Altered Retinal Flicker Response Indicates Microvascular Dysfunction in Women With Preeclampsia

Abstract

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.

Using critical flicker frequency in the evaluation of visual impairment in preeclamptic women

“…The HEPAtonorm Analyzer is portable, adapted for a bedside use, the costs are limited and the measurement is easy to interpret. This is in contrast to the flicker analysis of our previous study, where we measured retinal vessels under the influence of flickering light, using a mydriatic fundus camera [13].…”

“…Previously, we could show, that retinal vascular response under the influence of flickering light is altered in women with preeclampsia, indicating a commenced retinal microvascular dysfunction [13]. A completely new method arises with the assessment of critical flicker frequency (CFF), a simple and objective method to assess the visual and cognitive function [14,15].…”

Flicker-induced retinal vessels dilatation in diabetic patients without clinically detectable diabetic retinopathy

“…A Dynamic Vessel Analyzer with flicker light stimulation (DVA; Imedos, Jena, Germany) was used for measurements of retinal vessel diameter. A detailed description of the study protocol was previously provided in other publications (9,14,15). In general, only the major temporal arterial and venous segments approximately 1.5 mm long were evaluated.…”

Vaskuläre Biomarker der retinalen Gefäßanalyse

“…Verschiedene methodologische Modalitäten der dynamischen retinalen Gefäßanalyse wurden entwickelt und in klinischen Studien an Gesunden und an Patienten mit Augenerkrankungen und systemischen Erkrankungen getestet: [47], Neurochirurgie [64,65], Nephrologie [66], Gynäkologie [46], Sportmedizin [28], Diabetologie [67 -69], Hypertensiologie [54,70] usw. durchgeführt.…”