Correlation of Light-Flicker–Induced Retinal Vasodilation and Retinal Vascular Caliber Measurements in Diabetes

Nguyen, Thanh Thanh L.; Kawasaki, Ryo; Kreis, Andreas; Wang, Jie Jin; Shaw, Jonathan E.; Vilser, Walthard; Wong, Tien Yin

doi:10.1167/iovs.09-3442

Cited by 62 publications

(43 citation statements)

References 36 publications

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“…Another possible mechanism is inflammation, because larger retinal venules were linked to higher levels of inflammatory biomarkers (37,38). In addition, studies on vasodilatory response to flicker-light stimulation, a process reflecting the endothelial function of retinal vessels, propose that larger retinal venular and arteriolar calibers indicate endothelial dysfunction (39,40). Our findings on arteriolar calibers do not confirm this, though.…”

Section: Discussioncontrasting

confidence: 65%

Retinal Vessel Calibers Predict Long-term Microvascular Complications in Type 1 Diabetes: The Danish Cohort of Pediatric Diabetes 1987 (DCPD1987)

et al. 2014

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Diabetic neuropathy, nephropathy, and retinopathy cause significant morbidity in patients with type 1 diabetes, even though improvements in treatment modalities delay the appearance and reduce the severity of these complications. To prevent or further delay the onset, it is necessary to better understand common underlying pathogenesis and to discover preclinical biomarkers of these complications. Retinal vessel calibers have been associated with the presence of microvascular complications, but their long-term predictive value has only been sparsely investigated. We examined retinal vessel calibers as 16-year predictors of diabetic nephropathy, neuropathy, and proliferative retinopathy in a young population-based Danish cohort with type 1 diabetes. We used semiautomated computer software to analyze vessel diameters on baseline retinal photos. Calibers of all vessels coursing through a zone 0.5-1 disc diameter from the disc margin were measured and summarized as the central artery and vein equivalents. In multiple regression analyses, we found wider venular diameters and smaller arteriolar diameters were both predictive of the 16-year development of nephropathy, neuropathy, and proliferative retinopathy. Early retinal vessel caliber changes are seemingly early markers of microvascular processes, precede the development of microvascular complications, and are a potential noninvasive predictive test on future risk of diabetic retinopathy, neuropathy, and nephropathy.Diabetic microvascular complications, namely diabetic peripheral neuropathy (DPN), diabetic nephropathy (DN), and diabetic retinopathy (DR), are common in type 1 diabetes (1) despite advances in metabolic care. Identifying new predictors of microvascular disease could be helpful for early individual risk stratification, which may provide better opportunity for timely implementation of effective interventions. For this purpose, the retinal vasculature provides a unique opportunity to assess vascular health directly and noninvasively in vivo.Studies have investigated how retinal vessel calibers are associated with microvascular complications in both type 1 and type 2 diabetes (2-14). The evidence to date suggests that wider retinal venular diameters are associated with presence of both DN and severe levels of DR in several cross-sectional studies (3,(8)(9)(10) and with incident DN (4,5) and progression to severe

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Section: Discussioncontrasting

confidence: 65%

Retinal Vessel Calibers Predict Long-term Microvascular Complications in Type 1 Diabetes: The Danish Cohort of Pediatric Diabetes 1987 (DCPD1987)

et al. 2014

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“…39,40 Hence, it is possible that the association of outdoor sporting activities with wider retinal arterioles reflects both structural microvascular changes and pathophysiological processes related to endothelial function. Indeed, recent studies in adults using brachial flow-mediated dilation 41 and light-flicker-induced vasodilation 42 suggest that retinal vascular caliber changes could be markers of systemic endothelial dysfunction. In the present study, however, we were not able to assess endothelial function; hence, we are not able to confirm whether endothelial dysfunction is a potential mechanism underlying the relationship between time spent in outdoor activity and retinal arteriolar narrowing.…”

Section: Discussionmentioning

confidence: 99%

Influence of Physical Activity and Screen Time on the Retinal Microvasculature in Young Children

Gopinath

Baur

Wang

et al. 2011

ATVB

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Objective-It is not clear whether physical activity and sedentary behavior affect retinal microvascular caliber. We investigated associations among physical activity (outdoor and indoor sporting activities), sedentary behaviors (including screen time, television [TV] viewing, and computer and videogame usage), and retinal microvascular caliber in schoolchildren. Methods and Results-Six-year-old students (1765/2238) from a random cluster sample of 34 Sydney schools were examined. Parents completed questionnaires about physical and sedentary activities. Retinal images were taken, and retinal vessel caliber was quantified. After adjusting for age, sex, ethnicity, eye color, axial length, body mass index, birth weight, and mean arterial blood pressure, children who spent more time in outdoor sporting activities (in the highest tertile of activity) had 2.2 m (95% CI 0.65 to 3.71) wider mean retinal arteriolar caliber than those in the lowest tertile (P trend ϭ0.004). Increasing quartiles of time spent watching TV were associated with narrower mean retinal arteriolar caliber Ϸ2.3 m (95% CI 0.73 to 3.92), P trend ϭ0.003. Conclusion-These data suggest that physical activity could have a beneficial influence, whereas screen time has a potential adverse influence on retinal microvascular structure. The magnitude of arteriolar narrowing associated with each hour daily of TV viewing is similar to that associated with a 10-mm Hg increase in systolic blood pressure in children. Key Words: cardiovascular disease prevention Ⅲ epidemiology Ⅲ exercise Ⅲ microcirculation Ⅲ obesity Ⅲ risk factors Ⅲ Sydney Childhood Eye Study Ⅲ children Ⅲ retinal vascular caliber Ⅲ sedentary behavior R educed participation in physical activity coinciding with an increase in sedentary behaviors is thought to contribute to the documented increases in prevalent childhood obesity. 1 The benefits of physical activity in childhood and adolescence are well known. 2-4 Numerous observational studies have reported inverse associations between physical activity levels and blood pressure (BP) in children and adolescents. [5][6][7] Evidence also exists that physical activity and cardiovascular disease (CVD) risk factors track from childhood and adolescence into adulthood. 8 Conversely, screen time, particularly television (TV) viewing, is associated with higher intakes of energy-dense, nutrient-poor foods and beverages and lower intakes of vegetables. 9 It is therefore not surprising that TV viewing and screen time are positively associated with childhood adiposity. 10 -12 Several observational studies have also demonstrated that certain indicators of sedentariness, such as screen time, could be potential targets for addressing hypertension in children. [13][14][15] Despite these data, it is not known whether physical activity and sedentary behavior influence the microvascular structure and microcirculation. The retinal blood vessels can be viewed noninvasively, offering a unique opportunity to investigate the effects of obesity, BP, diet, and other CVD risk f...

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“…These cellular interactions are best recognized in the processes of neurovascular coupling, whereby neural, glial, and vascular cell interactions in both large and small vessels regulate blood flow to meet the metabolic demands of the retinal neuropile. This response is dysregulated in the diabetic retina prior to appearance of observable vascular lesions, although it regulates the changes in blood flow that occur in animal models of DR (63) and in diabetic patients (64). Retinal vascular responses to diffuse illuminance flicker reflects impaired neurovascular coupling and abnormal endothelial-glia associations (65), resulting in attenuated arteriolar and venular dilatory responses (66) that may have early predictive value (67) in early-stage DR.…”

Section: The Neurovascular Unit: a Framework For Understanding Drmentioning

confidence: 99%

Diabetic retinopathy: current understanding, mechanisms, and treatment strategies

Duh¹,

Sun²,

Stitt³

2017

JCI Insight

764

648

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Correlation of Light-Flicker–Induced Retinal Vasodilation and Retinal Vascular Caliber Measurements in Diabetes

Cited by 62 publications

References 36 publications

Retinal Vessel Calibers Predict Long-term Microvascular Complications in Type 1 Diabetes: The Danish Cohort of Pediatric Diabetes 1987 (DCPD1987)

Retinal Vessel Calibers Predict Long-term Microvascular Complications in Type 1 Diabetes: The Danish Cohort of Pediatric Diabetes 1987 (DCPD1987)

Influence of Physical Activity and Screen Time on the Retinal Microvasculature in Young Children

Diabetic retinopathy: current understanding, mechanisms, and treatment strategies

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