Abstract
PurposeTo test the hypothesis of a significant relationship between systemic markers of renal and vascular function (processes linked to cardiovascular disease and its development) and retinal microvascular function in diabetes and/or cardiovascular disease.MethodsOcular microcirculatory function was measured in 116 patients with diabetes and/or cardiovascular disease using static and continuous retinal vessel responses to three cycles of flickering light. Endothelial function was evaluated by von Willebrand factor (vWf), endothelial microparticles and soluble E selectin, renal function by serum creatinine, creatinine clearance and estimated glomerular filtration rate (eGFR). HbA1c was used as a control index.ResultsCentral retinal vein equivalence and venous maximum dilation to flicker were linked to HbA1c (both p < 0.05). Arterial reaction time was linked to serum creatinine (p = 0.036) and eGFR (p = 0.039); venous reaction time was linked to creatinine clearance (p = 0.018). Creatinine clearance and eGFR were linked to arterial maximum dilatation (p < 0.001 and p = 0.003, respectively) and the dilatation amplitude (p = 0.038 and p = 0.048, respectively) responses in the third flicker cycle. Of venous responses to the first flicker cycle, HbA1c was linked to the maximum dilation response (p = 0.004) and dilatation amplitude (p = 0.017), vWf was linked to the maximum constriction response (p = 0.016), and creatinine clearance to the baseline diameter fluctuation (p = 0.029). In the second flicker cycle, dilatation amplitude was linked to serum creatinine (p = 0.022).ConclusionsSeveral retinal blood vessel responses to flickering light are linked to glycaemia and renal function, but only one index is linked to endothelial function. Renal function must be considered when interpreting retinal vessel responses.
Highlights
The relatively straightforward non-invasive assessment of the retinal circulation by methods such as fundus photography, video recording and tomography has led to the view that it has potential as a screening tool for cardiovascular disease such as myocardial infarction and stroke [1,2,3]
Cycle, HbA1c was linked to the maximum dilation response (p = 0.004) and dilatation amplitude (p = 0.017), von Willebrand factor (vWf) was linked to the maximum constriction response (p = 0.016), and creatinine clearance to the baseline diameter fluctuation (p = 0.029)
Several authors have demonstrated a link between measures of cardiovascular health and retinal vessel dynamics, such as a decrease in Graefes Arch Clin Exp Ophthalmol (2016) 254:2257–2265 retinal vessel dilation in the presence of decreased flow mediated dilation of the brachial artery [10], prolonged reaction times in retinal arterial responses to flicker light in patients suffering from coronary artery disease [11], and decreased vessel dilation to flicker light in patients with coronary artery disease, and which depends on the severity of the disease [12]
Summary
The relatively straightforward non-invasive assessment of the retinal circulation by methods such as fundus photography, video recording and tomography has led to the view that it has potential as a screening tool for cardiovascular disease such as myocardial infarction and stroke [1,2,3]. This concept has been supported through large population studies [4,5,6] that together demonstrate a relationship between certain retinal vessel indices and cardiovascular risk [7, 8]. There is considerable evidence that retinal vessel reactivity to flicker light provocation is blunted in the presence of diabetes and in diabetic retinopathy [13,14,15,16]
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