'retinal vessel analyzer' software (IMEDOS). We generated age and sex-specific nomograms in a disease-free subpopulation of 890 participants for determining the central retinal arteriolar equivalent (CRAE), the central retinal venular equivalent, and the arteriovenous ratio (AVR).

RESULTS

Women had higher values of CRAE, central retinal venular equivalent, and AVR than men, and the decrease in measures with increasing age was less steep in women than in men. Systemic hypertension was associated with lower values [odds ratio (OR), 95% confidence interval (CI) referring to area below the 5% percentile] of AVR (men: OR 2.41, 95% CI 1.669-3.490, P < 0.001; women: OR 3.01, 95% CI 2.126-4.268, P < 0.001) and CRAE (men: OR 2.60, 95% CI 1.563-4.326, P < 0.001, women: OR 3.00, 95% CI 2.004-4.487, P < 0.001). Both median CRAE and AVR were lower in participants with uncontrolled hypertension (172.28, range 83.05-251.04; and 0.81, range 0.56-1.04) versus those with screening-detected hypertension (175.72, range 101.23-222.09, P < 0.001; and 0.82, range 0.64-1.05, P = 0.001), and versus those with controlled (179.10, range 108.19-221.92, P < 0.001; and 0.84, range 0.60-1.08, P < 0.001) hypertension.

CONCLUSION

The study provides sex and age-specific normative data for retinal vasculature. Persons with untreated or insufficiently treated hypertension are more likely to have retinal vessel equivalents outside the reference range.