Determinants of Retinal Microvascular Architecture in Normal Subjects

Hughes, Alun D.; Wong, Tien Yin; Witt, Nicholas; Evans, Richard; Thom, Simon; Klein, Barbara E.K.; Chaturvedi, Nish; Klein, Ronald

doi:10.1080/10739680802353868

Cited by 48 publications

(50 citation statements)

References 34 publications

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“…Microvascular dilatation has been found previously in smokers [13] but was demonstrated here in former smokers too. Smoking has complex and sometimes long-lasting effects on the small vessels.…”

Section: Discussionmentioning

confidence: 44%

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Hypertensive/Microvascular Disease and COPD: a Case Control Study

Chew

Colville²,

Canty³

et al. 2016

Kidney Blood Press Res

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Background/Aims: This study tested the hypothesis that individuals with chronic obstructive pulmonary disease (COPD) have more small vessel disease and more severe disease than an age- and gender- matched hospital patient comparison group. Methods: This was a single centre, case-control study of 151 individuals with COPD (FEV1/VC) < 0.7 recruited consecutively immediately after respiratory function tests at a Melbourne teaching hospital over a 4 month period in 2010. Controls were individuals with normal respiratory function tests recruited contemporaneously from the same centre. Retinal images were obtained with a nonmydriatic camera (KOWA or Canon CR5-45NM), deidentiifed and graded by two trained graders for microvascular retinopathy (Wong and Mitchell classification), and vessel calibre using a computer-assisted method and Knudtson's modification of the Parr-Hubbard formula. Differences in microvascular retinopathy and vessel calibre between COPD patients and the comparison group were examined using Fisher's exact test or the t test (StataCorp, Texas). Results: Patients with COPD had more microvascular retinopathy (121, 80% and 76, 50%; OR 3.98, 95%CI 2.39 to 6.64) and more severe disease (42, 28% and 18, 12%; OR 2.85, 95% CI 1.55 to 5.23) than other hospital patients. COPD remained an independent determinant of microvascular retinopathy (OR 4.56, 95%CI 2.49 to 8.36) after adjusting for gender, hypertension, smoking, and diabetes duration. Retinal arterioles and venules were wider in patients with COPD than other hospital patients (mean difference +6.5µm, 95% confidence interval 1.4 to 11.6; and +17.4µm, 95%CI 9.4 to 25.5, respectively). Larger venules were more common in younger individuals (+0.6 µm, 0.1 to 1.17) with more cigarette exposure (+0.3 µm, 0.2 to 0.5) or a lower serum albumin (+23.0 µm, 6.0 to 40.0). Venular calibre was not different in current and former smokers (p=0.77). There were trends for venules to be larger with more severe COPD (lower FEV1/VC, p=0.09) and with CT-demonstrated emphysema (p=0.06). Conclusions: Hypertensive/microvascular disease is more common and more severe in patients with COPD. This is likely to contribute to the associated increase in cardiac risk.

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Section: Discussionmentioning

confidence: 44%

“…However the determinants of small vessel calibre are complex. For example, arteriole calibre is reduced in males and with increasing age, hypertension, atherosclerosis and renal failure [13]. Venular calibre is increased in diabetes, smoking, inflammation, obesity, dyslipidemia and hypoxemia [11,[14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Hypertensive/Microvascular Disease and COPD: a Case Control Study

Chew

Colville²,

Canty³

et al. 2016

Kidney Blood Press Res

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“…36,46 Recent prospective data from the ARIC Study further showed that retinal vascular changes are associated with incident cerebral atrophy, incident cerebral infarct, incident lacunar infarct, and white matter lesion incidence and progression, independent of traditional risk factors. 47,48 These data provide strong evidence that retinal vascular Retinal arteriolar branching asymmetry ratio Increased Current blood pressure 28 Retinal arteriolar length:diameter ratio Increased Current blood pressure, 121 essential and malignant phase hypertension, 122 and stroke mortality 88 Retinal arteriolar branching coefficient (optimality ratio)…”

Section: Relationship With Subclinical Strokementioning

confidence: 87%

Retinal Microvasculature as a Model to Study the Manifestations of Hypertension

Cheung

Ikram²,

Sabanayagam³

et al. 2012

Hypertension

217

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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“…1c) is defined as the extent to which the relationship between the parent and daughter arteriolar diameters deviates from theoretically defined optimum [24,25,26]. Griffith et al [27] showed that optimal deviation allows for the uniform distribution of sheer stress on the vessels involved.…”

Section: Methodsmentioning

confidence: 99%

Retinal Vascular Calibre, Geometry and Progression of Diabetic Retinopathy in Type 2 Diabetes Mellitus

2012

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Purpose: To determine whether changes in retinal vascular calibre and geometry are associated with progression of diabetic retinopathy in type 2 diabetes (T2D). Procedures: The retinal vascular calibre and geometry of 30 subjects with more than 20 years of diagnosed T2D with no retinopathy (NR) were compared to 30 subjects that progressed to proliferative diabetic retinopathy (PDR). The images of PDR subjects included in this study were those obtained before the onset of retinopathy. The diameter of retinal arterioles (CRAE), retinal venules (CRVE), tortuosity of retinal vessels, junctional exponent deviation (JE_a) and fractal dimension (D_f) were measured using Singapore I Vessel Assessment (SIVA 3.0) software and compared using Mann-Whitney U test. Results: The median CRAE and the median CRVE were significantly wider in PDR subjects compared to NR subjects (p = 0.014 and 0.016), respectively. Curvature tortuosity of the retinal arteries and veins and D_f were significantly decreased in the PDR subjects compared to NR subjects (p = 0.015, 0.016 and 0.03, respectively). The JE_a was significantly increased in PDR subjects (p = 0.01). Conclusions: Retinal vessel calibre and geometry of the retinal vasculature may be important risk factors for the progression to PDR. More longitudinal prospective studies will be needed to further explore the findings of this study.

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Determinants of Retinal Microvascular Architecture in Normal Subjects

Cited by 48 publications

References 34 publications

Hypertensive/Microvascular Disease and COPD: a Case Control Study

Hypertensive/Microvascular Disease and COPD: a Case Control Study

Retinal Microvasculature as a Model to Study the Manifestations of Hypertension

Retinal Vascular Calibre, Geometry and Progression of Diabetic Retinopathy in Type 2 Diabetes Mellitus

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