Quantitative retinal vascular calibre changes in diabetes and retinopathy: the Singapore Malay eye study

Abstract

Purpose To describe the relationship of retinal vascular calibre with diabetes and diabetic retinopathy in an Asian population. Methods A total of 3280 (78.7% response) subjects, aged 40-80 years, of Malay ethnicity residing in Singapore participated in this population-based, cross-sectional study. Retinal vascular calibre was measured and summarized using a validated computer programme from digital retinal photographs. Diabetic retinopathy signs were graded from photographs using the modified Airlie House classification. Results Of the 3004 subjects with data for this analysis, 682 (22.7%) had diabetes, of whom 194 (28.4%) had retinopathy. After multivariable adjustment, retinal arteriolar calibre was significantly wider in persons with diabetes (141 vs 139 lm, Po0.001); venular calibre was not associated with diabetes (P ¼ 0.93). Among participants with diabetes, venular calibre increased from 218.7 lm in those without retinopathy to 231.1 lm in those with moderate and 231.4 lm in those with severe retinopathy (P for trend ¼ o0.001); arteriolar calibre was not associated with diabetic retinopathy. Conclusions This study shows wider retinal arterioles in diabetes and wider venules in those with diabetic retinopathy in an Asian population. These findings confirm earlier data on white population, supporting the concept that a quantitative assessment of retinal vasculature may provide further insights into early diabetic microvascular damage.

Retinal Vessel Oxygen Saturation under Flicker Light Stimulation in Patients with Nonproliferative Diabetic Retinopathy

“…16 This may be explained by a reduced retinal blood passage time due to shunt vessels, 17 by a decreased oxygen diffusion through the diabetic vessel wall resulting from a thickening of its basal membrane, or to a higher oxygen affinity of the hemoglobin A1c. However, in agreement with findings of increased vessel diameters 32,33 and blood flow 34 in diabetes, it also may indicate that blood flow regulation, even in rest, is at the upper limit of its control range in the patients to prevent tissue hypoxia. This also would explain why hardly any further increase of the SO 2 is seen in the patients during flicker stimulation.…”

A new unified framework for the early detection of the progression to diabetic retinopathy from fundus images

“…Nonetheless, the experiments showed that the vascular geometry is indeed affected during the progression of diabetes, which is more or less in line with some of the previous findings [2,17,70]. The vessel widths, FD, venular angle to BC ratio, CRVE and CRAE were found to be important discriminative features of progression to DR. CRVE and CRAE observations are in line with the findings of Klein [71] and partly with [14,72,73]. These observations are linked possibly to the endothelial dysfunction, inflammatory changes, and hyperglycemia, all of which are factors involved in the pathogenesis of DR [74,75].…”

Retinal Vascular Geometry in Asian Persons with Diabetes and Retinopathy

“…For example, our finding that persons with diabetes were more likely to have wider arterioles and venules than nondiabetic persons is compatible with many others with similar findings. 10,11,38 We also showed that people with diabetes had less tortuous arterioles than those without diabetes. We previously demonstrated that decreased retinal arteriolar tortuosity were associated with elevated blood pressure in our cohort, 21 and Witt and associates 39 found that decreased arteriolar tortuosity was associated with risk of ischemic heart disease mortality.…”