Retinal Microvascular Abnormalities as Surrogate Markers of Cerebrovascular Ischemic Disease: A Meta-Analysis

Dumitrascu, Oana M.; Demaerschalk, Bart M.; Sánchez, Cristina Valencia; Almader‐Douglas, Diana; O’Carroll, Cumara B; Aguilar, Maria I.; Lyden, Patrick D.; Kumar, Gyanendra

doi:10.1016/j.jstrokecerebrovasdis.2018.02.041

Cited by 49 publications

(42 citation statements)

References 32 publications

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“…DM and hypertension cause microvascular abnormalities, including DR and hypertensive retinopathy (HR) [14, 34–37]. Microvascular abnormalities, especially retinal arterial narrowing and retinal hemorrhages, have been used to monitor the impact on the microvasculature in the body as a whole, in the central nervous system, and small vessel white matter disease [38, 39]. In addition, retinopathy poses a threat to vision and may cause blindness.…”

Section: Discussionmentioning

confidence: 99%

Improving diabetic and hypertensive retinopathy with a medical food containing L-methylfolate: a preliminary report

et al. 2019

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Background Homocysteine and vitamin D may play a role in the development of diabetic and hypertensive retinopathy in patients with diabetes mellitus (DM) and hypertension. Supplementing food with L-methylfolate and vitamin D theoretically may improve diabetic and hypertensive retinopathy, however, the outcome of these nutritional approaches has not been fully examined. A retrospective case review was done of cases of retinopathy reversal in patients on Ocufolin™ and a similar nonprescription multivitamin, Eyefolate™. In this study, they were administered L-methylfolate (2.7 mg and 3.0 mg, respectively) and vitamin D3 (4500 IU each). These dosages are significantly above the RDA but well below levels associated with toxicity. Case presentation Seven patients had nonproliferative diabetic retinopathy (NPDR) and some of them had hypertension. One patient had only hypertensive retinopathy. All patients were instructed to take Ocufolin™ medical food as a food supplement. Baseline genetic testing for MTHFR polymorphisms was conducted. Fundus photography was used to document the fundus condition of the enrolled eyes in 8 NPDR patients at the initial and follow-up visits. Microaneurysms (MA) and exudates were observed to be improved in some trial patients. All subjects had one or more MTHFR polymorphisms. All had diabetic retinopathy, hypertensive retinopathy, or both. MAs were resolved, and exudates were decreased in 8/8 cases after taking the medical food. Retinal edema was found in 2/8 cases and improved or resolved in both cases after taking the medical food or the supplement. The best corrected visual activity was stable or improved in 8/8 cases. Conclusion We report a series of diabetic and hypertensive retinopathy cases with MTHFR polymorphisms and the improvement of retinal microvasculature (mainly MAs) in serial fundus photography after taking a medical food or supplement containing L-methylfolate and vitamin D. It appears that the use of nutritional supplements and medical foods containing L-methylfolate and vitamin D may be effective in facilitating the improvement of diabetic and hypertensive retinopathy.

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Section: Discussionmentioning

confidence: 99%

Improving diabetic and hypertensive retinopathy with a medical food containing L-methylfolate: a preliminary report

et al. 2019

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“…Retinal vessels share the embryological origin and morphological as well as physiological properties with the cerebral vasculature and are considered a biomarker of cerebrovascular disease in adults (Patton et al, 2005). A very recent meta-analysis has demonstrated the use of retinal vessel abnormalities as a surrogate marker for ischemic cerebrocascular disease (Dumitrascu et al, 2018). Retinal vessels are regulators of local retinal blood flow, and as such, they are valid and robust microvascular surrogate biomarkers of CV risk.…”

Section: Introductionmentioning

confidence: 99%

Exercise and Arterial Modulation in Children: The EXAMIN YOUTH Study

et al. 2019

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Background: Cardiovascular disease (CVD) remains to be one of the most frequent causes of death worldwide. Cardiovascular (CV) risk factors such as hypertension and obesity often manifest in childhood. The study examines the associations of blood pressure, body mass index and physical activity with cardiopulmonary, metabolic, and psychosocial health of children in a systems physiology approach.Methods/Design: This cross-sectional study will be performed in a cohort of 6 to 8 year old school children (n = 1000). As a measure of vascular health, retinal microvascular diameters and large artery pulse wave velocity will be examined. Anthropometric parameters, such as weight, height, body mass index, and blood pressure will be assessed according to standardized protocols for children. Physical fitness and activity will be measured by a 20 m shuttle run, a 20 m sprint and a proxy-reported questionnaire on lifestyle behavior. Spirometry, assessment of heart rate variability and skin advanced glycation end products as well as a flanker test will be performed to determine systemic end organ alterations.Discussion: The study offers a unique integrative primary prevention concept that aims to set the grounds for a healthy and active lifestyle approach during childhood. It will help optimize CV risk stratification to identify children at risk of disease progression later in life. The study will demonstrate the importance of specific CV screening programs in children to reduce the growing burden of CV disease in adulthood. Prospective follow-up studies will have to prove the efficacy of primary prevention programs in children to achieve healthier aging as a long-term goal.

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“…Therefore, dysregulation of ocular blood flow (OBF) reflects dysregulation of cerebral blood flow 1 . Studies have shown several ocular impairments resulting from stroke and chronic stenosis: retinal vascular diseases, impaired visual acuity, glaucoma, microaneurysms and retinal hamorrhage 2 , 3 . Specifically, evidence indicates that OBF dysregulation in the ONH may have an important role as a risk factor for stroke 1 , 4 .…”

Section: Introductionmentioning

confidence: 99%

Longitudinal effects of common carotid artery stenosis on ocular hemodynamics assessed using laser speckle flowgraphy in a rabbit model

Ismail

Chen

Faye

et al. 2020

Sci Rep

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Real-time impairment of ocular blood flow (OBF) under common carotid artery stenosis (CCAS) has not been ascertained. We aimed to longitudinally assess the impact of CCAS on OBF using a rabbit model. About 75% stenosis was created by tying the common carotid artery with a plastic mandrel using a nylon suture. The plastic mandrel was gently removed, leaving a ligature. Neurological and behavioral assessments were recorded as the clinical indicator of stroke severity. With laser speckle flowgraphy, the pulse waveform parameters namely mean blur rate (MBR), blowout score (BOS), blowout time (BOT), rising rate, S1-area, falling rate (FR), S2-area, flow acceleration index (FAI), acceleration time index, resistive index (RI) and the difference between the maximum and minimum values of MBR (AC) were assessed in overall, vessel, and tissue regions of the optic nerve head (ONH). Longitudinally, BOS significantly increased until day 19 post-surgery, whereas FAI, RI, and AC significantly decreased. Beyond day 19, BOS, BOT, FR, FAI, RI, and AC significantly decreased. We defined two stages representing impaired vessel conditions, namely the vessel resistance phase, where BOS increases and FAI, RI, and AC decrease, and the vessel elasticity phase where BOS, BOT, FR, FAI, RI and AC decrease. These stages provide information about atherosclerosis, assessable non-invasively through the eye.

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Retinal Microvascular Abnormalities as Surrogate Markers of Cerebrovascular Ischemic Disease: A Meta-Analysis

Cited by 49 publications

References 32 publications

Improving diabetic and hypertensive retinopathy with a medical food containing L-methylfolate: a preliminary report

Improving diabetic and hypertensive retinopathy with a medical food containing L-methylfolate: a preliminary report

Exercise and Arterial Modulation in Children: The EXAMIN YOUTH Study

Longitudinal effects of common carotid artery stenosis on ocular hemodynamics assessed using laser speckle flowgraphy in a rabbit model

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