Ocular and systemic causes of retinopathy in patients without diabetes mellitus

Venkatramani, Jayant

doi:10.1136/bmj.328.7440.625

Cited by 36 publications

(25 citation statements)

References 25 publications

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“…Carotid artery disease (ocular ischemic syndrome) is well described as a causative factor in the development of more severe retinopathy 37. Recent epidemiological data including our own demonstrate an association of retinopathy with carotid artery IMT 7.…”

Section: Discussionmentioning

confidence: 70%

Retinopathy Signs in People without Diabetes

et al. 2011

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Objective To describe the prevalence of retinopathy and associations with cardiovascular risk factors in persons without diabetes in four racial/ethnic groups (white, black, Hispanic and Chinese). Design Population-based cross-sectional study. Participants 6,176 subjects aged 45 to 84 years without diabetes, selected from six United States communities. Methods Fundus images were taken using 45° digital camera through dark adapted pupils and were graded for retinopathy as defined by the Early Treatment Diabetic Retinopathy Study severity scale: microaneurysms, hemorrhages, cotton wool spots, intraretinal microvascular abnormalities, hard exudates, venous beading and new vessels. Main Outcome Measures Retinopathy and the association with cardiovascular risk factors Results Prevalence rates of retinopathy in persons without diabetes were 12.5% overall, varying from 11.9% (white), 13.9% (black), 12.6% (Hispanic) to 17.2% (Chinese). Hypertension was strongly associated with retinopathy (odds ratio [OR] of 1.47, 95% confidence interval [CI] 1.23, 1.75). After adjusting for age, sex, race and other parameters, smoking (OR 1.50, 95% CI 1.09, 2.06) and increased internal carotid intima media thickness (OR 1.22, 95% CI 1.05, 1.41) were associated with retinopathy. A range of serum inflammatory factors were examined but none were found to be statistically significant. Conclusions Retinopathy in persons without diabetes is common, varies with race/ethnicity and associated with cardiovascular risk factors, including hypertension, smoking and carotid artery intima media thickness.

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Section: Discussionmentioning

confidence: 70%

Retinopathy Signs in People without Diabetes

et al. 2011

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“…Isolated retinal microaneurysms, on the contrary, may indicate hypertensive retinopathy (Fig. 2b) in association with focal retinal arteriolar signs [44]. Hemorrhagic processes may also demonstrate subtle morphological differences in hypertensive and diabetic retinopathy as retinal hemorrhages in diabetes is often a result of intra-retinal hemorrhages (Fig.…”

Section: Similarities and Differencesmentioning

confidence: 97%

“…Retinopathy, particularly at its early stage, share a number of similar morphological features representing small vessel damage by hypertensive or diabetic processes [42][43][44][45]. One challenge that often confronts clinicians is to understand the contribution of diabetes or hypertension in the development of retinopathy.…”

Section: Similarities and Differencesmentioning

confidence: 99%

Similarities and differences in early retinal phenotypes in hypertension and diabetes

Grosso¹,

Cheung

Veglio

et al. 2011

Journal of Hypertension

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The use of retinal photography in clinical practice and research has substantially increased the knowledge about the epidemiology, natural history and significance of diabetic and hypertensive retinopathy. Early retinopathy signs, including retinal microaneurysms, blot hemorrhages, cotton-wool spots and hard exudates, are common vascular abnormalities found in middle-aged to older people with diabetes and hypertension. The presence of these early retinopathy signs is associated with an increased risk of systemic vascular diseases, such as stroke, cognitive impairment, coronary heart disease, heart failure and nephropathy. These retinopathy lesions may therefore be considered as biomarkers of systemic microvascular processes caused by diabetes and hypertension. Nevertheless, whereas the interest in retinopathy assessment continues to grow, a core concept remains undefined: what is the relative importance and contribution of diabetes and hypertension in the development of early retinopathy signs? The answer of this fundamental question holds the key to better understanding of the systemic associations of early hypertensive and diabetic retinopathy. In this review, we summarize the similarities and differences of early retinopathy signs seen in diabetes and hypertension, and discuss the conceptual relevance from epidemiological, pathophysiological, and clinical perspectives.

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“…Population-based studies, most of which excluded patients with diabetes, reported that microvascular changes or retinopathy are present in 0.8% to 12.5% of people. [20][21][22][23][24][25][26][27][28][29][30][31] It is possible that the higher prevalence of RVAs in this study reflects the older age of people with AMD, as increasing age is a risk factor for retinopathy, 22 but this seems unlikely because many of the population-based studies selected older adults, 21,22,[27][28][29][30][31] and all had lower rates than this study. It is more likely that we were better able to detect RVAs as, unlike the population-based studies, we incorporated FA.…”

Section: Discussionmentioning

confidence: 81%