Flicker Light–Induced Retinal Vasodilation in Diabetes and Diabetic Retinopathy

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

doi:10.2337/dc09-0075

Cited by 147 publications

(132 citation statements)

References 25 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: 56%

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: 56%

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 retinopathy (DR) is an important complication of diabetes which progresses from mild to moderate nonproliferative change in retinal microvascular architecture and arterial blood flow to severe proliferative vascular abnormalities [1,2]. It is widely recognized as the most frequent cause of visual impairment and legal blindness among adults aged 20-74 [3], especially in type 1 diabetic (T1DM) patients [4].…”

Section: Introductionmentioning

confidence: 99%

Circulating Dipeptidyl Peptidase-4 Activity is Associated with Diabetic Retinopathy in Type 1 Diabetic Patients

Blaslov

Bulum

Duvnjak

2015

European Journal of Ophthalmology

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Purpose Diabetic retinopathy (DR) is the most frequent complication among patients with type 1 diabetes mellitus (T1DM). Dipeptidyl peptidase–4 (DPP4) is a protease with elevated activity in patients with T1DM. Several studies indicate that DPP4 inhibitors might have beneficial effect on nonproliferative retinopathy (NPR) development as well as on its progression to proliferative retinopathy (PR). We aimed to explore the relationship between serum DPP4 activity and DR in patients with T1DM. Methods This cross-sectional study recruited 44 patients with T1DM. The DPP4 activity was measured by colorimetric assay in a microplate reader. Photodocumented retinopathy status was made according to the EURODIAB protocol. Results A total of 28 (63.6%) patients were men, mean age 45.36 years, diabetes duration 23.71 years, glycated hemoglobin A1c (HbA1c) 7.4%. Patients were stratified into 2 groups according to retinopathy prevalence. Group 1 comprised 14 (31.85%) patients with DR absence while the second group consisted of 30 (68.15%) patients with both PR and NPR. Group 1 had lower fasting serum DPP4 activity (25.85 vs 33.84 U/L, p<0.001) when compared to the second group. In the binary logistic regression model adjusted for age, sex, diabetes duration, and HbA1c level, DPP4 activity was associated with DR prevalence (odds ratio 1.887 [1.073-3.321]). Conclusions Serum DPP4 activity may be independently associated with both DR types in patients with T1DM. Further study is warranted to elucidate whether there is an association between DPP4 activity and DR severity and/or progression.

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“…We recruited 224 patients (18-70 years of age) with diabetes (85 with type 1 and 139 with type 2), as previously described [4][5][6][7]. We excluded participants who had a history of epilepsy or glaucoma, had undergone previous vitreal surgery, and/or had a cataract on examination.…”

Section: Study Populationmentioning

confidence: 99%

“…Flicker-light-induced vasodilation Assessment of flickeringlight-dependent vasodilation was performed using The Dynamic Vessel Analyzer (IMEDOS, Jena, Germany) [6]. Retinal arteriolar and venular dilation in response to flickering light was represented as the mean increase in the vessel diameter in response to light flicker during the three measurement cycles and was expressed as the percentage increase relative to the baseline diameter size.…”

Section: Study Populationmentioning

confidence: 99%

“…However, whether these novel markers have additional predictive value in DR is uncertain. In previous reports, we have also demonstrated that several novel systemic and retinal risk markers, including serum levels of apolipoprotein (Apo) AI and B [4], skin microvascular responses to sodium nitroprusside (SNP) and acetylcholine (ACh) iontophoresis [5], flicker-light-induced retinal vasodilation [6] and static measurement of retinal arteriolar tortuosity from photographs [7], are independently associated with DR. However, there are no data on whether these novel markers, in isolation or in combination, add to traditional risk factors in predicting DR.…”

Section: Introductionmentioning

confidence: 99%

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Novel versus traditional risk markers for diabetic retinopathy

et al. 2011

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Aims/hypothesis To explore the relative contribution of novel and traditional risk markers for diabetic retinopathy (DR). Methods A clinic-based study of 224 diabetic patients (85 type 1, 139 type 2) from a diabetes clinic was performed. DR was graded from fundus photographs according to the Airlie House Classification system and classified as absent or present (at least ETDRS level 14). Novel risk markers assessed included serum apolipoprotein (Apo) AI and B, skin microvascular responses to acetylcholine (endotheliumdependent) and sodium nitroprusside (endothelium-independent) iontophoresis, flicker-light-induced retinal vasodilation and retinal vascular tortuosity. Relative contribution was determined by semi-partial correlation coefficient generated from a logistic regression model containing all traditional and novel risk markers simultaneously. Results There were 144 (64.3%) participants with DR. Of the novel markers, ApoAI, flicker-light-induced vasodilation and retinal arteriolar tortuosity were significantly associated with DR, independently of traditional measures (all p<0.03). Diabetes duration contributed most (51%) to the risk of DR, followed by ApoAI (16%), systolic blood pressure (13%), retinal arteriolar tortuosity (8%) and flicker-light-induced venular and arteriolar dilation (3% and 0.5%, respectively). Conclusions/interpretation ApoAI and retinal arteriolar tortuosity made considerable contributions to DR risk, independently of traditional risk markers. Findings from this study suggest that serum ApoAI and retinal arteriolar tortuosity may be novel and independent risk markers of DR.

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Flicker Light–Induced Retinal Vasodilation in Diabetes and Diabetic Retinopathy

Cited by 147 publications

References 25 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)

Circulating Dipeptidyl Peptidase-4 Activity is Associated with Diabetic Retinopathy in Type 1 Diabetic Patients

Novel versus traditional risk markers for diabetic retinopathy

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