Retinal Vascular Tortuosity, Blood Pressure, and Cardiovascular Risk Factors

Cheung, Carol Y.; Zheng, Yingfeng; Hsu, Wynne; Lee, Mong Li; Lau, Qiangfeng Peter; Mitchell, Paul; Wang, Jie Jin; Klein, Michael L.; Wong, Tien Yin

doi:10.1016/j.ophtha.2010.08.045

Cited by 246 publications

(205 citation statements)

References 35 publications

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“…Unlike Cheung et al and Sasongko et al [9] [10] finding a negative association between age and tortuosity, we demonstrated that age was positively associated with vascular tortuosity as an independent risk factor. This difference may come from the fact that Cheung's study was performed in a healthy population and Sasongko's study only included patients aged 12 -20 years with type 1 diabetes.…”

Section: Discussioncontrasting

confidence: 97%

“…However, these associations are not investigated in Chinese hospitalized type 2 diabetic patients yet. In addition, the quantitative measuring method of retinal vascular tortuosity, also for much smaller vessels, in our study was different from the way it was measured in prior studies [9] [10].…”

Section: Previous Researchmentioning

confidence: 67%

“…Cheung et al investigated retinal vascular tortuosity is positively associated with age, BMI and blood pressure [9], Sasongko et al found that retinal vascular tortuosity is associated with high HbA1c, even before the presence of retinopathy [10]. It suggests that changes in retinal vascular tortuosity may be an early pathology indicator before the clinical manifestation of diabetic microvascular complications.…”

Section: Previous Researchmentioning

confidence: 99%

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Retinal Vascular Tortuosity in Hospitalized Patients with Type 2 Diabetes and Diabetic Retinopathy in China

Zhu¹,

Triest²,

Tong³

et al. 2016

JBiSE

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Context: Diabetic patients are at high risk for microvascular complications of disease such as diabetic retinopathy (DR) and diabetic neuropathy. Imaging the retinal microvasculature offers a chance to measure quantitatively the microvascular changes in diabetic patients' onset and progression. However, the relation between retinal biomarkers and diabetic risk factors is unclear in Chinese hospitalized type 2 diabetic patients. Aims: To examine the associations of retinal vascular tortuosity with risk factors of type 2 diabetes and diabetic retinopathy in Chinese hospitalized patients. Patients and Methods: Our cross-sectional study includes 504 participants with type 2 diabetes hospitalized in the department of endocrinology in Shengjing hospital, Shenyang, China. Patients' socio-demographic, clinical and biological information was retrieved from their ID card, the interview, and the local hospital information system. Retinal photographs were taken by laser-scanning ophthalmoscopy of both eyes and checked if gradable for analysis. The weighted mean and standard deviation of tortuosity were calculated from the retinal photographs using a novel robust and fully automatic quantitative method. DR was assessed from the retinal photographs by the ophthalmologist according to the modified Airlie House classification into No DR and Any DR in our current study. Data were analyzed by SPSS Version 22 with Student's t test, Mann-Whitney U test, Chi-square test, and linear regression. Results:For the total participants (504) in this study, the weighted mean and standard deviation (SD) of tortuosity was 12.05 × 10 −3 (SD: 1.66 × 10 −3 ) and 24.31 × 10 −3 (SD: 3.69 × 10 −3 ), respectively. 386 (76.6%) patients were diagnosed with DR who had older age, long duration of diabetes, higher brachial ankle pulse wave velocity (baPWV), higher systolic blood pressure (SBP), higher diastolic blood pressure (DBP), and higher reHow to cite this paper: Zhu, S., van Triest, M., Tong, M., Lamers, T., Han, P., Qian, W. 144tinal vascular tortuosity values. In univariable linear regression analyses, older age, longer duration, higher baPWV, higher urine microalbuminuria, higher urine albumin/creatinine ratio, diagnosed with high blood pressure, thrombosis or Any DR, were significantly associated with both higher tortuosity measures (all P values < 0.05). In multivariable-adjusted linear regression analyses, age and diabetes duration (all P values < 0.05) were independently and positively associated with both tortuosity measures, after adjustment for low-density lipoprotein (LDL), high-density lipoprotein (HDL) and high blood pressure. Furthermore, after adding some kidney failure factors, the urine albumin/creatinine ratio was also an independent risk factor of vascular tortuosity. These associations remained even after including or excluding the factor of DR. Conclusions: Retinal vascular tortuosity is independently associated with older age, longer duration, and higher urine albumin/creatinine ratio in Chinese hospitalized type 2 di...

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Section: Discussioncontrasting

confidence: 97%

Section: Previous Researchmentioning

confidence: 67%

Section: Previous Researchmentioning

confidence: 99%

See 1 more Smart Citation

Retinal Vascular Tortuosity in Hospitalized Patients with Type 2 Diabetes and Diabetic Retinopathy in China

Zhu¹,

Triest²,

Tong³

et al. 2016

JBiSE

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“…Finally, there was a possibility that retinal arterioles and venules were misclassified during the measurement process, particularly in participants who underwent laser treatment (4.6%), which is usually associated with poor image quality. However, reliability of our measurements were high (intra-class coefficient 0.80) [36] and our findings remained unchanged after excluding patients with previous laser treatments from the analysis (ESM Table 3). In summary, in this study we showed the potential utility of quantitative assessment of retinal vascular tortuosity in assessing the early stage structural changes in retinal microvasculature associated with diabetes and DR.…”

Section: Discussionmentioning

confidence: 54%

Retinal vascular tortuosity in persons with diabetes and diabetic retinopathy

et al. 2011

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Aim/hypothesis The aim of this hypothesis was to examine the association of retinal vessel tortuosity with diabetes and diabetic retinopathy (DR). Methods A clinic-based study of 327 participants (224 with diabetes and 103 non-diabetic controls) aged ≥18 years. DR was graded from fundus photographs according to the modified Airlie House Classification system and categorised into mild non-proliferative DR (NPDR), moderate NPDR and vision-threatening DR (VTDR). Retinal vessel tortuosity was measured from disc-centred retinal photographs. Measurements were taken, using a semiautomated computer program by a single grader, of arterioles and venules within 0.5 to 2 disc diameters away from the optic disc. Results There were 114 (44%)

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“…Further markers of hypertension include reduced arteriolar bifurcation angles and increased arteriolar tortuosity, which reflect a suboptimal or diseased retinal vascular network. 25,26 Atherosclerosis causes coronary heart disease (CHD), which leads to over 80,000 deaths in the UK every year and is the country's biggest killer. 27 It is estimated that 2.7 million people in the UK are living with the condition and 2 million people are affected by angina, the most common symptom of CHD.…”

Section: 18mentioning

confidence: 99%

Retinal imaging as a source of biomarkers for diagnosis, characterization and prognosis of chronic illness or long-term conditions

MacGillivray¹,

Trucco²,

Cameron³

et al. 2014

BJR

121

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imaging as a source of biomarkers for diagnosis, characterization and prognosis of chronic illness or long-term conditions. Br J Radiol 2014;87:20130832. REVIEW ARTICLERetinal imaging as a source of biomarkers for diagnosis, characterization and prognosis of chronic illness or long-term conditions 1,2 T J MACGILLIVRAY, MSc ABSTRACTThe black void behind the pupil was optically impenetrable before the invention of the ophthalmoscope by von Helmholtz over 150 years ago. Advances in retinal imaging and image processing, especially over the past decade, have opened a route to another unexplored landscape, the retinal neurovascular architecture and the retinal ganglion pathways linking to the central nervous system beyond. Exploiting these research opportunities requires multidisciplinary teams to explore the interface sitting at the border between ophthalmology, neurology and computing science. It is from the detail and depth of retinal phenotyping that novel metrics and candidate biomarkers are likely to emerge. Confirmation that in vivo retinal neurovascular measures are predictive of microvascular change in the brain and other organs is likely to be a major area of research activity over the next decade. Unlocking this hidden potential within the retina requires integration of structural and functional data sets, that is, multimodal mapping and longitudinal studies spanning the natural history of the disease process. And with further advances in imaging, it is likely that this area of retinal research will remain active and clinically relevant for many years to come. Accordingly, this review looks at state-of-the-art retinal imaging and its application to diagnosis, characterization and prognosis of chronic illness or long-term conditions.Currently about 20 million people in the UK suffer from at least 1 long-term condition (a health problem that cannot be cured but can be controlled by medication or other therapies), and this is set to increase 3-fold over the next decade placing an enormous economic and humanresource strain on the National Health Service.1-3 The retina is unique in the body in allowing easy observation of blood vessels with simple, non-invasive instruments. It is also the only accessible site for studying the central nervous system (CNS) in vivo.4 This makes it a ripe environment for the study of systemic and neurological disease, in a patient-acceptable way. Changes to the retina can occur in some chronic diseases years before other signs become apparent. [5][6][7][8][9] Thus, studying the retina may provide an additional means for clinicians to stratify risk and help identify people who would benefit from early lifestyle changes and preventative therapies, as well as assessing the efficacy of new treatments. In addition, there is some early evidence that certain retinal measures may correlate with disease characterization and also prognosis, which not only provides clinicians with a useful assessment tool but also offers research scientists new avenues to explore in the understanding of the p...

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Retinal Vascular Tortuosity, Blood Pressure, and Cardiovascular Risk Factors

Cited by 246 publications

References 35 publications

Retinal Vascular Tortuosity in Hospitalized Patients with Type 2 Diabetes and Diabetic Retinopathy in China

Retinal Vascular Tortuosity in Hospitalized Patients with Type 2 Diabetes and Diabetic Retinopathy in China

Retinal vascular tortuosity in persons with diabetes and diabetic retinopathy

Retinal imaging as a source of biomarkers for diagnosis, characterization and prognosis of chronic illness or long-term conditions

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