Systemic Associations of Dynamic Retinal Vessel Analysis: A Review of Current Literature

Lim, Michelle; Sasongko, Muhammad Bayu; Ikram, M. Kamran; Lamoureux, Ecosse L.; Wang, Jie Jin; Wong, Tien Yin; Cheung, Carol Y.

doi:10.1111/micc.12026

Cited by 69 publications

(81 citation statements)

References 76 publications

(90 reference statements)

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“…It has been proposed that pupillometry can be used as a diagnostic tool in early stages of AD (Lim et al 2013). Reductions in pupillary responses have been reported, but the effect is highly variable and it is difficult to distinguish between patients with AD and patients with Parkinsonism or vascular dementia.…”

Section: Combining Clinical and Retinal Imaging Biomarkersmentioning

confidence: 99%

Can the retina be used to diagnose and plot the progression of Alzheimer's disease?

Mahajan

Votruba

2017

Acta Ophthalmologica

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Alzheimer's disease (AD) is a neurodegenerative disease and the most common cause of senile dementia. It impairs the quality of life of a person and their family, posing a serious economic and social threat in developed countries. The fact that the diagnosis can only be definitively made post‐mortem, or when the disease is fairly advanced, presents a serious problem if novel therapeutic interventions are to be devised and used early in the course of the disease. There is therefore a pressing need for more sensitive and specific diagnostic tests with which we can detect AD in the preclinical stage. The tau proteins and beta‐amyloid proteins start to accumulate 20 years before the symptoms begin to manifest. Detecting them in the preclinical stage would be a potential breakthrough in the management of AD. A high degree of clinical suspicion is needed to correlate problems in cognition with the changes in the eye, particularly the retina, pupil and ocular movements, so that the disease can be detected early and managed in the prodromal phase. In this systematic review, we ask the question whether the retina can be used to make a specific and early diagnosis of AD.

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Section: Combining Clinical and Retinal Imaging Biomarkersmentioning

confidence: 99%

Can the retina be used to diagnose and plot the progression of Alzheimer's disease?

Mahajan

Votruba

2017

Acta Ophthalmologica

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“…Afterward, RFR was measured with Dynamic Vessel Analyzer, Imedos, Jena, Germany, as previously described. 10,11,13 After marking an arteriole and venule segment of ≈1 mm in the superior temporal region (0.5-2 disk diameters from optic disc margin), the vessel diameters were continuously (25×/second) measured (Figure 1). The 350-second measurement cycle starts with a 50-second baseline diameter acquisition, followed by three 20-second flicker and 80-second relaxation periods ( Figure S2).…”

Section: Retinal Flicker Responsementioning

confidence: 99%

“…Twenty-two nonpregnant age-matched (to PE), nulliparous, nonsmoking controls (NC) without family history of CVD and without hormonal contraceptive use were measured on the 5th day of menstrual cycle to state a normal RFR, without possible confounders. 10,12 Five pregnant women had to be excluded from final analysis because of later development of gestational diabetes mellitus (PE=1, NP=2) and HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome (NP=2). For postpartum analysis (at least >10 weeks postpartum), 27 PE women and 36 NP women with uncomplicated pregnancies remained (PE: 2 relocations and 5 withdrawals; NP: 3 relocations and 6 withdrawals; Figure S1 in the online-only Data Supplement).…”

Section: Recruitment Of Subjectsmentioning

confidence: 99%

“…9 The dynamic behavior of the microvasculature can be assessed measuring retinal vessels in response to flickering light, and the reduction in neurovascular coupling may be a consequence of EDF. 10,11 This light-evoked reaction induces both flow-mediated dilatation of larger retinal vessels nearby and vasoconstriction in more distant vessels to redistribute the blood flow to certain regions. 12 This evoked vasodilatation of retinal vessels is a measure of microvascular endothelial function because it is impaired in known diseases with EDF, such as diabetes mellitus 10 or hypertension, 13 and it is altered after NO synthase inhibition 12 and endothelial removal.…”

mentioning

confidence: 99%

“…10,11 This light-evoked reaction induces both flow-mediated dilatation of larger retinal vessels nearby and vasoconstriction in more distant vessels to redistribute the blood flow to certain regions. 12 This evoked vasodilatation of retinal vessels is a measure of microvascular endothelial function because it is impaired in known diseases with EDF, such as diabetes mellitus 10 or hypertension, 13 and it is altered after NO synthase inhibition 12 and endothelial removal. 14 Minor alterations in retinal flicker response (RFR) were associated with aging, suggesting microvascular changes in biomechanical properties of the endothelium.…”

mentioning

confidence: 99%

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Altered Retinal Flicker Response Indicates Microvascular Dysfunction in Women With Preeclampsia

Brückmann¹,

Seeliger²,

Lehmann³

et al. 2015

Hypertension

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Abstract-Flicker-induced dilatation is reduced in patients with cardiovascular risk, and the following arteriolar constriction is reduced with aging, leading to a reduced arteriolar amplitude and, thereby, indicating microvascular endothelial dysfunction. As endothelial dysfunction is associated with preeclampsia, we assessed retinal flicker response during pregnancy and postpartum. Between 2006 and 2013, women were recruited from University Hospital Jena and Prenatal Diagnostic Center Erfurt, Germany, of which 34 women with preeclampsia, 45 women with normal pregnancy, and 22 nonpregnant controls were included in the study. Women with normal pregnancy were matched for age, nulliparity, smoking, previous gestational hypertensive disorders, and family history of cardiovascular disease. Nonpregnant women were age-matched, nulliparous, nonsmoking, without family history of cardiovascular disease. Retinal vessel measurement using Dynamic Vessel Analyzer consisted of 50-seconds baseline acquisition, followed by three 20-second flicker and 80-second relaxation periods. Arteriolar constriction and arteriolar amplitude were reduced during pregnancy (P=0.001 and P=0.008) and postpartum (P=0.018 and P=0.034) in women with preeclampsia, adjusted for age, body mass index, mean arterial pressure, baseline diameter, and family history of cardiovascular disease. Flicker-induced dilatation was unchanged within the groups and throughout the study period. The unchanged flicker-induced dilatation may support a preserved autoregulatory competence of the microvasculature, and the diminished arteriolar amplitude, mainly because of the absence of the arteriolar constriction, indicates a commenced retinal microvascular dysfunction in women with preeclampsia during pregnancy and postpartum. Mechanisms responsible for altered retinal flicker response in preeclampsia need to be clarified in further studies.

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Retinal microvascular dysfunction in patients with coronary artery disease with and without heart failure: a continuum?

Barthelmes

Nägele

Cantatore

et al. 2019

European J of Heart Fail

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Aims Dynamic retinal vessel analysis is a novel, non‐invasive method to assess microvascular function. The primary aim of this study was to investigate whether retinal microcirculation is impaired in patients with stable coronary artery disease (CAD) compared to patients with heart failure due to CAD (ischaemic heart failure, IHF). Methods and results A total of 150 adults were enrolled to prospectively assess micro‐ and macrovasculature. The pre‐defined primary outcome was flicker‐induced arterial dilatation (FIDa) in patients with CAD [n = 40; median age 63 years, interquartile range (IQR) 53–70] and IHF (n = 40; median age 63 years, IQR 59–71) compared to healthy controls (HC, n = 70; median age 57 years, IQR 41–69). Secondary outcomes included arterial stiffness, flow‐mediated dilatation, biomarkers, and ergospirometry parameters. Patients with CAD demonstrated impairment in FIDa that was even more pronounced in patients with IHF (CAD: 1.93 ± 0.28% vs. IHF: 0.41 ± 0.28%, P < 0.001; FIDa in HC: 3.69 ± 0.21%, both P < 0.001) adjusting for age, sex, concomitant medication, and co‐morbidities. While pulse wave velocity was increased and flow‐mediated dilatation reduced in CAD and IHF patients (both P < 0.001 compared to HC), neither differed between CAD and IHF patients. N‐terminal pro‐B‐type natriuretic peptide (r = −0.49, P < 0.001,) and high‐sensitivity troponin T (r = −0.28, P = 0.003) correlated with FIDa. Intriguingly, mean metabolic equivalents (5.3 ± 2.3 kcal/kg/h, n = 39) showed a positive correlation with FIDa (r = 0.58, P < 0.001). Conclusion This study demonstrates a decline of retinal arterial function in CAD patients that is significantly more pronounced in the presence of reduced left ventricular ejection fraction, suggesting a continuum of microvascular damage.

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Systemic Associations of Dynamic Retinal Vessel Analysis: A Review of Current Literature

Cited by 69 publications

References 76 publications

Can the retina be used to diagnose and plot the progression of Alzheimer's disease?

Can the retina be used to diagnose and plot the progression of Alzheimer's disease?

Altered Retinal Flicker Response Indicates Microvascular Dysfunction in Women With Preeclampsia

Retinal microvascular dysfunction in patients with coronary artery disease with and without heart failure: a continuum?

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