Impact of systemic vascular risk factors on the choriocapillaris using optical coherence tomography angiography in patients with systemic hypertension

Chua, Jacqueline; Chin, Calvin Woon Loong; Tan, Bingyao; Wong, Si Han; Devarajan, Kavya; Le, Thu‐Thao; Ang, Marcus; Wong, Tien Yin; Schmetterer, Leopold

doi:10.1038/s41598-019-41917-4

Cited by 59 publications

(61 citation statements)

References 58 publications

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“…Our results support the hypothesis that microvascular damage is present in patients with hypertensive crisis and correspond with studies in patients with chronic systemic hypertension in whom reduction of retinal capillary density has previously been shown. [23][24][25][26][27] Chua et al 23 found significant correlations between blood pressure and glomerular filtration rate, on one hand, and retinal capillary density on OCTA, on the other hand, in 77 subjects with chronic hypertension. They hypothesized that arteriolar narrowing due to atherosclerosis could lead to a loss of the retinal vascular autoregulation and capillary rarefaction.…”

Section: Discussionmentioning

confidence: 99%

Retinal and Choroidal Capillary Perfusion Are Reduced in Hypertensive Crisis Irrespective of Retinopathy

Terheyden

Wintergerst

Pizarro

et al. 2020

Trans. Vis. Sci. Tech.

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Hypertensive crisis causes end-organ damage through small-vessel damage as described histologically. Noninvasive optical coherence tomography angiography (OCTA) makes it possible to image retinal and choroidal capillaries on a microscopic level in vivo. We quantified eye vessel perfusion changes in hypertensive crisis using OCTA. Methods: Patients with hypertensive crisis (systolic blood pressure ≥180 mm Hg and/or diastolic blood pressure ≥110 mm Hg) and age-matched healthy controls were included in the study. OCTA en face 3 × 3-mm images of the superficial and deep retinal layers and the choriocapillaris were acquired. Outcome parameters included vessel density (VD) and vessel skeleton density (VSD) of the superficial and deep retinal layers, as well as flow voids of the choriocapillaris. Results: Twenty-eight eyes of 17 patients and 31 age-matched control eyes of 18 healthy subjects were included. VD and VSD of the deep retinal layer were significantly reduced in hypertensive crisis (P ≤ 0.004). Choriocapillaris signal intensity was more heterogeneous in patients, and flow voids exhibited confluence with a larger average area and a lower absolute count (P ≤ 0.045). These changes were independent of time since onset of hypertensive crisis and of the presence and extent of retinopathy. Deep retinal changes were associated with renal end-organ failure (P = 0.045). Conclusions: Hypertensive crisis is associated with a significant reduction in retinal and choroidal capillary perfusion based on OCTA findings. These alterations are independent of retinopathy and related to end-organ damage. Translational Relevance: OCTA might help distinguish hypertensive urgency from hypertensive emergency earlier than currently possible.

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Section: Discussionmentioning

confidence: 99%

Retinal and Choroidal Capillary Perfusion Are Reduced in Hypertensive Crisis Irrespective of Retinopathy

Terheyden

Wintergerst

Pizarro

et al. 2020

Trans. Vis. Sci. Tech.

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“…Third, we adjusted the possible confounding effects of age, gender, race, and the presence of diabetes, and systemic blood pressure levels during multivariate analysis and excluded possible confounding factors, such as glaucoma, vascular or nonvascular retinopathies, age-related macular degeneration. [24,25,32] Our present study has a few limitations. First, even though there was reduced retinal VD in those with AD and MCI using OCTA, this was only a cross-sectional study.…”

Section: Foveal Avascular Zone Areamentioning

confidence: 90%

“…We excluded participants from the analysis if the OCTA images from both eyes were of poor quality (poor signal strength index < 7, signi cant motion artefacts visible as irregular vessel patterns on the en face angiogram, local weak signal caused by artefacts such as oaters, misalignment or incorrect segmentation). [24,25] A randomly selected eye was analyzed for each participant since measurements of both eyes were highly correlated.…”

Section: Optical Coherence Tomography Angiographymentioning

confidence: 99%

“…We adjusted for age, gender, race, and included factors with biologically plausible relations to cognitive status and/or OCTA variable, such as the presence of diabetes, and blood pressure levels (systolic and diastolic). [24,25,32] Statistical analyses were performed using Stata version 16.0 (StataCorp LLC, College Station, TX).…”

Section: Optical Coherence Tomography Angiographymentioning

confidence: 99%

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Retinal Microvascular Alterations in Alzheimer’s Disease and Mild Cognitive Impairment

Chua

et al. 2020

Preprint

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Background: The retina and brain share many neuronal and vasculature characteristics developmentally and potential biomarkers may be present in the retina. We investigated the retinal microvasculature in Alzheimer’s disease (AD) and mild cognitive impairment (MCI) using optical coherence tomography angiography (OCTA).Methods: In this cross-sectional study, 24 AD participants, 37 MCI participants, and 29 controls were diagnosed according to internationally accepted criteria. OCTA images of the superficial and deep capillary plexus (SCP, DCP) of the retinal microvasculature were obtained using a commercial OCTA system (Zeiss Cirrus HD-5000 with AngioPlex, Carl Zeiss Meditec, Dublin, CA). The main outcome measures were vessel density (VD) and fractal dimension (FD) in the SCP and DCP within a 2.5-mm ring around the fovea were compared between groups. Perfusion density of large vessels and foveal avascular zone (FAZ) area were additional outcome parameters.Results: Age, gender and race did not differ among groups. However, there was a significant difference in diabetes status (P=0.039), and systolic blood pressure (P=0.008) among the groups. After adjusting for confounders, AD participants showed significantly decreased VD in SCP and DCP (P = 0.005 and P = 0.016, respectively) and decreased FD in SCP (P = 0.008), compared to controls. MCI participants showed significantly decreased VD and FD only in SCP (P = 0.005 and P < 0.001, respectively) and not the DCP (P > 0.05) compared with controls. There was no difference in the OCTA variables between AD and MCI (P > 0.05). Perfusion density of large vessels and FAZ area did not differ significantly between groups (P > 0.05).Conclusions and relevance: Eyes of patients with AD have significantly reduced macular VD in both plexuses whereas MCI participants only showed reduction in the superficial plexus. Changes in the retinal microvasculature and capillary network may mirror small vessel cerebrovascular changes in AD.

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“…This finding was supported by a recent OCTA study of choriocapillaris perfusion in patients with wellcontrolled vs. poorly controlled hypertension. Patients with well-controlled hypertension (and lower systolic blood pressure) had small increases in choriocapillary flow voids compared to patients with poorly controlled hypertension (and higher systolic blood pressure) (Chua et al 2019). Similarly, in a population of normotensive patients, increasing blood pressure was associated with increased choroidal perfusion (Polak et al 2003).…”

Section: Hypertensionmentioning

confidence: 97%

Microvascular contributions to age-related macular degeneration (AMD): from mechanisms of choriocapillaris aging to novel interventions

et al. 2019

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Aging of the microcirculatory network plays a central role in the pathogenesis of a wide range of agerelated diseases, from heart failure to Alzheimer's disease. In the eye, changes in the choroid and choroidal microcirculation (choriocapillaris) also occur with age, and these changes can play a critical role in the pathogenesis of age-related macular degeneration (AMD). In order to develop novel treatments for amelioration of choriocapillaris aging and prevention of AMD, it is essential to understand the cellular and functional changes that occur in the choroid and choriocapillaris during aging. In this review, recent advances in in vivo analysis of choroidal structure and function in AMD patients and patients at risk for AMD are discussed. The pathophysiological roles of fundamental cellular and molecular mechanisms of aging including oxidative GeroScience

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Impact of systemic vascular risk factors on the choriocapillaris using optical coherence tomography angiography in patients with systemic hypertension

Cited by 59 publications

References 58 publications

Retinal and Choroidal Capillary Perfusion Are Reduced in Hypertensive Crisis Irrespective of Retinopathy

Retinal and Choroidal Capillary Perfusion Are Reduced in Hypertensive Crisis Irrespective of Retinopathy

Retinal Microvascular Alterations in Alzheimer’s Disease and Mild Cognitive Impairment

Microvascular contributions to age-related macular degeneration (AMD): from mechanisms of choriocapillaris aging to novel interventions

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