Association Between Systemic Hypertension and Macular Thickness Measured by Optical Coherence Tomography

Kong, Mingui; Kwun, Youngkyo; Sung, Joohon; Ham, Don-Il; Song, Yun-Mi

doi:10.1167/iovs.14-16080

Cited by 34 publications

(32 citation statements)

References 32 publications

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“…More studies need to be done to establish the effect of retinal microvascular changes seen in hypertensive eyes and its impact on the outer retina, photoreceptors and ultimately visual function. Similar to a previous study by Kong et al on OCT findings in hypertensive eyes, a decrease in peri-foveal macular thickness was observed in the univariate analysis however this was no longer significant in the between the hypertensive and control groups in our multivariate analysis 56 . In contrast to another cross-sectional cohort study by Lee et al which found a reduction in the foveal vessel density, perfusion density, mean GC-IPL thickness, CFT and RNFL and an increase in the FAZ at the level of the SVP in the hypertensive group compared to controls, our paper did not find any significant differences between the 2 groups at the level of the SVP.…”

Section: Discussionsupporting

confidence: 90%

Systemic hypertension associated retinal microvascular changes can be detected with optical coherence tomography angiography

Sun

Ladores

Hong

et al. 2020

Sci Rep

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A major complication of hypertension is microvascular damage and capillary rarefaction is a known complication of hypertensive end-organ damage which confers a higher risk of systemic disease such as stroke and cardiovascular events. Our aim was to study the effect of hypertension on the retinal microvasculature using non-invasive optical coherence tomography angiography (octA). We performed a case-control study of 94 eyes of 94 participants with systemic hypertension and 46 normal control eyes from the Singapore chinese eye Study using a standardized protocol to collect data on past medical history of hypertension, including the number and type of hypertensive medications and assessed mean arterial pressure. Retinal vascular parameters were measured in all eyes using octA. in the multivariate analysis adjusting for confounders, compared to controls, eyes of hypertensive patients showed a decrease in the macular vessel density at the level of the superficial [OR 0.02; 95% CI, 0 to 0.64; P 0.027] and deep venous plexuses [OR 0.03; 95% CI, 0 to 0.41; P 0.009] and an increase in the deep foveal avascular zone. this shows that hypertension is associated with reduced retinal vessel density and an increased foveal avascular zone, especially in the deep venous plexus, as seen on octA and there is a potential role in using octA as a clinical tool to monitor hypertensive damage and identifying at risk patients Hypertension is a major cause of morbidity and mortality globally 1,2 , affecting 29.2% men and 24.8% women in 2012 3. A major complication of hypertension is microvascular damage, related partly to abnormal vasomotor tone and increased wall-to-lumen ratio in relation to higher blood pressure 4,5. It has also been suggested that vascular rarefaction may due to either functional alterations such as microvessel constriction resulting in non-perfusion or anatomical alterations resulting in actual non-perfusion and vessel loss 4. There have been many previous studies on the association between hypertension and retinal vasculature. Retinal fundus photo changes seen in response to hypertension include classic hypertensive retinopathy signs such as arteriovenous (AV) nicking, generalized or focal arteriolar narrowing, microaneurysms, intraretinal hemorrhages, cotton wool spots and papilloedema 6. These changes have been shown to confer a higher risk of systemic disease such as stroke and cardiovascular events 6-9. Other studies have also looked at larger retinal vessels (200-300 µm) using color fundus photos and demonstrated a correlation between narrower arteriolar diameter in hypertension 10-13. The impact of hypertension on capillary microvasculature is less clear. Historically, invasive fundus fluorescein angiography (FFA) was needed to evaluate perfusion and the structure of capillary microvasculature. Previous studies using FFA have shown that in patients with hypertension, there is an increase in perifoveal inter-capillary area and decrease in capillary blood velocity 14. However, FFA is not suitable for use in larg...

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Section: Discussionsupporting

confidence: 90%

Systemic hypertension associated retinal microvascular changes can be detected with optical coherence tomography angiography

Sun

Ladores

Hong

et al. 2020

Sci Rep

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“…A subsequent cross-sectional study from Korea found that patients with hypertension (n = 140) had significant retinal thinning in nearly all regions assessed as compared with those without hypertension (n = 687). 98 Notably, the hypertensive group was older with a higher prevalence of CVD risk factors. More recently, a single-center study from Italy of 100 patients with hypertension found consistent retinal and choroidal thinning in hypertensive patients with coexistent CKD (defined as an eGFR <60 ml/min per 1.73 m 2 and/or moderate albuminuria) as compared with hypertensive patients with preserved renal function.…”

Section: Retinal Imaging the Kidney And Cvdmentioning

confidence: 99%

The eye, the kidney, and cardiovascular disease: old concepts, better tools, and new horizons

Farrah

Dhillon

Keane

et al. 2020

Kidney International

105

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Chronic kidney disease (CKD) is common, with hypertension and diabetes mellitus acting as major risk factors for its development. Cardiovascular disease is the leading cause of death worldwide and the most frequent end point of CKD. There is an urgent need for more precise methods to identify patients at risk of CKD and cardiovascular disease. Alterations in microvascular structure and function contribute to the development of hypertension, diabetes, CKD, and their associated cardiovascular disease. Homology between the eye and the kidney suggests that noninvasive imaging of the retinal vessels can detect these microvascular alterations to improve targeting of at-risk patients. Retinal vessel–derived metrics predict incident hypertension, diabetes, CKD, and cardiovascular disease and add to the current renal and cardiovascular risk stratification tools. The advent of optical coherence tomography (OCT) has transformed retinal imaging by capturing the chorioretinal microcirculation and its dependent tissue with near-histological resolution. In hypertension, diabetes, and CKD, OCT has revealed vessel remodeling and chorioretinal thinning. Clinical and preclinical OCT has linked retinal microvascular pathology to circulating and histological markers of injury in the kidney. The advent of OCT angiography allows contrast-free visualization of intraretinal capillary networks to potentially detect early incipient microvascular disease. Combining OCT’s deep imaging with the analytical power of deep learning represents the next frontier in defining what the eye can reveal about the kidney and broader cardiovascular health.

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“…Dizygotic (DZ) twins were pooled with siblings because the genetic sharing within DZ twin pairs is similar to the genetic sharing between siblings, and the number of DZ twin pairs was too small to be separated 19 . While estimating ICCs, age, sex, axial length, presence of diabetes, and hypertension, and smoking history were adjusted as they may influence macular thickness [33][34][35][36][37] .…”

Section: Statistical Analysesmentioning

confidence: 99%

Heritability of Inner Retinal Layer and Outer Retinal Layer Thickness: The Healthy Twin Study

Kong

Hwang

et al. 2020

Sci Rep

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the purpose of the study is to evaluate the heritability of inner retinal layer (iRL) and outer retinal layer (ORL) thicknesses in the healthy Korean population. This was a cross-sectional, twin and family study. We included 374 Korean adults with healthy eyes from 89 families. IRL thickness (from the internal limiting membrane to the external limiting membrane) and oRL thickness (from the external limiting membrane to the outer border of the retinal pigment epithelium layer) were measured in the nine macular subfields as defined by the Early Treatment of Diabetic Retinopathy Study using optical coherence tomography. the heritability on iRL and oRL thicknesses were investigated using a variance decomposition model. The heritability of IRL thickness was 0.87, 0.58, 0.85, 0.89, and 0.74 for the central, inner superior, inner inferior, inner temporal, inner nasal subfields, respectively; and 0.62, 0.83, 0.62, and 0.60 for the outer superior, outer inferior, outer temporal, outer nasal subfields, respectively. The heritability of ORL thickness was 0.56, 0.75, 0.66, 0.72, and 0.56 for the central, inner superior, inner inferior, inner temporal, inner nasal subfields, respectively; and 0.64, 0.63, 0.73, 0.54 for the outer superior, outer inferior, outer temporal, and outer nasal subfields, respectively. The heritability estimates of iRL thickness and oRL thickness ranged from moderate to high. the iRL thickness at the central, inner temporal, and inner inferior subfields had particularly high heritability.

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Association Between Systemic Hypertension and Macular Thickness Measured by Optical Coherence Tomography

Cited by 34 publications

References 32 publications

Systemic hypertension associated retinal microvascular changes can be detected with optical coherence tomography angiography

Systemic hypertension associated retinal microvascular changes can be detected with optical coherence tomography angiography

The eye, the kidney, and cardiovascular disease: old concepts, better tools, and new horizons

Heritability of Inner Retinal Layer and Outer Retinal Layer Thickness: The Healthy Twin Study

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