Retinal vascular geometry and 6 year incidence and progression of diabetic retinopathy

Cheung, Carol Y.; Sabanayagam, Charumathi; Law, Antony; Neelam, Kumari; Ting, Daniel; Tan, Gavin Siew Wei; Mitchell, Paul; Cheng, Ching‐Yu; Wong, Tien Yin

doi:10.1007/s00125-017-4333-0

Cited by 66 publications

(36 citation statements)

References 55 publications

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“…In both type 1 diabetes (T1D) and T2D, clinical retinopathy is preceded by subtle abnormalities of microcirculatory structure (retinal arteriolar widening [20][21][22][23][24][25], greater fractal dimension [25,26], and greater arteriolar tortuosity [25]) and function (reduced retinal arteriolar and venular dilation after flicker-light stimulation [27,28]). These subtle abnormalities may predict clinically apparent lesions (16,25,29) (Fig. 2, left panel).…”

Section: Diabetic Retinopathymentioning

confidence: 99%

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Microvascular Dysfunction and Hyperglycemia: A Vicious Cycle With Widespread Consequences

2018

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Microvascular and metabolic physiology are tightly linked. This Perspective reviews evidence that ) the relationship between hyperglycemia and microvascular dysfunction (MVD) is bidirectional and constitutes a vicious cycle;) MVD in diabetes affects many, if not all, organs, which may play a role in diabetes-associated comorbidities such as depression and cognitive impairment; and ) MVD precedes, and contributes to, hyperglycemia in type 2 diabetes (T2D) through impairment of insulin-mediated glucose disposal and, possibly, insulin secretion. Obesity and adverse early-life exposures are important drivers of MVD. MVD can be improved through weight loss (in obesity) and through exercise. Pharmacological interventions to improve MVD are an active area of investigation.

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Section: Diabetic Retinopathymentioning

confidence: 99%

“…been speculated to reflect changes to improve neuroretinal perfusion (25). Arteriolar and venular dilation after flickerlight stimulation are endothelium-dependent responses, impairment of which thus signifies dysfunction of retinal microvascular endothelium (16).…”

Section: Diabetic Retinopathymentioning

confidence: 99%

Microvascular Dysfunction and Hyperglycemia: A Vicious Cycle With Widespread Consequences

2018

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“…53 Finally, reduced Df in those with diabetes can predict incident neuropathy, nephropathy, and progressive retinopathy, independent of other risk factors for microvascular complications although the strength of these associations is modest. 54,55 CKD. Retinopathy (diabetic, hypertensive, or otherwise) is more prevalent in patients with CKD, independent of standard CVD risk factors including diabetes and proteinuria.…”

Section: The Retinal Circulation: Cvd Risk Factors and Outcomesmentioning

confidence: 99%

The eye, the kidney, and cardiovascular disease: old concepts, better tools, and new horizons

Farrah

Dhillon

Keane

et al. 2020

Kidney International

105

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Chronic kidney disease (CKD) is common, with hypertension and diabetes mellitus acting as major risk factors for its development. Cardiovascular disease is the leading cause of death worldwide and the most frequent end point of CKD. There is an urgent need for more precise methods to identify patients at risk of CKD and cardiovascular disease. Alterations in microvascular structure and function contribute to the development of hypertension, diabetes, CKD, and their associated cardiovascular disease. Homology between the eye and the kidney suggests that noninvasive imaging of the retinal vessels can detect these microvascular alterations to improve targeting of at-risk patients. Retinal vessel–derived metrics predict incident hypertension, diabetes, CKD, and cardiovascular disease and add to the current renal and cardiovascular risk stratification tools. The advent of optical coherence tomography (OCT) has transformed retinal imaging by capturing the chorioretinal microcirculation and its dependent tissue with near-histological resolution. In hypertension, diabetes, and CKD, OCT has revealed vessel remodeling and chorioretinal thinning. Clinical and preclinical OCT has linked retinal microvascular pathology to circulating and histological markers of injury in the kidney. The advent of OCT angiography allows contrast-free visualization of intraretinal capillary networks to potentially detect early incipient microvascular disease. Combining OCT’s deep imaging with the analytical power of deep learning represents the next frontier in defining what the eye can reveal about the kidney and broader cardiovascular health.

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“…Several recent studies have explored geometric biomarkers in the retina for evaluating DR [7][8][9][10][11][12][13][14] and other systemic complications [15]. However, the investigated features were somewhat limited and did not provide indications on how the geometry of retinal vasculature changed within each patient during DR progression [16,17].…”

Section: Introductionmentioning

confidence: 99%

Fully automated geometric feature analysis in optical coherence tomography angiography for objective classification of diabetic retinopathy

Alam

Miao

et al. 2019

Biomed. Opt. Express

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This study is to establish quantitative features of vascular geometry in optical coherence tomography angiography (OCTA) and validate them for the objective classification of diabetic retinopathy (DR). Six geometric features, including total vessel branching angle (VBA: θ), child branching angles (CBAs: α1 and α2), vessel branching coefficient (VBC), and children-to-parent vessel width ratios (VWR1 and VWR2), were automatically derived from each vessel branch in OCTA. Comparative analysis of heathy control, diabetes with no DR (NoDR), and non-proliferative DR (NPDR) was conducted. Our study reveals four quantitative OCTA features to produce robust DR detection and staging classification: (ANOVA, P<0.05), VBA, CBA1, VBC, and VWR1.

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Retinal vascular geometry and 6 year incidence and progression of diabetic retinopathy

Abstract: Retinal vascular geometry measured from fundus photographs predicted the incidence and progression of diabetic retinopathy in adults with diabetes, beyond established risk factors.

Cited by 66 publications

References 55 publications

Microvascular Dysfunction and Hyperglycemia: A Vicious Cycle With Widespread Consequences

Microvascular Dysfunction and Hyperglycemia: A Vicious Cycle With Widespread Consequences

The eye, the kidney, and cardiovascular disease: old concepts, better tools, and new horizons

Fully automated geometric feature analysis in optical coherence tomography angiography for objective classification of diabetic retinopathy

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