Retinal vessel diameters and reactivity in diabetes mellitus and/or cardiovascular disease

Heitmar, Rebekka; Lip, Gregory Y.H.; Ryder, Robert E.; Blann, A.

doi:10.1186/s12933-017-0534-6

Cited by 29 publications

(19 citation statements)

References 40 publications

(48 reference statements)

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“…It is therefore possible that the high proportion of patients with increased levels of systemic inflammation in this study might attenuate the association between retinal venular diameter and DM. This is confirmed by the study of Heitmar et al, in which no association was found between retinal vessel diameter and DM in different patients groups with increased levels of inflammation 42 .…”

Section: Discussionsupporting

confidence: 64%

Structural analysis of retinal blood vessels in patients with COPD during a pulmonary rehabilitation program

Vaes

Spruit

Keer

et al. 2020

Sci Rep

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cardiovascular diseases are frequently present in chronic obstructive pulmonary disease (copD). population-based studies found associations between retinal vessel diameters and cardiovascular health, but it is unknown whether this also applies to COPD patients. Therefore, we measured retinal vessel diameters in copD patients and aimed to determine the association with cardiovascular risk factors, lung function, and functional outcomes. In addition, we investigated whether an exercisebased pulmonary rehabilitation (PR) program would change retinal vessel diameters, as a proxy for improved microvascular health. Demographics and clinical characteristics, including pulmonary function, exercise capacity, blood pressure, blood measurements and level of systemic inflammation were obtained from 246 patients during routine assessment before and after PR. Retinal vessel diameters were measured from digital retinal images. older age and higher systolic blood pressure were associated with narrower retinal arterioles (β: −0.224; p = 0.042 and β: −0.136; p < 0.001, respectively). Older age, higher systolic blood pressure and lower level of systemic inflammation were associated with narrower retinal venules (β: −0.654; −0.229; and −13.767, respectively; p < 0.05). No associations were found between retinal vessel diameters and lung function parameters or functional outcomes. After PR, no significant changes in retinal venular or arteriolar diameter were found. To conclude, retinal vessel diameters of COPD patients were significantly associated with systolic blood pressure and systemic inflammation, whilst there was no evidence for an association with lung function parameters, functional outcomes or other cardiovascular risk factors. Furthermore, an exercise-based PR program did not affect retinal vessel diameter. Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases 1. Although the diagnosis of COPD is based on spirometry, it is well recognized that COPD is associated with a range of systemic extrapulmonary effects 1. Indeed, comorbidities are frequently present and contribute to the severity of disease 2-4. Cardiovascular disease (including hypertension, coronary artery disease, congestive heart failure, stroke and peripheral arterial disease) is a common comorbidity in COPD 2,5. Smoking is the most important risk factor for the development of COPD, but it is also a major risk factor for the development of cardiovascular disease 6,7. Indeed, cigarette smoke not only affects the airway epithelium, but also causes vascular endothelial damage and loss of microvascular integrity in several organs, including the heart, brain, and kidney 8,9. In addition, systemic inflammatory processes, oxidative stress, and hypoxia may contribute

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Section: Discussionsupporting

confidence: 64%

Structural analysis of retinal blood vessels in patients with COPD during a pulmonary rehabilitation program

Vaes

Spruit

Keer

et al. 2020

Sci Rep

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“…Cardiovascular risk factors like diabetes mellitus have been shown to alter retinal vessel diameters and/or responses to stimulation ( 32 ) and could thus act as important confounding factors. There was only one patient with diabetes in our study, excluding further analysis of its potential as a confounding factor.…”

Section: Resultsmentioning

confidence: 99%

Non-invasive Assessment of Neurovascular Coupling After Aneurysmal Subarachnoid Hemorrhage: A Prospective Observational Trial Using Retinal Vessel Analysis

et al. 2021

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Objective: Delayed cerebral ischemia (DCI) is a common complication after aneurysmal subarachnoid hemorrhage (aSAH) and can lead to infarction and poor clinical outcome. The underlying mechanisms are still incompletely understood, but animal models indicate that vasoactive metabolites and inflammatory cytokines produced within the subarachnoid space may progressively impair and partially invert neurovascular coupling (NVC) in the brain. Because cerebral and retinal microvasculature are governed by comparable regulatory mechanisms and may be connected by perivascular pathways, retinal vascular changes are increasingly recognized as a potential surrogate for altered NVC in the brain. Here, we used non-invasive retinal vessel analysis (RVA) to assess microvascular function in aSAH patients at different times after the ictus.Methods: Static and dynamic RVA were performed using a Retinal Vessel Analyzer (IMEDOS Systems GmbH, Jena) in 70 aSAH patients during the early (d0−4), critical (d5−15), late (d16−23) phase, and at follow-up (f/u > 6 weeks) after the ictus. For comparison, an age-matched cohort of 42 healthy subjects was also included in the study. Vessel diameters were quantified in terms of the central retinal arterial and venous equivalent (CRAE, CRVE) and the retinal arterio-venous-ratio (AVR). Vessel responses to flicker light excitation (FLE) were quantified by recording the maximum arterial and venous dilation (MAD, MVD), the time to 30% and 100% of maximum dilation (tMAD30, tMVD30; tMAD, tMVD, resp.), and the arterial and venous area under the curve (AUCart, AUCven) during the FLE. For subgroup analyses, patients were stratified according to the development of DCI and clinical outcomes after 12 months.Results: Vessel diameter (CRAE, CRVE) was significantly smaller in aSAH patients and showed little change throughout the whole observation period (p < 0.0001 vs. control for all time periods examined). In addition, aSAH patients exhibited impaired arterial but not venous responses to FLE, as reflected in a significantly lower MAD [2.2 (1.0–3.2)% vs. 3.6 (2.6–5.6)% in control subjects, p = 0.0016] and AUCart [21.5 (9.4–35.8)%*s vs. 51.4 (32.5–69.7)%*s in control subjects, p = 0.0001] on d0−4. However, gradual recovery was observed during the first 3 weeks, with close to normal levels at follow-up, when MAD and AUCart amounted to 3.0 [2.0–5.0]% (p = 0.141 vs. control, p = 0.0321 vs. d5−15) and 44.5 [23.2–61.1]%*s (p = 0.138 vs. control, p < 0.01 vs. d0−4 & d5−15). Finally, patients with clinical deterioration (DCI) showed opposite changes in the kinetics of arterial responses during early and late phase, as reflected in a significantly lower tMAD30 on d0−4 [4.0 (3.0–6.8) s vs. 7.0 (5.0–8.0) s in patients without DCI, p = 0.022) and a significantly higher tMAD on d16−23 (24.0 (21.0–29.3) s vs. 18.0 (14.0–21.0) s in patients without DCI, p = 0.017].Conclusion: Our findings confirm and extend previous observations that aSAH results in sustained impairments of NVC in the retina. DCI may be associated with characteristic changes in the kinetics of retinal arterial responses. However, further studies will be required to determine their clinical implications and to assess if they can be used to identify patients at risk of developing DCI.Trial Registration:ClinicalTrials.gov Identifier: NCT04094155.

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“… 5 6 Specifically, vessel calibre measurements have been correlated with worsening of eye diseases such as diabetic retinopathy 7 and systemic health status in hypertension, 8 diabetic nephropathy 9 and cardiovascular disease. 10 Therefore, accurate and reliable measurements of the retinal vessel calibre with OCTA may be attractive. Recently, Ghasemi Falavarjani et al 11 compared the vessel diameter measurements obtained from OCTA scans and fundus photographs, and reported that the vessels measured from OCTA scans appeared to be nearly 20 µm thicker when compared with fundus photographs.…”

Section: Introductionmentioning

confidence: 99%

Comparison of retinal vessel diameter measurements from swept-source OCT angiography and adaptive optics ophthalmoscope

Yao

et al. 2020

Br J Ophthalmol

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Background/imsTo compare the retinal vessel diameter measurements obtained from the swept-source optical coherence tomography angiography (OCTA; Plex Elite 9000, Carl Zeiss Meditec, USA) and adaptive optics ophthalmoscope (AOO; RTX1, Imagine Eyes, France).MethodsFifteen healthy subjects, 67% women, mean age (SD) 30.87 (6.19) years, were imaged using OCTA and AOO by a single experienced operator on the same day. Each eye was scanned using two OCTA protocols (3×3 mm2 and 9×9 mm2) and two to five AOO scans (1.2×1.2 mm2). The OCTA and AOO scans were scaled to the same pixel resolution. Two independent graders measured the vessel diameter at the same location on the region-of-interest in the three coregistered scans. Differences in vessel diameter measurements between the scans were assessed.ResultsThe inter-rater agreement was excellent for vessel diameter measurement in both OCTA protocols (ICC=0.92) and AOO (ICC=0.98). The measured vessel diameter was widest from the OCTA 3×3 mm2 (55.2±16.3 µm), followed by OCTA 9×9 mm2 (54.7±14.3 µm) and narrowest by the AOO (50.5±15.6 µm; p<0.001). Measurements obtained from both OCTA protocols were significantly wider than the AOO scan (OCTA 3×3 mm2: mean difference Δ=4.7 µm, p<0.001; OCTA 9×9 mm2: Δ=4.2 µm, p<0.001). For vessels >45 µm, it appeared to be larger in OCTA 3×3 mm2 scan than the 9×9 mm2 scan (Δ=1.9 µm; p=0.005), while vessels <45 µm appeared smaller in OCTA 3×3 mm2 scan (Δ=−1.3 µm; p=0.009)ConclusionsThe diameter of retinal vessels measured from OCTA scans were generally wider than that obtained from AOO scans. Different OCTA scan protocols may affect the vessel diameter measurements. This needs to be considered when OCTA measures such as vessel density are calculated.

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Retinal vessel diameters and reactivity in diabetes mellitus and/or cardiovascular disease

Cited by 29 publications

References 40 publications

Structural analysis of retinal blood vessels in patients with COPD during a pulmonary rehabilitation program

Structural analysis of retinal blood vessels in patients with COPD during a pulmonary rehabilitation program

Non-invasive Assessment of Neurovascular Coupling After Aneurysmal Subarachnoid Hemorrhage: A Prospective Observational Trial Using Retinal Vessel Analysis

Comparison of retinal vessel diameter measurements from swept-source OCT angiography and adaptive optics ophthalmoscope

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