SummaryBackground and objectives Retinal abnormalities are common in inherited and acquired renal disease. This study determined the prevalence of retinal abnormalities in chronic kidney disease (CKD) stages 3 to 5.Design, setting, participants, & measurements One hundred fifty patients with CKD stages 3 to 5 and 150 age-and gender-matched hospital patients with CKD stages 1 to 2 underwent bilateral retinal photography. These images were reviewed for incidental abnormalities, microvascular (Wong and Mitchell classification) and diabetic retinopathy (Airlie House criteria), and macular degeneration (Seddon classification).Results Three (2%) patients with CKD stages 3 to 5 had retinal features characteristic of inherited renal disease (atrophy in Myopathy, Encephalopathy, Lactic Acidosis, Stroke-like episodes [MELAS] syndrome; and 2 with drusen in dense deposit disease). Fifty-nine (39%) patients had moderate-severe microvascular retinopathy (hemorrhages, exudates, etc.) compared with 19 (13%) with CKD stages 1 to 2. Forty-one (28%) had moderate-severe diabetic retinopathy (microaneurysms, exudates, etc.) compared with 16 (11%) with CKD stages 1 to 2. Ten (7%) had severe macular degeneration (geographic atrophy, hemorrhage, exudates, membranes) compared with one (1%) with CKD stages 1 to 2. Renal failure was an independent risk factor for microvascular retinopathy, diabetic retinopathy, and macular degeneration. Eleven (7.3%) patients with renal failure and one (0.7%) with CKD stages 1 to 2 had previously unrecognized vision-threatening retinal abnormalities that required immediate ophthalmologic attention. ConclusionsRetinal abnormalities are common in CKD stages 3 to 5, and are more severe and more likely to threaten vision than in hospital patients with CKD stages 1 to 2.

Hypertension is a leading risk factor for increased mortality and morbidity. One pathogenesis mechanism, increased peripheral vascular resistance, relates to arteriolar diameter. Retinal arterioles, visualized and measured through retinal images, provide an insight into the microvascular structure and hints of peripheral vascular resistance. Multiple studies have demonstrated an inverse association between increasing blood pressure and narrowing retinal arteriolar diameter. This systematic review summarizes the currently available evidence from cross-sectional and longitudinal population-based studies that have investigated this association. A meta-analysis of five cross-sectional studies (19,633 adults) provided an averaged regression coefficient of -3.07 μm (95% CI, -3.73, -2.40) narrowing in retinal arteriolar diameter for every 10 mm Hg increase in mean arterial blood pressure. Four longitudinal studies (6,247 adults) with follow-up periods ranging from 3 to 7 years consistently showed that generalized retinal arteriolar narrowing (defined as the lowest tertile, quartile, or quintile in the population) was associated with an increased risk of incident hypertension (meta-analysis odds ratio 1.91; 95% CI, 1.56-2.34).

Citation: Gin TJ, Wu Z, Chew SKH, Guymer RH, Luu CD. Quantitative analysis of the ellipsoid zone intensity in phenotypic variations of intermediate age-related macular degeneration. Invest Ophthalmol Vis Sci. 2017;58:207958: -208658: . DOI:10.1167 PURPOSE. Reduction of the ellipsoid zone (EZ) intensity has been reported in eyes with agerelated macular degeneration (AMD). This study determined whether overall EZ intensity, in retinal locations undisturbed by pathologic features, is associated with the presence of clinical features, which are known important phenotypic risk factors for disease progression, large drusen, reticular pseudodrusen (RPD), and pigmentary abnormalities. METHODS.A horizontal B-scan through the foveola on spectral-domain optical coherence tomography (SD-OCT) was performed in both eyes of 75 participants with bilateral intermediate AMD and 10 age-similar control participants. Eyes with AMD were classified as per the presence of large drusen, RPD, and hyperpigmentary changes. The relative EZ intensity profile, up to an eccentricity of 3400 lm, was averaged over seven 1000-lm retinal segments. The association between relative EZ intensity profile over seven retinal segments and AMD pathologic features was analyzed.RESULTS. The average relative EZ intensities were significantly reduced in eyes with intermediate AMD compared to normal eyes (P 0.025) and with increasing age (P 0.020). On multivariate analyses, only the presence of hyperpigmentary changes and increasing age were significantly associated with reduced overall relative intensities (P 0.024), but not the presence of large drusen or RPD (P ‡ 0.115).CONCLUSIONS. The presence of hyperpigmentary change in the macula in association with large drusen, not large drusen alone, nor large drusen with RPD, was significantly associated with a generalised reduction in EZ intensity. Quantitative assessment of the relative EZ intensity may serve as an effective biomarker of disease severity and progression.

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The presence and severity of diabetic retinopathy but not diabetic macular oedema are independently associated with self-reported erectile dysfunction.