Age, Blood Pressure, and Vessel Diameter as Factors Influencing the Arterial Retinal Flicker Response

Nagel, Edgar; Vilser, Walthard; Lanzl, Ines

doi:10.1167/iovs.03-0667

Cited by 135 publications

(155 citation statements)

References 21 publications

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“…This finding is in agreement with several previous reports indicating impairment of blood flow regulation in the retina before the clinical appearance of retinopathy (21,29). In our study we showed an association between flicker response and age; however, the coefficient of correlation was weak, which is in agreement with previous reports (30). For example, Jeppesen et al (31) reported significantly reduced diameter response in normal individuals aged Ͼ40 years.…”

Section: Discussionsupporting

confidence: 93%

Influence of Flickering Light on the Retinal Vessels in Diabetic Patients

Mandecka

Dawczynski²,

Blum³

et al. 2007

Diabetes Care

178

149

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OBJECTIVE—Stimulation of the retina with flickering light increases retinal vessel diameters in humans. Nitric oxide is a mediator of the retinal vasodilation to flicker. The reduction of vasodilation is considered an endothelial dysfunction. We investigated the response of retinal vessels to flickering light in diabetic patients in different stages of diabetic retinopathy. RESEARCH DESIGN AND METHODS—We studied 53 healthy volunteers, 68 type 1 diabetic patients, and 172 type 2 diabetic patients. The diameter of retinal vessels was measured continuously online with the Dynamic Vessel Analyzer (DVA). Diabetic retinopathy was classified using Early Treatment Diabetic Retinopathy Study criteria. Changes in vasodilation are expressed as percent change over baseline values. RESULTS—After adjustments for age, sex, and antihypertensive treatment, the response of retinal arterioles to diffuse luminance flicker was significantly diminished in patients with type 1 diabetes compared with healthy volunteers. The vasodilation of retinal arterioles and venules decreased continuously with increasing stages of diabetic retinopathy. The retinal arterial diameter change was 3.6 ± 2.1% in the control group, 2.6 ± 2.5% in the no diabetic retinopathy group, 2.0 ± 2.7% in the mild nonproliferative diabetic retinopathy (NPDR) group, 1.6 ± 2.2% in the moderate NPDR group, 1.8 ± 1.9% in severe NPDR group, and 0.8 ± 1.6% in proliferative diabetic retinopathy group. CONCLUSIONS—Flicker responses of retinal vessels are abnormally reduced in diabetic patients. This decreased response deteriorated with increasing stages of retinopathy. The response was already reduced before clinical appearance of retinopathy. The noninvasive testing of retinal autoregulation with DVA might prove to be of value in early detection of diabetic vessel pathological changes.

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Section: Discussionsupporting

confidence: 93%

Influence of Flickering Light on the Retinal Vessels in Diabetic Patients

Mandecka

Dawczynski²,

Blum³

et al. 2007

Diabetes Care

178

149

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“…Recent small sample size studies demonstrated a reduced flicker response in retinal arteriole dilation in hypertension. 94,95 These studies suggest that the flicker response of retinal vessel diameter could be a new and noninvasive method for detecting early functional damage (endothelial dysfunction) and may potentially indicate the improved microvascular function under antihypertensive therapy.…”

Section: Assessment Of Dynamic Retinal Vascular Changesmentioning

confidence: 99%

Retinal Microvasculature as a Model to Study the Manifestations of Hypertension

Cheung

Ikram²,

Sabanayagam³

et al. 2012

Hypertension

222

166

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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.

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“…In contrast, the DVA doesn't require much training, and the measurement can be performed in less than 15 min. The DVA quantifies non-invasively retinal vessel dilation in response to flickering light, 8 which is believed to reflect endothelial function, given the documentation of the role of nitric oxide played in this flickering light induced retinal vasodilation. [9][10][11][12] The strength of this study is to extend the application of DVA beyond whites and confirm the same …”

Section: Current Eye Researchmentioning

confidence: 99%

“…Previous clinical studies using the DVA have shown the impaired dilation to this flicker, reflecting possibly endothelial dysfunction, is associated with systemic diseases, 13 including hypertension 8 and diabetes, 14 and ocular diseases, such as diabetic retinopathy 14 and glaucoma. 15 However, although DVA has previously been shown to be reproducible in whites, 16 there have been no similar data in groups/races other than whites, including Asians.…”

Section: Introductionmentioning

confidence: 96%

“…Recent studies show that structural retinal microvascular changes, such as the presence of retinopathy or variations in retinal vascular caliber, are predictive of a range of systemic and ocular conditions, such as diabetes, stroke, coronary heart disease and heart failure, and diabetic retinopathy. [1][2][3][4][5][6][7] It has been hypothesized that dilation of retinal vessels in response to diffuse luminance flicker may reflect intrinsic endothelial function, 8 mediated possibly by nitric oxide. [9][10][11][12] Thus, such measurements may allow in vivo quantification of retinal endothelial function, which may help in understanding the physiological and pathological alterations of retinal microcirculation in various ocular and systemic diseases.…”

Section: Introductionmentioning

confidence: 99%

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