Retinal Signs Research Articles

Not Only Diabetic Retinopathy - Retinal Vascular Lesions and Signs in Diabetic Patients: Description and Associations

Retinal vascular changes other than diabetic retinopathy (DRP) namely microaneurysms, intraretinal microvascular abnormalities so called IRMA, microinfarctions, hemorrhages, lipid exudates and edema, as well as venous beading and new vessels (NV) on the disk and/or on the retina and their sequalae pre-retinal and vitreous hemorrhages and fibrovascular proliferations and vitreoretinal tractions are common in diabetic patients. These changes are general or focal arteriolar narrowing or arteriolar or venous dilatation, arteriolar sinusoidal elongation or straightening, venous tortuosity, increased arteriolar wall reflex and arterio-venous crossing signs. They reflect cumulative response to aging, cardiovascular risk factors such as hyperglycemia, hypertension and dyslipidemia, as well as inflammation and endothelial dysfunction. Retinal vascular changes are under the influence of both systemic and environmental as well as genetic factors and serve as cardiovascular risk stratification indicator. Furthermore, these changes may cause as such ocular morbidity and threaten vision and influence the occurrence and progression of DRP. Many of these changes were recognized soon after the invention of ophthalmoscope by von Helmholz in 1851 and have since been described in literature. Many of these changes can be accurately measured today.

The Diabetic Eye: A Window to the Heart & Vascular System

Diabetic retinopathy is a serious complication of diabetes mellitus that could potentially lead to blindness. There is growing interest in the association between this important microvascular complication and cardiovascular morbidity and mortality. In this review article, the authors analyse the currently available data that link diabetic retinopathy with cardiovascular events in both type 1 and type 2 diabetic patients, including its association with coronary heart disease, heart failure, cerebrovascular disease and cardiac autonomic neuropathy. Important retinal signs that suggest underlying cardiovascular disease are discussed together with possible underlying pathophysiological mechanisms. The clinical implications involved are considered together with future studies. The latter should address not only possible pathological mechanisms, including genetic contribution, but also the implementation of diabetic retinopathy assessment as a risk stratification tool as well as novel therapeutic agents that might be beneficial both in the management of diabetic retinopathy and cardiovascular disease in general.

A review of malarial retinopathy in severe malaria

The ocular manifestations of severe malaria in patients with cerebral malaria (CM) include retinal whitening, vessel discolouration, retinal haemorrhages and papilloedema. A large prospective study of Malawian children with CM found that the severity of retinal signs, including the number of retinal haemorrhages, was related to the outcome and length of coma in survivors of malaria. In a smaller number of Kenyan children with cerebral malaria, retinal haemorrhages were associated with deep coma and severe anaemia. A study on the effect of malarial retinopathy on vision found no detectable effect on visual acuity (VA) but where malaria isaggravated by failure to receive treatment this may possibly affect VA. The failure to receive treatment may be directly linked to the socio-economic status (SES) of those affected and this may occur in the KwaZulu-Natal, Mpumalanga and Limpopo provinces of South Africa where malaria is endemic. This suggests the need for effective health education and health promotion amongst those affected by malaria especially in severely affected provinces of South Africa. Also, in view of the direct ocular consequences of severe malaria, optometrists should engage communities in health education and health promotion. This is particularly relevant because in some communities, a large majority of those suffering from malarial infections do not visit formal health facilities for treatment. In so doing, optometrists in South Africa will be contributing positively to the Millennium Development Goals which seek, amongst others, to reduce unwarranted sources of morbidity worldwide. (S Afr Optom 2011 70(3) 129-135)

Retinal Microvascular Signs and Disability in the Cardiovascular Health Study

To study the associations of retinal microvascular changes, which are associated with systemic conditions and cognitive decline, with disability in performing activities of daily living (ADL). Prospective cohort study of 1487 community-dwelling participants in the Cardiovascular Health Study (mean age, 78 years) who were free of ADL disability and had available data on retinal signs and carotid intima-media thickness at the 1998-1999 visit. Main outcome measures were incident ADL disability, defined as self-reported difficulty in performing any ADL, by the presence of retinal signs and advanced carotid atherosclerosis, defined by carotid intima-media thickness in the 80th percentile or more or 25% or more stenosis, and potential mediation by cerebral microvascular disease on brain imaging or by executive dysfunction, slow gait, and depressive mood, which are symptoms of frontal subcortical dysfunction. During the median follow-up of 3.1 years (maximum, 7.8 years), participants with 2 or more retinal signs had a higher rate of disability than those with fewer than 2 retinal signs (10.1% vs 7.1%; adjusted hazard ratio, 1.45; 95% confidence interval, 1.24-1.69; P<.001). There was no evidence of interaction by advanced carotid atherosclerosis (P>.10). The association seemed to be partially mediated by executive dysfunction, slow gait, and depressive symptoms but not by cerebral microvascular disease on brain imaging. These results provide further support for the pathophysiologic and prognostic significance of microvascular disease in age-related disability. However, it remains to be determined how to best use retinal photography in clinical risk prediction.

Abstracts: ASUM Annual Scientific Congress 2011

Abstracts: ASUM Annual Scientific Congress 2011

Manifestações retinianas em pacientes portadores de anemia de células falciformes

The World Health Organization counts that more than 5% of the world's population carry some type of hemoglobinopathy. Among them we find the sickle cell aneamia that presents its main harmful effect on the peripheral vasculature. In the retina, the falciform lesions have a well defined physiopathology and classification. To identify the retinal manifestations caused by the falciform aneamia in patients directed to the Bettina Ferro de Souza Hospital from the Hemocenter of the State of Para - HEMOPA, in the months of September through December of 2006. METHODS: Ophthalmologic examination was performed in the Department of Ophthalmology of the Bettina Ferro de Souza Hospital. and fifty patients with sickle cell aneamia (SS or SC) followed by the department of falciform aneamia of the Hematologia e Hemoterapia do Para - HEMOPA have been randomly selected and submitted to interview in order to register their: sex; age; color; genotype; ocular alterations; medicines taken. Ophthalmologic examination was performed in the Department of Ophthalmology of the Bettina Ferro de Souza Hospital. It consisted of: evaluation of the acuity of vision with and without correction, indirect biomicroscopy, indirect binocular ophthalmoscopy, and, in case the latter presented alterations, a complementary study with angiofluoresceinography would be carried through. RESULTS: The outcomes have been registered in research protocol and later submitted to the statistic analysis using the Qui-square test, adopting, as level of significance, p<0,05. Eighty-eight percent of the patients did not present any falciform retinal sign, 3% presented peripheral vascular occlusion; in 2%, pigmented plate was shown, and 7% presented injuries which were not compatible with the falciform disease; there was a proportionality of 50% for males and females; there was a higher predominance (38%) of people aged from 11 and 15; 74% had SS genotype and 26% SC genotype; in relation to the use of medicines there was a higher prevalence of ocular alterations in patients who had made use of the folic acid isolated, with 5%, in contrast with those who had used the hidroxyurea association and folic acid, when all (27%) presented normal fundoscopic examination; all the patients (29%) that showed fetal hemoglobin rate above 10% had retina without alterations. CONCLUSION: Few cases of retinal signs have been observed in the studied group, however this research does not diminish the importance of early and periodic ophthalmologic examination, since falciform retinopathy is largely registered and its complications can lead to amaurosis.

Découverte d’une fistule durale du sinus sigmoïde cliniquement caverneuse avec des signes ophtalmologiques controlatéraux : à propos d’un cas

We report the case of an 87-year-old patient who developed a dural arteriovenous fistula of the sigmoid sinus with progressive exophthalmia in the opposite eye. The patient had a unilateral decrease in visual acuity; the vessels of the conjunctiva were dilated, and a progressive central retinal vein occlusion occurred in the left eye. A dural carotid cavernous fistula of the right sigmoid sinus was diagnosed with an angiography exam and was successfully treated with embolization of the arteriovenous shunt using Onyx(®). A central partial facial nerve paralysis occurred after embolization and spontaneously resolved in 6 months. Six months after the treatment, visual acuity improved to 7/10 and the exophthalmia and central retinal vein occlusion signs regressed. Dural arteriovenous fistulae are abnormal shunts between a collateral vessel of the carotid artery and the cavernous sinus; the unilateral pulsating exophthalmia is the most frequent associated symptom. Cerebral MRI is useful to analyze indirect signs of the arteriovenous shunt showing an abnormal dilatation of the veins, but angiography of the carotid artery is essential to confirm the diagnosis. Furthermore, it allows treatment of the fistula at the same time, the main complication being the embolization of normal vessels close to the abnormal shunt. The clinical expression of the dural arteriovenous fistula on the opposite eye is infrequent and is related to the presence of complex septae within the cavernous sinus, resulting in a bilateral drainage of the cerebral venous system. The early diagnosis and management of the disease is necessary to improve the visual prognosis.

212 Retinal fundus: An open window to the coronary microcirculation

The non-invasive investigational methods of the CHD address macro-vascular manifestation while micro-vascular anomalies may be present long-term. Our hypothesis is that the retinal vascular abnormalities are the reflection of coronary micro-vascularisation ,these retinal vascular signs may add to the prediction of CHD over traditional CHD risk factors and this represents a unique “window” on a “difficultly” accessible world. We recruited patients who have at least one risk factor of CHD and have recently had (< 3 months) a coronary angiogram at the Montréal Heart Institute. 71 patients aged 60 ± 5 were recruited in the protocol. A Fundus examination was done on patients using a non-medriatic digital camera Canon CRG. Ratio arteriole/veinules caliber (A/V) was measured and retinal vascular abnormalities were scored from 0 to 4 reflecting the changes of microvascular arteriosclerosis. Risk factor included age, sex, body mass index (BMI), systolic and diastolic pressure, fasting blood glucose, lipids profil, hsCRP levels and clearance level were measured. The CAD extent was evaluated by Gensini score, and coronary angiograms were analyzed by 1 expert blinded of the patient retinal vessels status. Standard univariate and multivariate analyses were performed. Increased level of SBP (HR1.1per 1 unit increase [95% CI, 1.01, 1.2; P = 0.02]) and decreased level HDL (HR 0.09 per 1 mmol decrease [95% CI, 0.011, 0.7; P = 0.002]) correlate significantly with severe sclerotic change in retinal fundus. This association remained significant in both men and women and in persons with and without diabetes or hypertension in the multi-variate analysis. Sclerotic changes of the micro-vasculature of the retina were found to be associated with factors known to predispose to endothelial dysfunction. The observed changes were independent from the Framingham risk and macro-vascular CAD (Gensini score). These results suggest that the ophthalmic fundus may be a representation of the cardiac micro-vascular disease and therefore can open a way to evaluate a vascular bed that is otherwise very difficult to access.

Quantitative and qualitative retinal microvascular characteristics and blood pressure

The present study examined the effects of blood pressure on a spectrum of quantitative and qualitative retinal microvascular signs. Retinal photographs from the Singapore Malay Eye Study, a population-based cross-sectional study of 3280 (78.7% response) persons aged 40-80 years, were analyzed. Quantitative changes in the retinal vasculature (branching angle, vascular tortuosity, fractal dimension, and vascular caliber) were measured using a semi-automated computer-based program. Qualitative signs, including focal arteriolar narrowing (FAN), arteriovenous nicking (AVN), opacification of the arteriolar wall (OAW), and retinopathy (e.g., microaneurysms, retinal hemorrhages), were assessed from photographs by trained technicians. After excluding persons with diabetes and ungradable photographs, 1913 persons provided data for this analysis. In multivariable linear regression models controlling for age, sex, BMI, use of antihypertensive medication, and other factors, retinal arteriolar branching asymmetry ratio, arteriolar tortuosity, venular tortuosity, fractal dimension, arteriolar caliber, venular caliber, FAN, AVN, and retinopathy were independently associated with mean arterial blood pressure. In contrast, arteriolar/venular branching angle, venular branching asymmetry ratio and OAW were not related to blood pressure. Retinal arteriolar caliber (sβ = -0.277) and FAN (sβ = 0.170) had the strongest associations with mean arterial blood pressure, and higher blood pressure levels were associated with increasing number of both quantitative and qualitative retinal vascular signs (P trend <0.001). Elevated blood pressure is associated with a spectrum of quantitative and qualitative retinal vascular signs, with the number of signs increasing with higher blood pressure levels.

Retinal Arteriolar Wall Signs and Early Age-Related Macular Degeneration: The Singapore Malay Eye Study

To determine whether retinal arteriolar wall signs are associated with early age-related macular degeneration (AMD). Population-based cross-sectional study. The Singapore Malay Eye Study (SiMES) is a population-based eye survey including 3,280 (78.7% response) persons aged 40 to 80 years. Retinal arteriolar wall signs and AMD were assessed from photographs by trained technicians, according to standardized protocols. Data on major cardiovascular risk factors and blood pressure were collected. Of the 3,280 participants, 2,541 had photographs that were gradable for both AMD and retinal arteriolar wall signs. Early AMD was present in 76 subjects. There were no significant associations of any retinal arteriolar wall signs with early AMD. For specific AMD signs, retinal arteriolar wall opacification was associated with presence of soft distinct drusen (odds ratio [OR] 1.58, 95% confidence interval [CI]: 1.06, 2.35). This association was most significant among non-statin users (OR 1.90, 95% CI: 1.23, 2.93). Focal arteriolar narrowing was associated with retinal hypopigmentation (OR 1.67, 95% CI: 1.02, 2.73). Arteriovenous nicking was not associated with soft drusen (OR 0.89, 95% CI: 0.51, 1.57), hyperpigmentation (OR 0.49, 95% CI: 0.22, 1.08), or hypopigmentation (OR 0.86, 95% CI: 0.46, 1.61). Retinal arteriolar wall signs are not consistently associated with early AMD. We report a new association of retinal arteriolar wall opacification and the presence of soft drusen. This finding could support the hypothesis of a link between lipids and drusen formation.

Retinal Vascular Signs: A Window to the Heart?

There is increasing recognition that coronary microvascular dysfunction also plays an important role in coronary heart disease. Little is known about this aspect of coronary heart disease due to difficulties in studying the coronary microcirculation directly. The retina is a unique site where the microcirculation can be imaged directly, providing an opportunity to study in vivo the structure and pathology of the human circulation and the possibility of detecting changes in microvasculature relating to the development of cardiovascular disease. This review covers the recent progress in research linking retinal vascular signs to coronary heart disease, and finds accumulating evidence that retinal vascular signs may provide a window into the health of the coronary microvasculature. The most widely studied signs, arteriolar narrowing, and more recently, venular dilation, are likely associated with increased risk of coronary heart disease in women, independent of traditional risk factors. Attempts to improve coronary heart disease risk prediction by incorporating retinal vessel caliber size into risk prediction scores complementing traditional algorithms such as the Framingham risk scores have so far been disappointing. Research is ongoing into the predictive utility of other retinal vascular signs. Retinal photography provides long-lasting records that enable monitoring of longitudinal changes in these retinal signs and vascular health.

Manifestaciones vasculares retinianas: ¿reflejan el estado del corazón?

There is increasing recognition that coronary microvascular dysfunction also plays an important role in coronary heart disease. Little is known about this aspect of coronary heart disease due to difficulties in studying the coronary microcirculation directly. The retina is a unique site where the microcirculation can be imaged directly, providing an opportunity to study in vivo the structure and pathology of the human circulation and the possibility of detecting changes in microvasculature relating to the development of cardiovascular disease. This review covers the recent progress in research linking retinal vascular signs to coronary heart disease, and finds accumulating evidence that retinal vascular signs may provide a window into the health of the coronary microvasculature. The most widely studied signs, arteriolar narrowing, and more recently, venular dilation, are likely associated with increased risk of coronary heart disease in women, independent of traditional risk factors. Attempts to improve coronary heart disease risk prediction by incorporating retinal vessel calibre size into risk prediction scores complementing traditional algorithms such as the Framingham risk scores have so far been disappointing. Research is ongoing into the predictive utility of other retinal vascular signs. Retinal photography provides long-lasting records that enable monitoring of longitudinal changes in these retinal signs and vascular health. Full English text available from www.revespcardiol.org

Retinal microvascular signs and functional loss in older persons: the cardiovascular health study.

We hypothesized that retinal microvascular signs are associated with executive dysfunction, slow gait, and depressive mood, which are characteristic features of microvascular disease affecting frontal subcortical regions of the brain. In the Cardiovascular Health Study, 1744 participants (mean age, 78) free of stroke had retinal photographs and carotid ultrasound during the 1997 to 1998 visit. We examined the cross-sectional association of retinal signs with the digit-symbol substitution test (DSST) score, gait speed, the Center for Epidemiologic Studies-Depression score, and depressive mood, defined as Center for Epidemiologic Studies-Depression score >9 or antidepressant use. After adjusting for potential confounders, retinal signs were associated with lower DSST score (generalized arteriolar narrowing and arteriovenous nicking), slower gait (retinopathy), and depressive mood (generalized arteriolar narrowing). A higher number of retinal signs was associated with lower DSST score (-0.76 and -2.79 points for 1 sign and ≥2 signs versus none; P<0.001) and slower gait (-0.009 and -0.083 m/s; P=0.047), but not with the square root of Center for Epidemiologic Studies-Depression score (0.079 and -0.208; P=0.072). In addition, coexistence of retinal signs (generalized arteriolar narrowing and arteriovenous nicking) and carotid atherosclerosis was associated with lower DSST score compared with either process alone (P for interaction <0.01). Notably, further adjustment for ventricular size, white matter disease, and infarcts on MRI did not attenuate the association. Retinal signs are associated with executive dysfunction and slow gait, and possibly with depressive mood, suggesting a common process involving small vessels.

Retinopathy and Lobar Intracerebral Hemorrhage

The vascular pathogenesis underlying lobar intracerebral hemorrhage (ICH) is unclear. To determine whether certain retinal microvascular signs are associated with lobar ICH to improve understanding of its underlying cerebral vasculopathy. Prospective cohort study. Royal Melbourne Hospital and Westmead Hospital. Of 655 patients with acute stroke, 25 had lobar ICH, 51 had deep ICH, 93 had lacunar infarction, and 486 had nonlacunar cerebral infarction. Retinal photographs were assessed for retinopathy lesions (microaneurysms, retinal hemorrhages, cotton-wool spots, and hard exudates) and retinal arteriolar wall signs (focal arteriolar narrowing, arteriovenous nicking, and enhanced arteriolar wall light reflex) masked to the cerebral pathologic abnormalities and the study hypothesis. In patients without diabetes mellitus, retinopathy lesions were more likely to be present in persons with lobar ICH than in those with either lacunar infarction (47.8% vs 30.4%; adjusted odds ratio, 3.5; 95% confidence interval, 1.1-10.9) or nonlacunar cerebral infarction (47.8% vs 24.6%; 3.3;1.4-8.1). Most retinal arteriolar wall signs were less frequent in lobar ICH than in deep ICH, although this difference was significant only for focal arteriolar narrowing. Patients with lobar ICH were more likely than patients with lacunar or nonlacunar cerebral infarction to have retinopathy lesions, suggesting breakdown of the blood-retina barrier in patients with lobar ICH. These findings support a distinct vasculopathy in lobar ICH compared with other acute stroke subtypes resulting from cerebral small vessel disease or ischemic infarction.

Differential Associations of Cortical and Subcortical Cerebral Atrophy With Retinal Vascular Signs in Patients With Acute Stroke

The relationship of cortical and subcortical cerebral atrophy to cerebral microvascular disease is unclear. We aimed to assess the associations of retinal vascular signs with cortical and subcortical atrophy in patients with acute stroke. In the Multi-Centre Retinal Stroke Study, 1360 patients with acute stroke admitted to 2 Australian and 1 Singaporean tertiary hospital during 2005 to 2007 underwent neuroimaging and retinal photography. Cortical and subcortical cerebral atrophy were graded based on standard CT scans. A masked assessment of retinal photographs identified focal retinal vascular signs, including retinopathy and retinal arteriolar wall signs (ie, focal arteriolar narrowing, arteriovenous nicking, arteriolar wall light reflex) and measured quantitative signs (retinal arteriolar and venular caliber). After adjusting for age, gender, study site, hypertension, hypercholesterolemia, diabetes, and smoking status, none of the retinal vascular signs assessed were associated with cortical atrophy, whereas retinopathy (OR, 1.9; CI, 1.2 to 3.0) and enhanced arteriolar light reflex (OR, 2.0; CI, 1.2 to 3.2) were significantly associated with subcortical atrophy. Our finding that certain retinal vascular signs are associated with subcortical but not cortical atrophy, suggests a differential pathophysiology between these 2 cerebral atrophy subtypes and a potential role for small vessel disease underlying subcortical cerebral atrophy.

Electrophysiology of childhood retinal dystrophies

Abstract Purpose To provide a systematic approach to the diagnosis of causes of impaired vision in childhood with particular reference to the role of electrophysiology in retinal dystrophies Methods We have examined the contribution Electrodiagnostic Testing (EDT) can make in determining or confirming a diagnosis. Results We have set out a systematic approach to diagnosis of both early and late onset disorders, differentiating between retinal and non‐retinal causes. Signs, symptoms, inheritance patterns and test results are tabulated against specific disorders showing the contribution EDT can make. Recent example case studies are also presented. Conclusion Electrodiagnostic testing is of particular value in identifying and differentiating causes of poor vision where there may not be clear retinal signs in the early stages such as Leber’s congenital amaurosis, CSNB, cone dystrophy and albinism. A further role is in the differentiation of retinal from post‐retinal causes.

Retinopathy in severe malaria in Ghanaian children - overlap between fundus changes in cerebral and non-cerebral malaria

BackgroundIn malaria-endemic areas, reliably establishing parasitaemia for diagnosis of malaria can be difficult. A retinopathy with some features unique to severe malaria with a predictive value on prognosis, has been described. Detection of this retinopathy could be a useful diagnostic tool. This study was designed to determine the diagnostic usefulness of retinopathy on ophthalmoscopy in severe malaria syndromes: Cerebral malaria (CM) and non-cerebral severe malaria (non-CM), i.e. malaria with respiratory distress (RD) and malaria with severe anaemia (SA), in Ghanaian children. Secondly, to determine any association between retinopathy and the occurrence of convulsions in patients with CM.Methods and subjectsA cross-sectional study of consecutive patients on admission with severe malaria who were assessed for retinal signs, at the Department of Child Health, Korle-Bu Teaching Hospital, Accra, from July to August 2002 was done. All children had dilated-fundus examination by direct and indirect ophthalmoscopy.ResultsFifty-eight children aged between six months and nine years were recruited. Twenty six(45%) had CM, 22 with convulsion; 26(45%) had SA and six(10%) had RD.Any retinopathy was seen in: CM 19(73%), SA 14(54%), RD 3(50.0%), CM with convulsion 15(68%) and CM without convulsion 4(100%). Comparison between CM versus non-CM groups showed a significant risk relationship between retinal whitening and CM(OR = 11.0, CI = 2.2- 56.1, p = 0.001). There was no significant association with papilloedema(OR = 0.9, CI = 0.3 - 3.0, p = 0.9), macular whitening(OR = 1.6, CI = 0.5 - 4.8, p = 0.4), macular haemorrhage(OR = 0.28, CI = 0.03 - 2.7 p = 0.2), retinal haemorrhage(OR = 1.9, CI = 0.6 - 5.6, p = 0.3), vessel abnormality(OR = 1.9, CI = 0.6 - 6.1, p = 0.3) and cotton wool spots(OR not calculated, p = 0.08).Tortuous and engorged retinal veins, not previously described as a feature of CM, was the most common vascular abnormality(15/58 = 26%) and was detected even in the absence of papilloedema.ConclusionRetinal whitening, a sign suggestive of retinal ischaemia, was significantly more common in CM than in non-CM syndromes. However, the high prevalence of any retinopathy in the latter suggests that the brain and the retina may be suffering from ischaemia in both CM and non-CM.

Retinal Microvascular Signs and 10-Year Risk of Cerebral Atrophy

Background and Purpose— Cerebral atrophy, detected as ventricular enlargement or sulcal widening on MRI, is recognized as a risk factor for vascular dementia or Alzheimer disease. However, its underlying pathophysiology is not known. We examined whether retinal microvascular assessment could provide predictive information on the risk of ventricular enlargement and sulcal widening on MRI. Methods— A prospective, population-based study was conducted of 810 middle-aged persons without clinical stroke or MRI infarcts. All participants had a first cranial MRI and retinal photography in 1993 to 1995 and returned for a repeated MRI in 2004 to 2006 (median follow-up of 10.5 years). Retinal photographs were graded for presence of retinopathy and retinal microvascular abnormalities, and MRI images were graded for ventricular size and sulcal size according to standardized protocols. Ventricular enlargement and sulcal widening were defined as an increase in ventricular size or sulcal size of ≥3 of 10 grades between baseline and follow-up. Results— After adjusting for age, gender, and cardiovascular risk factors, retinopathy and arteriovenous nicking at baseline were associated with 10-year ventricular enlargement (OR and 95% CI: 2.03, 1.20 to 4.42 for retinopathy and 2.19, 1.23 to 3.90 for arteriovenous nicking). Retinal signs were not associated with 10-year sulcal widening. Conclusions— Retinopathy and arteriovenous nicking are predictive of long-term risk of ventricular enlargement, but not of sulcal widening, independent of cardiovascular risk factors. These data support a microvascular etiology for subcortical but not cortical cerebral atrophy.

Blood pressure is associated with retinal vessel signs in preadolescent children

Few studies have examined the effect of blood pressure (BP) on the retinal microvasculature in children. We examined the relationship between BP and retinal vessel caliber in a sample of preadolescent schoolchildren. Eligible high school students [2353/3144 (response 75.3%); mean age, 12.7 years] from 21 randomly selected schools in Sydney, Australia, were examined during 2004-2005. Retinal vessel caliber was quantified from digital retinal images using well known computer-based programs. BP was measured using a standard protocol and high BP was defined according to published guidelines for this age group. After adjusting for age, sex, ethnicity, BMI, iris color, axial length, birth weight and the fellow retinal vascular caliber, children in the highest quartiles of SBP, DBP or mean arterial BP had approximately 5 mum narrower mean retinal arteriolar caliber than those in the lowest quartiles of all three BP measures (all P for trend <0.0001). Children classified as having high BP had approximately 2.0 mum narrower mean retinal arteriolar caliber than normotensive children (P = 0.002). In boys, each 10-mmHg increase in SBP was associated with a 2.19-mum increase in the mean retinal venular caliber (P = 0.0003), but no similar significant association was evident in girls. Elevated BP is associated with narrower retinal arterioles in preadolescent boys and girls, and also with wider retinal venules in boys. These data provide further evidence of early microvascular changes associated with high BP in older children.

The transcription factor 7-like 2 (TCF7L2) polymorphism may be associated with focal arteriolar narrowing in Caucasians with hypertension or without diabetes: the ARIC Study

BackgroundTranscription factor 7-like 2 (TCF7L2) has emerged as a consistently replicated susceptibility gene for type 2 diabetes, however, whether the TCF7L2 gene also has similar effects on the retinal microvasculature is less clear. We therefore aimed to investigate the association between the transcription factor 7-like 2 (TCF7L2) rs7903146 polymorphism and retinal microvascular phenotypes in the Atherosclerosis Risk in Communities (ARIC) Study (1993-1995).MethodsThis was a population-based, cross-sectional study of 10,320 middle-aged African American (n = 2,199) and Caucasian (n = 8,121) men and women selected from four United States communities to examine the association between TCF7L2 rs7903146 polymorphism and retinal microvascular signs (retinopathy, focal arteriolar narrowing, arteriovenous nicking, arteriolar and venular calibers). Photographs on one randomly selected eye were graded for presence of retinal microvascular signs and used to measure retinal vessel calibres.ResultsAfter adjusting for age, sex, study center, mean arterial blood pressure, total serum cholesterol, triglycerides, and other covariates, few associations of TCF7L2 rs7903146 and retinal microvascular signs were noted. TCF7L2 rs7903146 T risk allele was significantly associated with focal arteriolar narrowing in Caucasians with hypertension [odds ratio (OR)CT vs. CC (95% CI) = 1.25 (1.09-1.44); ORTT vs. CC = 1.56 (1.18-2.06); P = 0.002] and in Caucasians without diabetes [OR CT vs. CC = 1.18 (1.06-1.32); OR TT vs. CC = 1.40 (1.12, 1.75); P = 0.003]. No significant association of the TCF7L2 rs7903146 polymorphism and retinal vascular signs was noted among African American individuals.ConclusionsTCF7L2 rs7903146 is not consistently associated with retinal microvascular signs. However, we report an association between the TCF7L2 rs7903146 polymorphism and focal arteriolar narrowing in Caucasians with hypertension or without diabetes. Further research in other large, population-based studies is needed to replicate these findings.