Retinal Arteriolar Narrowing Research Articles

Accumulation of Microvascular Target Organ Damage in Systemic Lupus Erythematosus Patients Is Associated with Increased Cardiovascular Risk.

Background: Systemic lupus erythematosus (SLE) is a prototype autoimmune disease associated with increased cardiovascular (CV) burden. Besides increased arterial stiffness and subclinical atherosclerosis, microvascular dysfunction is considered an important component in the pathophysiology of CV disease. However, there is a lack of data regarding the effect of multiple target organ damage (TOD) on CV health. Objectives: This study aimed to evaluate (i) the presence of microvascular changes in SLE in various vascular beds, (ii) the possible associations between the accumulation of microvascular TOD and CV risk and (iii) whether Galectin-3 represents a predictor of combined microvascular TOD. Methods: Participants underwent (i) evaluation of skin microvascular perfusion (laser speckle contrast analysis), (ii) fundoscopy (non-mydriatic fundus camera), (iii) indirect assessment of myocardial perfusion (subendocardial viability ratio) and (iv) determination of urine albumin-to-creatinine ratio (UACR). CV risk was calculated using the QResearch Risk Estimator version 3 (QRISK3). Serum Galectin-3 levels were determined. Results: Forty-seven SLE patients and fifty controls were studied. SLE patients demonstrated impaired skin microvascular reactivity (160.2 ± 41.0 vs. 203.6 ± 40.1%), retinal arteriolar narrowing (88.1 ± 11.1 vs. 94.6 ± 13.5 μm) and higher UACR levels compared to controls. Furthermore, SLE individuals had significantly higher Galectin-3 levels [21.5(6.1) vs. 6.6(6.6) ng/dL], QRISK3 scores [7.0(8.6) vs. 1.3(3.6)%] and a greater chance for microvascular dysfunction. In the SLE group, patients with multiple TOD exhibited higher QRISK3. In the multivariate analysis, the accumulation of TOD correlated with disease activity and Galectin-3 (p < 0.05). Conclusions: Our study showed for the first time that SLE patients exhibit a greater number of cases of TOD. The accumulation of TOD was associated with increased CV risk. Clinicians dealing with SLE should be aware and seek microvascular alterations.

Retinal Vascular Imaging Application in Women’s Reproductive Health: Clinical Implications and Future Directions

Abstract Over the past two decades, population-based studies employing semiautomatic computer-assisted programs have uncovered associations between retinal microvascular features and various systemic conditions. As the recognition of retinal imaging in cardiometabolic health grows, there is increasing evidence supporting its application in women’s health, particularly during the reproductive age. This review aims to summarize the indications of retinal imaging in women’s health and intergenerational health, where suboptimal retinal imaging has been found to mirror pathological systemic changes, such as suboptimal hemodynamic circulation, inflammation, endothelial dysfunction, oxidative stress, and hypoxia in vivo. Findings from Singapore Growing Up in Singapore Towards Healthy Outcomes and Singapore Preconception Study of Long-Term Maternal and Child Outcomes cohorts have reported serial changes in retinal conventional microvascular features (e.g., retinal arteriolar narrowing, retinal venular widening) and retinal geometric microvascular features (e.g., sparse fractal dimension, enlarged branching angle, and increased curvature tortuosity) during the preconception and antenatal phases. These morphological abnormalities were found to be related to female fertility, maternal antenatal health conditions, postnatal maternal cardiometabolic health, and intergenerational health in the fetus. Given the compelling evidence of the ability to detect microvascular changes through noninvasive methods at an early stage, retinal imaging holds the potential to facilitate timely interventions, mitigate the progression of complications, and prevent adverse pregnancy outcomes. Looking ahead, the convergence of artificial intelligence and advanced imaging techniques heralds a promising era in women’s health research and clinical practice.

Association between deep learning measured retinal vessel calibre and incident myocardial infarction in a retrospective cohort from the UK Biobank

BackgroundCardiovascular disease is a leading cause of global death. Prospective population-based studies have found that changes in retinal microvasculature are associated with the development of coronary artery disease. Recently, artificial...

THE OPTICAL COHERENCE TOMOGRAPHY (OCT) IN A PATIENT WITH RETINOPATHY-ASSOCIATED ECLAMPSIA: WHAT TO EXPECT?

Introduction : Eclampsia is a common pregnancy complication, that has been associated with retinopathy. Screening of retinopathy in preeclampsia/eclampsia is essential for early detection and management. Various imaging modalities are used to diagnose retinopathy. However, because of the higher-resolution imaging demand, optical coherence tomography (OCT) suggests a better option. The present study aimed to report the OCT findings of retinopathy-associated eclampsia.&#x0D; Case Illustration : A 24-year-old pregnant woman in 27th-week gestation with eclampsia presented the new onset of bilateral sudden diminution of vision. The vision in her right eye was limited to hand movement and that in her left eye was light perception only. Clinical examination revealed Siegrist streaks, Elschnig spots, and flame shape hemorrhages. OCT of both eyes demonstrated subretinal fluid, intraretinal fluid, thickening of the retinal layer, also inner retinal hyperreflectivity. Two months after the follow-up, there was an improvement in the OCT findings and also in the visual acuity.&#x0D; Discussion : An increase in macular thickness could be a characteristic feature in the OCT of retinopathy- associated eclampsia caused by retinal arteriolar narrowing due to systemic hypertension and ischemia. Previous studies have demonstrated subretinal/intraretinal fluid with or without serous retinal detachment in preeclampsia. Following our case, we report subretinal fluid, intraretinal fluid in the outer plexiform layer with retinal detachment and macular edema. The subretinal fluid and serous detachment were most likely caused by the changes in the fluid and ion-transport function of the retinal pigment epithelium (RPE).&#x0D; Conclusion : OCT can provide valuable information for diagnosis and follow-up retinopathy in preeclampsia/eclampsia.

A deep learning system for retinal vessel calibre improves cardiovascular risk prediction in Asians with chronic kidney disease.

Cardiovascular disease (CVD) and mortality is elevated in chronic kidney disease (CKD). Retinal vessel calibre in retinal photographs is associated with cardiovascular risk and automated measurements may aid CVD risk prediction. Retrospective cohort study of 860 Chinese, Malay and Indian participants aged 40-80 years with CKD [estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2] who attended the baseline visit (2004-2011) of the Singapore Epidemiology of Eye Diseases Study. Retinal vessel calibre measurements were obtained by a deep learning system (DLS). Incident CVD [non-fatal acute myocardial infarction (MI) and stroke, and death due to MI, stroke and other CVD] in those who were free of CVD at baseline was ascertained until 31 December 2019. Risk factors (established, kidney, and retinal features) were examined using Cox proportional hazards regression models. Model performance was assessed for discrimination, fit, and net reclassification improvement (NRI). Incident CVD occurred in 289 (33.6%) over mean follow-up of 9.3 (4.3)years. After adjusting for established cardiovascular risk factors, eGFR [adjusted HR 0.98 (95% CI: 0.97-0.99)] and retinal arteriolar narrowing [adjusted HR 1.40 (95% CI: 1.17-1.68)], but not venular dilation, were independent predictors for CVD in CKD. The addition of eGFR and retinal features to established cardiovascular risk factors improved model discrimination with significantly better fit and better risk prediction according to the low (<15%), intermediate (15-29.9%), and high (30% or more) risk categories (NRI 5.8%), and with higher risk thresholds (NRI 12.7%). Retinal vessel calibre measurements by DLS were significantly associated with incident CVD independent of established CVD risk factors. Addition of kidney function and retinal vessel calibre parameters may improve CVD risk prediction among Asians with CKD.

Food intake in South African children and retinal microvascular health: The ExAMIN Youth SA study

Background and aimsRetinal arteriolar narrowing and venular widening are associated with increased cardiovascular risk, even at young ages. Whether diet contributes to early microvascular changes in children is not widely explored. We explored the associations of frequency of healthy and unhealthy food group intake with retinal vessel calibers in black and white children. Methods and resultsThis study included school-aged (5–9 years) black (N = 433, 7.46 ± 0.98 years), and white (N = 403, 7.43 ± 0.82 years) children. Anthropometric and blood pressure measurements were taken, along with retinal vessel calibers (central retinal arteriolar (CRAE) and venular (CRVE) equivalents). Frequencies of food group intake were assessed using a food-frequency questionnaire. A factor analysis was performed to describe food group patters. Independent associations between retinal vessel calibers and frequencies of food group intake and food group patters were explored. In black children, cookies, cakes, and biscuits were associated with narrower arterioles (p < 0.05). In white children, cold sweetened beverages were associated with narrower arterioles (p = 0.02), whereas salty snacks were associated with narrower arterioles (p = 0.01) and wider venules (p < 0.05). Fruits were positively associated with CRAE (p = 0.03) in white children only. ConclusionA higher frequency of unhealthy food group consumption was associated with retinal arteriolar narrowing and venular widening in both black and white children. However, fruit intake was shown beneficial for retinal microvascular health in white children only. Our findings may highlight the importance of promoting healthy eating patterns from early childhood which may reduce the risk of premature cardiovascular disease development.

Preconception maternal retinal arteriolar narrowing and fetal growth throughout pregnancy: A prospective cohort study.

To investigate the association between preconception maternal retinal arteriolar calibre and fetal growth. A hospital-based, prospective preconception cohort including 369 women with a singleton live birth. We collected detailed information on sociodemographic status, pregnancy history and lifestyle, and performed retinal imaging at the preconception visit. We retrieved medical records documenting fetal growth biometrics (e.g., abdominal circumference [AC], head circumference [HC], femur length [FL]) at 11-13, 18-21, 24-28, and 32-34 weeks throughout pregnancy. We then computed the z scores for all fetal growth biometrics from 14 weeks of gestation where data were available, referencing the INTERGROWTH-21st fetal growth chart. We used a linear mixed model to estimate the association between maternal preconception retinal arteriolar calibre and fetal growth biometrics z scores throughout pregnancy, with random intercept accounting for repeated measures within individuals. We then performed a multivariable linear regression of maternal preconception retinal arteriolar calibre and z score changes for all fetal growth biometrics between 24-28 weeks and 32-34 weeks of gestation, after full adjustment. Maternal preconception generalised retinal arteriolar narrowing was consistently associated with a reduction in fetal AC z scores (-0.34; 95% CI -0.66 to -0.03) throughout pregnancy. In addition, women with preconception generalised retinal arteriolar narrowing tended to have significantly reduced z score changes in AC (-0.41; 95% CI -0.90 to -0.001) and fetal FL (-0.55; 95% CI -1.00 to -0.10) between 24-28 weeks and 32-34 weeks of gestation, respectively. Our findings suggest that women with narrower preconception retinal arterioles had smaller fetuses, evidenced by reductions in AC and FL z score throughout pregnancy.

URINARY PROTEOMIC SIGNATURE OF THE RETINAL MICROVASCULATURE

Objective: The retinal vasculature provides a window into the body's microcirculation. Variations in retinal vessel diameters have been associated with adverse cardiovascular outcomes, such as stroke and coronary heart disease. As the pathogenesis of retinal microvascular diameter changes remain poorly understood, this study aimed to provide novel insights by characterizing the urinary proteomic signature of the retinal microvasculature. Design and method: The central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), and arteriole-to venule-ratio (AVR) were measured from digitized retinal photographs of 562 randomly recruited Flemish participants (mean age, 48.9 years; 50.9% women). The urinary proteome was analyzed using capillary electrophoresis coupled with mass spectrometry. Multivariable linear regression analysis identified significant urinary peptides with adjustment for age, sex, body mass index, smoking, hypertension, plasma glucose, total and HDL cholesterol, eGFR, and history of cardiovascular disease. Reactome pathway enrichment analysis was performed to interpret the proteomic signature. Results: Table 1 shows participant characteristics. Of the 359 peptides analyzed, 19 were significantly associated with CRAE after adjusting for potential confounders and multiple testing (Table 2). In the proteomic profile, 14 peptides (74%) were fragments of collagen I, III, and XI proteins, while the remaining peptides were fragments of the fibrinogen alpha chain (11%), xylosyltransferase 1 (5%), S100 calcium-binding protein A9 (5%), and hemoglobin subunit alpha (5%) proteins. Pathway analysis showed that these proteins were predominantly involved in endothelial cell proliferation and migration, collagen formation and degradation, and cell-extracellular matrix interactions (Figure 1). No peptides were significantly associated with CRVE and AVR following adjustment. Conclusions: This study revealed a novel urinary proteomic signature as a potential biomarker of retinal arteriolar narrowing. The signature suggests fibrosis and neovascularization may be involved in retinal microvascular diameter changes. Further investigation may help elucidate the pathophysiologic mechanisms underlying the relationship between microvascular and macrovascular disease.

Retinal vessel caliber and tortuosity and prediction of 5-year incidence of hypertension.

With arterial hypertension as a global risk factor for cerebrovascular and cardiovascular diseases, we examined whether retinal blood vessel caliber and tortuosity assessed by a vessel-constraint network model can predict the incidence of hypertension. The community-based prospective study included 9230 individuals who were followed for 5 years. Ocular fundus photographs taken at baseline were analyzed by a vessel-constraint network model. Within the 5-year follow-up, 1279 (18.8%) and 474 (7.0%) participants out of 6813 individuals free of hypertension at baseline developed hypertension and severe hypertension, respectively. In multivariable analysis, a higher incidence of hypertension was related to a narrower retinal arteriolar diameter ( P < 0.001), wider venular diameter ( P = 0.005), and a smaller arteriole-to-venule diameter ratio ( P < 0.001) at baseline. Individuals with the 5% narrowest arteriole or the 5% widest venule diameter had a 17.1-fold [95% confidence interval (CI):7.9, 37.2] or 2.3-fold (95% CI: 1.4, 3.7) increased risk for developing hypertension, as compared with those with the 5% widest arteriole or the 5% narrowest venule. The area under the receiver operator characteristic curve for predicting the 5-year incidence of hypertension and severe hypertension was 0.791 (95% CI: 0.778, 0.804) and 0.839 (95% CI: 0.821, 0.856), respectively. Although the venular tortuosity was positively associated with the presence of hypertension at baseline ( P = 0.01), neither arteriolar tortuosity nor venular tortuosity was associated with incident hypertension (both P ≥ 0.10). Narrower retinal arterioles and wider venules indicate an increased risk for incident hypertension within 5 years, while tortuous retinal venules are associated with the presence rather than the incidence of hypertension. The automatic assessment of retinal vessel features performed well in identifying individuals at risk of developing hypertension.

Commentary: Clinical profile, demographic distribution, and outcomes of ocular siderosis: Electronic medical record-driven big data analytics from an eye care network in India.

Commentary: Clinical profile, demographic distribution, and outcomes of ocular siderosis: Electronic medical record-driven big data analytics from an eye care network in India.

Automated Systems for Calculating Arteriovenous Ratio in Retinographies: A Scoping Review.

There is evidence of an association between hypertension and retinal arteriolar narrowing. Manual measurement of retinal vessels comes with additional variability, which can be eliminated using automated software. This scoping review aims to summarize research on automated retinal vessel analysis systems. Searches were performed on Medline, Scopus, and Cochrane to find studies examining automated systems for the diagnosis of retinal vascular alterations caused by hypertension using the following keywords: diagnosis; diagnostic screening programs; image processing, computer-assisted; artificial intelligence; electronic data processing; hypertensive retinopathy; hypertension; retinal vessels; arteriovenous ratio and retinal image analysis. The searches generated 433 articles. Of these, 25 articles published from 2010 to 2022 were included in the review. The retinographies analyzed were extracted from international databases and real scenarios. Automated systems to detect alterations in the retinal vasculature are being introduced into clinical practice for diagnosis in ophthalmology and other medical specialties due to the association of such changes with various diseases. These systems make the classification of hypertensive retinopathy and cardiovascular risk more reliable. They also make it possible for diagnosis to be performed in primary care, thus optimizing ophthalmological visits.

Prehypertension and Retinal Arteriolar Narrowing in PWH in Tanzania.

Prehypertension and Retinal Arteriolar Narrowing in PWH in Tanzania.

Retinal Microvascular Abnormalities Predict Clinical Outcomes in Patients with Heart Failure.

Background: Narrower retinal arterioles and wider retinal venules have been associated with the incidence of heart failure (HF). However, whether they are predictive of the prognosis of heart failure (HF) is unclear. We aimed to explore the role of retinal vessel calibers in predicting long-term clinical outcomes of HF. Methods: This is a prospective, single-center, observational study that surveyed patients in a tertiary referral hospital for the treatment of HF. Retinal vessel caliber was graded using retinal photography. The primary endpoint was the composite endpoint of HF rehospitalization and mortality at 12 months. Results: There were 55 patients with chronic HF included in the final analysis. At 12 months, the cumulative incidence of the primary endpoint, HF rehospitalization, and mortality tended to be higher with the widening of the central retinal venular equivalent (CRVE) (p for non-linearity = 0.059) and was significantly increased when CRVE reached a cut-off value (283 μm) (p = 0.011) following adjustment for age, sex, etiology of HF, and diabetes. No association between the central retinal arteriolar equivalent (CRAE) and arteriolar-to-venular caliber ratio (AVR) was found with the clinical outcome in both univariable and multivariable Cox regression. CRAE, CRVE, and AVR had no relationship with the concentration of the N-terminal pro-B-type natriuretic peptide. In addition, CRVE was not associated with cardiac diastolic and systolic function. Conclusions: When the retinal venular caliber widens to a certain point, the composite incidence of HF rehospitalization and mortality significantly increase, suggesting retinal vessel caliber imaging may provide insight into the development of HF.

Obstructive sleep apnea, chronic obstructive pulmonary disease and hypertensive microvascular disease: a cross-sectional observational cohort study

Hypertensive microvascular disease is associated with an increased risk of diastolic heart failure, vascular dementia and progressive renal impairment. This study examined whether individuals with obstructive sleep apnoea (OSA) had more retinal hypertensive microvascular disease than those with chronic obstructive pulmonary disease (COPD) and hospital controls. This was a single-centre, cross-sectional, observational study of participants recruited consecutively from a general respiratory clinic and a general medical clinic. OSA was diagnosed on overnight polysomnography study (apnoea:hypopnoea index ≥ 5), and controls with COPD had a forced expiratory volume/forced vital capacity (forced expiratory ratio) < 70%. Individuals with both OSA and COPD were excluded. Hospital controls had no COPD on respiratory function testing and no OSA on specialist physician questioning. Study participants completed a medical questionnaire, and underwent resting BP measurement, and retinal photography with a non-mydriatic camera. Images were deidentified and graded for microvascular retinopathy (Wong and Mitchell classification), and arteriole and venular calibre using a semiautomated method at a grading centre. Individuals with OSA (n = 79) demonstrated a trend to a higher mean arterial pressure than other hospital patients (n = 143) (89.2 ± 8.9 mmHg, p = 0.02), and more microvascular retinopathy (p < 0.001), and narrower retinal arterioles (134.2 ± 15.9 μm and 148.0 ± 16.2 μm respectively, p < 0.01). Microvascular retinopathy and arteriolar narrowing were still more common in OSA than hospital controls, after adjusting for age, BMI, mean arterial pressure, smoking history and dyslipidaemia (p < 0.01, p < 0.01, respectively). Individuals with OSA demonstrated a trend to a higher mean arterial pressure than those with COPD (n = 132, 93.2 ± 12.2 mmHg and 89.7 ± 12.8 mmHg respectively, p = 0.07), and more microvascular retinopathy (p = 0.0001) and narrower arterioles (134.2 ± 15.9 and 152.3 ± 16.8, p < 0.01). Individuals with OSA alone had more systemic microvascular disease than those with COPD alone or other hospital patients without OSA and COPD, despite being younger in age.

ASSOCIATION OF CEREBRAL OXYGENATION DURING EXERCISE WITH TARGET ORGAN DAMAGE IN HYPERTENSIVE AND NORMOTENSIVE INDIVIDUALS

Objective: To investigate whether indices of cerebral oxygenation during exercise correlate with subclinical markers of target organ damage (TOD), namely carotid intima-media thickness (cIMT), arterial stiffness, and retinal vessel diameter in newly diagnosed hypertensives and healthy individuals. Design and method: Hypertension was diagnosed using 24-hour ambulatory blood pressure (BP) monitoring. Patients with white coat or masked hypertension were excluded. Cerebral oxygenation was measured continuously during a three-minute isometric hand grip exercise at 30% of maximal voluntary contraction using near infrared spectroscopy. The average response during exercise in oxygenated-hemoglobin (O2Hb), deoxygenated-hemoglobin (HHb), and total-hemoglobin (tHb, reflecting changes in regional blood volume) were examined. CIMT was measured using ultrasound, arterial stiffness was estimated with augmentation index and pulse wave velocity, and retinal vessel diameters were estimated by the central retinal arteriolar (CRAE) and vein (CRVE) equivalent and retinal arteriovenous ratio (AVR). Univariate analyses were performed and partial correlation was used to account for traditional cardiovascular risk factors to identify independent associations between cerebral oxygenation indices and TOD. Results: Fifty-two newly-diagnosed, never treated hypertensives and 41 healthy normotensive individuals with no known medical history of any other disease were included in our study. There were no differences in anthropometric and laboratory variables between groups except for their BP levels, as expected by study design. Mean cIMT was negatively correlated with the average exercise response in cerebral oxygenation (rhoO2Hb = -0.348, pO2Hb = 0.001; rhotHb = -0.253, ptHb = 0.02). Augmentation index was negatively correlated with cerebral-oxygenation during exercise (rhoO2Hb = -0.374, p &lt; 0.001; rhotHb = -0.332, p = 0.02), whereas no significant correlation was observed between pulse wave velocity and cerebral oxygenation indices. In the adjusted analysis, cerebral oxygenation was correlated with central retinal arteriolar diameter (CRAE rO2Hb = 0.233, pO2Hb = 0.043). Conclusions: Our novel findings suggest that indices of cerebral oxygenation during a submaximal physical task are associated with markers of early, subclinical target organ damage, namely increased carotid intima-media thickness, arterial stiffness and retinal arteriolar narrowing in a population of newly diagnosed hypertensive individuals.

A Critical Modern Review on BRVO (Branch Retinal Vein Occlusion)

Branch retinal vein occlusion (BRVO) may be a common reason behind retinal vascular disease. General vascular diseases corresponding to cardiovascular disease and induration of the arteries are risk issues for BRVO. Age is additionally a powerful risk factor for BRVO. And lots of epidemiological studies have confirmed that the prevalence will increase with increasing age. It happens most often between the ages of sixty and seventy years. Men and ladies are affected equally. Age, systemic hypertension and also the retinal artery changes related to it, together with blood vessel nicking and retinal arteriolar narrowing, are well-established risk factors for BRVO. Other vessel risk factors, reminiscent of diabetes, smoking, hyperlipidemia, chamber fibrillation, urinary organ dysfunction, and atherosclerosis, have conjointly been related to an exaggerated risk of BRVO. The pathologic interruption of blood vessel flow in eyes with BRVO nearly always happens at a blood vessel crossing. Patients with BRVO gift with unexpected painless loss of vision or a visible field defect. Prognosis and we have a tendency to the effectiveness of various treatment choices. So it's necessary to grasp the explanation of BRVO. BRVO could be a common reason behind vision loss, however several treatment options are accessible and rising therapies are under investigation. Here, we gift a review of the chance factors, pathological process in BRVO, clinical features, natural history, clinical evaluation, diagnostic workup, clinical treatments for BRVO patients also as connected clinical trials also are reviewed.

Evidence of retinal arteriolar narrowing in patients with autosomal-dominant polycystic kidney disease

Abstract Introduction The aim of this study was to examine retinal vessels in autosomal dominant polycystic kidney disease (ADPKD) patients with normal kidney function and without diabetes mellitus. Materials and Methods We enrolled 39 adult individuals with ADPKD and 45 gender- and age-matched individuals as controls. A full ophthalmologic examination, including retinal vessel caliber and reactions to flicker stimulation analysis and grading of hypertensive retinopathy according to the Keith-Wagener classification, was performed. Results Multivariable analysis of ADPKD patients and controls, adjusted for age, gender, estimated glomerular filtration rate (e-GFR) and the presence of hypertension, revealed that ADPKD was an independent factor associated with lower arteriovenous ratio (AVR) values (by 0.069 on average, β = −0.50, p &lt; 0.0001). The severity of hypertensive retinopathy according to the Keith-Wagener classification appeared to be more advanced in the ADPKD group than in the controls, despite the lack of vascular abnormalities, such as retinal hemorrhages, exudates, cotton wool spots or papilledema, as well as microaneurysms, which are very characteristic signs of ADPKD in other vascular beds. Conclusions Lower AVR values could be a specific pathophysiological ocular manifestation of systemic vasculopathy in the course of ADPKD.

Evidence of retinal arteriolar narrowing in patients with autosomal-dominant polycystic kidney disease

Abstract Introduction The aim of this study was to examine retinal vessels in autosomal dominant polycystic kidney disease (ADPKD) patients with normal kidney function and without diabetes mellitus. Materials and Methods We enrolled 39 adult individuals with ADPKD and 45 gender- and age-matched individuals as controls. A full ophthalmologic examination, including retinal vessel caliber and reactions to flicker stimulation analysis and grading of hypertensive retinopathy according to the Keith-Wagener classification, was performed. Results Multivariable analysis of ADPKD patients and controls, adjusted for age, gender, estimated glomerular filtration rate (e-GFR) and the presence of hypertension, revealed that ADPKD was an independent factor associated with lower arteriovenous ratio (AVR) values (by 0.069 on average, β = −0.50, p &lt; 0.0001). The severity of hypertensive retinopathy according to the Keith-Wagener classification appeared to be more advanced in the ADPKD group than in the controls, despite the lack of vascular abnormalities, such as retinal hemorrhages, exudates, cotton wool spots or papilledema, as well as microaneurysms, which are very characteristic signs of ADPKD in other vascular beds. Conclusions Lower AVR values could be a specific pathophysiological ocular manifestation of systemic vasculopathy in the course of ADPKD.

Vascular health assessment with flow-mediated dilatation and retinal image analysis: a pilot study in an adult population from Cape Town.

Flow-mediated dilatation (FMD) and retinal vascular analysis (RVA) may assist in predicting cardiovascular disease (CVD) but are poorly characterised in South Africa. We recorded baseline FMD and retinal vascular widths in healthy participants, and investigated associations with cardiovascular risk factors. Endothelial function (measured with FMD), microvascular structure (evaluated via fundus image analysis) and major CVD risk factors were assessed in 66 participants from Cape Town. Median FMD% was 9.6%, with higher values in females. Mean retinal arteriolar and venular widths were ˜156 and ˜250 µm, respectively. FMD was not associated with CVD risk factors. Hypertension was associated with narrower retinal arterioles and venules. We report novel baseline FMD data in healthy South African adults from the Western Cape, and show that retinal microvascular calibres are associated with blood pressure. Our baseline FMD and RVA data could serve as a reference for future studies in South Africa.

Changes in retinal vascular diameters in senior and geriatric cats in association with variation in systemic blood pressure.

Early diagnosis of arterial hypertension is essential to prevent target organ damage. In humans, retinal arteriolar narrowing predicts hypertension. This blinded prospective observational study investigated the retinal vessel diameters in senior and geriatric cats of varying systolic blood pressure (SBP) status and evaluated retinal vascular changes in hypertensive cats after treatment. Cats with a median age of 14 years (range 9.1-22 years) were categorised into five groups: group 1, healthy normotensive (SBP <140 mmHg; n = 40) cats; group 2, pre-hypertensive (SBP 140-160 mmHg; n = 14) cats; group 3, cats with chronic kidney disease (CKD) and normotensive (n = 26); group 4, cats with CKD and pre-hypertensive (n = 13); and group 5, hypertensive cats (SBP >160 mmHg, n = 15). Colour fundus images (Optibrand ClearView) were assessed for hypertensive lesions. Retinal vascular diameters and bifurcation angles were annotated and calculated using the Vascular Assessment and Measurement Platform for Images of the Retina annotation tool (VAMPIRE-AT). When available, measurements were obtained at 3 and 6 months after amlodipine besylate treatment. Ten hypertensive cats had retinal lesions, most commonly intraretinal haemorrhages and retinal exudates. Arteriole and venule diameters decreased significantly with increasing age (-0.17 ± 0.05 pixels/year [P = 0.0004]; -0.19 ± 0.05 pixels/year). Adjusted means ± SEM for arteriole and venule diameter (pixels) were 6.3 ± 0.2 and 8.9 ± 0.2 (group 1); 7.6 ± 0.3 and 10.1 ± 0.4 (group 2); 6.9 ± 0.2 and 9.5 ± 0.3 (group 3); 7.4 ± 0.3 and 10.0 ± 0.4 (group 4); and 7.0 ± 0.3 and 9.8 ± 0.4 (group 5). Group 1 arteriole and venule diameters were significantly lower than those of groups 2 and 4. Group 2 arteriole bifurcation angle was significantly narrower than those of groups 1 and 3. Post-treatment, vessel diameters decreased significantly at 3 and 6 months in seven hypertensive cats. Increased age was associated with reduced vascular diameters. Longitudinal studies are required to assess if vessel diameters are a risk indicator for hypertension in cats.