Relationship of Retinal Vascular Caliber With Diabetes and Retinopathy

Abstract

OBJECTIVE -To examine the relationship of retinal vascular caliber with diabetes, glycemia, and diabetic retinopathy.RESEARCH DESIGN AND METHODS -Population-based study using data from the Multi-Ethnic Study of Atherosclerosis (MESA), comprising 5,976 individuals (whites, blacks, Hispanics, and Chinese) residing in six U.S. communities who were free of clinical cardiovascular disease at baseline. Retinal vascular caliber was measured from digital retinal photographs.RESULTS -There were 4,585 individuals with normal fasting glucose (NFG), 499 with impaired fasting glucose (IFG), 165 with diabetes with retinopathy signs, and 727 with diabetes without retinopathy signs. After multivariate analysis, retinal arteriolar caliber increased from 143.8 m in subjects with NFG to 144.5 m in IFG and 146.1 m in diabetes (P Ͻ 0.001 for trend). Retinal venular caliber increased from 214.4 m in NFG to 216.7 m in IFG and 218.0 m in diabetes (P Ͻ 0.001 for trend). Retinal venular caliber was significantly larger with increasing levels of fasting glucose and A1C. In a subgroup analysis by ethnicity, the association between wider arteriolar caliber and diabetes was evident in whites only, whereas wider venular caliber and diabetes was evident in Hispanics and Chinese only. In people with diabetes, eyes with retinopathy had larger retinal venular but not arteriolar caliber.CONCLUSIONS -Retinal arteriolar and venular calibers are larger in individuals with diabetes, but the pattern of associations appears to vary by ethnicity. Retinal venular caliber is additionally associated with retinopathy signs. These findings add further to the concept that variations in retinal vascular caliber may reflect early diabetic microvascular damage. Diabetes Care 31:544-549, 2008

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

“…20 Our study now clearly shows that in Asian Malays, as in white population, wider retinal arterioles are associated with diabetes. The association of wider retinal venules with diabetic retinopathy signs in our study is also consistent with clinical experience, as well as with findings from white population from BMES, 10 AusDiab, 8 MESA, 7 and Wisconsin Epidemiological Study of Diabetic Retinopathy (WESDR). 6,9 The mechanisms underlying wider retinal arterioles with diabetes are uncertain, but multiple aetiologies have been suggested, including impaired autoreguation of small vessels caused by hyperglycaemia and hypoxia.…”

“…However, due to the small number of Asian participants, such an observation would need confirmation by other studies. 7 We have now confirm that the effect of diabetes and diabetic retinopathy on the retinal vascular calibre in our Asian population are similar to that previously shown in white/Caucasian populations from MESA, 7 BMES, 10 and AusDiab 8 studies. Similarly, we have also previously shown that the effects of blood pressure on the retinal vascular calibre in this population are similar to that observed in white populations.…”

“…[1][2][3][4][5] Several studies have shown that subtle variations in retinal vascular calibre are related to prediabetes, diabetes development, and diabetic retinopathy. [5][6][7][8][9][10][11] The Blue Mountain Eye Study (BMES) 10 and the Australian Diabetes, Obesity, and Lifestyle (AusDiab) 8 reported that wider retinal arterioles are associated with diabetes, whereas wider retinal venules are associated with diabetic retinopathy. However, most earlier studies examined only white populations.…”

Comparison of the retinal microvasculature in European and African-Caribbean people with diabetes

“…Recent observations from the Multi-Ethnic Study of Atherosclerosis (MESA) in the US showed wider adjusted central retinal artery equivalents in African American participants compared with White American participants across categories of normoglycaemia, impaired fasting glucose and diabetes, although a statistical comparison of this difference between ethnic groups were not reported. Interestingly, in MESA there was attenuation of the trend for wider retinal arterioles with increasing dysglycaemia in African Americans compared with White Americans [42].…”

“…Several reasons for this have been suggested including differences in BP, duration or onset of diabetes, and glycaemic control. A previous large population-based study [41] also reported that increased duration of diabetes was associated with arteriolar widening assessed using AVR and more recent observations from the Multi-Ethnic Study of Atherosclerosis (MESA) also showed significantly wider retinal arterioles in people with diabetes, despite high blood pressures [42]. Our observations also indicate that differences in duration of diabetes may at least partially explain ethnic differences in arteriolar narrowing in diabetes, however although differences arteriolar narrowing were no longer statistically significant after adjustment for duration of diabetes they remained substantial and we cannot exclude that other factors contribute to inter-ethnic differences in retinal arteriolar narrowing.…”