Skip to main content
SpringerLink
Log in

The Optic Fundus and Retinal Circulation: New Technology for an Old Examination

  • Chapter
  • First Online:
Special Issues in Hypertension

  • 1263 Accesses

Abstract

Retinal changes in patients with arterial hypertension have been described since the middle of the 19th century. From the famous work by Keith, Wagener, and Barker in 1939 until today, advanced retinal changes assessed by ophthalmoscopy, i.e., grades 3 and 4 of hypertensive retinopathy, as defined according to the traditional classification system established by the aforementioned authors, are indicative of adverse cardiovascular prognosis in patients with arterial hypertension. However, ophthalmoscopy has been repeatedly criticized over the last decades as it was found to be unreliable in mild and moderate arterial hypertension. Therefore, in the last decades, much research effort has been focused on the improvement of imaging technologies that can detect early vascular changes, i.e., arteriolar narrowing, microvascular rarefaction, arteriolar remodeling, and vascular dysfunction among others, in the retinal vascular bed and to assess the prognostic role of these early retinal vascular changes in arterial hypertension.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Tso MO, Jampol LM (1982) Pathophysiology of hypertensive retinopathy. Ophthalmology 89:1132–1145

    PubMed  CAS  Google Scholar 

  2. Rizzoni D, De Ciuceis C, Porteri E et al (2011) Close relationship between media to lumen ratio of subcutaneous small arteries and wall to lumen ratio of retinal arterioles evaluated non invasively by scanning lasaer doppler flowmetry. J Hypertens 29(e-Supplement A):e11 (Abstract)

    Google Scholar 

  3. Goto I, Katsuki S, Ikui H et al (1975) Pathological studies on the intracerebral and retinal arteries in cerebrovascular and noncerebrovascular diseases. Stroke 6:263–269

    Article  PubMed  CAS  Google Scholar 

  4. Wong TY, Klein R, Nieto FJ et al (2003) Retinal microvascular abnormalities and 10-year cardiovascular mortality: a population-based case-control study. Ophthalmology 110:933–940

    Article  PubMed  Google Scholar 

  5. Chobanian AV, Bakris GL, Black HR et al (2003) Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42:1206–1252

    Article  PubMed  CAS  Google Scholar 

  6. Mancia G, De Backer G, Dominiczak A et al (2007) Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European society of hypertension (ESH) and of the European society of cardiology (ESC). J Hypertens 25:1105–1187

    Article  PubMed  CAS  Google Scholar 

  7. Mancia G, Laurent S, Agabiti-Rosei E et al (2009) Reappraisal of European guidelines on hypertension management: a European society of hypertension task force document. J Hypertens 27:2121–2158

    Article  PubMed  CAS  Google Scholar 

  8. Wong TY, Mitchell P (2004) Hypertensive retinopathy. N Engl J Med 351:2310–2317

    Article  PubMed  CAS  Google Scholar 

  9. van den Born BJ, Hulsman CA, Hoekstra JB et al (2005) Value of routine funduscopy in patients with hypertension: systematic review. BMJ 331:73

    Article  PubMed  Google Scholar 

  10. Chatterjee S, Chattopadhya S, Hope-Ross M et al (2002) Hypertension and the eye: changing perspectives. J Hum Hypertens 16:667–675

    Article  PubMed  CAS  Google Scholar 

  11. Liebreich R (1859) Ophthalmoskopischer Befund bei Morbus Brightii. Albrecht von Graefes Arch Ophthalmol 5:265–268

    Google Scholar 

  12. Gunn RM (1892) Ophthalmoscopic evidence of (1) arterial changes with chronic renal diseases and (2) of increased arterial tension. Trans Ophthalmol Soc U K 12:124–125

    Google Scholar 

  13. Keith NM, Wagener HP, Barker NW (1939) Some different types of essential hypertension: their course and prognosis. Am J Med Sci 197:332–343

    Article  Google Scholar 

  14. Aoki N, Horibe H, Ohno Y et al (1977) Epidemiological evaluation of funduscopic findings in cerebrovascular diseases. III. Observer variability and reproducibility for funduscopic findings. Jpn Circ J 41:11–17

    Article  PubMed  CAS  Google Scholar 

  15. Dimmitt SB, West JN, Eames SM et al (1989) Usefulness of ophthalmoscopy in mild to moderate hypertension. Lancet 1:1103–1106

    Article  PubMed  CAS  Google Scholar 

  16. Kagan A, Aurell E, Tibblin G (1967) Signs in the fundus oculi and arterial hypertension: unconventional assessment and significance. Bull World Health Organ 36:231–241

    PubMed  CAS  Google Scholar 

  17. Wong TY, Klein R, Couper DJ et al (2001) Retinal microvascular abnormalities and incident stroke: the atherosclerosis risk in communities study. Lancet 358:1134–1140

    Article  PubMed  CAS  Google Scholar 

  18. Wong TY, Klein R, Sharrett AR et al (2003) The prevalence and risk factors of retinal microvascular abnormalities in older persons: the cardiovascular health study. Ophthalmology 110:658–666

    Article  PubMed  Google Scholar 

  19. Nakayama T, Date C, Yokoyama T et al (1997) A 15.5-year follow-up study of stroke in a Japanese provincial city. The Shibata Study. Stroke 28:45–52

    Article  PubMed  CAS  Google Scholar 

  20. Moss SE, Klein R, Kessler SD et al (1985) Comparison between ophthalmoscopy and fundus photography in determining severity of diabetic retinopathy. Ophthalmology 92:62–67

    PubMed  CAS  Google Scholar 

  21. Hubbard LD, Brothers RJ, King WN et al (1999) Methods for evaluation of retinal microvascular abnormalities associated with hypertension/sclerosis in the atherosclerosis risk in communities study. Ophthalmology 106:2269–2280

    Article  PubMed  CAS  Google Scholar 

  22. Sharrett AR, Hubbard LD, Cooper LS et al (1999) Retinal arteriolar diameters and elevated blood pressure: the atherosclerosis risk in communities study. Am J Epidemiol 150:263–270

    Article  PubMed  CAS  Google Scholar 

  23. Wong TY, Hubbard LD, Klein R et al (2002) Retinal microvascular abnormalities and blood pressure in older people: the cardiovascular health study. Br J Ophthalmol 86:1007–1013

    Article  PubMed  CAS  Google Scholar 

  24. Wong TY, Knudtson MD, Klein R et al (2004) Computer-assisted measurement of retinal vessel diameters in the Beaver Dam Eye Study: methodology, correlation between eyes, and effect of refractive errors. Ophthalmology 111:1183–1190

    Article  PubMed  Google Scholar 

  25. Nguyen TT, Wong TY (2006) Retinal vascular manifestations of metabolic disorders. Trends Endocrinol Metab 17:262–268

    Article  PubMed  CAS  Google Scholar 

  26. Ikram MK, de Jong FJ, Vingerling JR et al (2004) Are retinal arteriolar or venular diameters associated with markers for cardiovascular disorders? The Rotterdam Study. Invest Ophthalmol Vis Sci 45:2129–2134

    Article  PubMed  Google Scholar 

  27. Kawasaki R, Tielsch JM, Wang JJ et al (2008) The metabolic syndrome and retinal microvascular signs in a Japanese population: the funagata study. Br J Ophthalmol 92:161–166

    Article  PubMed  CAS  Google Scholar 

  28. Wong TY, Duncan BB, Golden SH et al (2004) Associations between the metabolic syndrome and retinal microvascular signs: the atherosclerosis risk in communities study. Invest Ophthalmol Vis Sci 45:2949–2954

    Article  PubMed  Google Scholar 

  29. Sun C, Liew G, Wang JJ et al (2008) Retinal vascular caliber, blood pressure, and cardiovascular risk factors in an Asian population: the Singapore Malay Eye Study. Invest Ophthalmol Vis Sci 49:1784–1790

    Article  PubMed  Google Scholar 

  30. Intengan HD, Schiffrin EL (2001) Vascular remodeling in hypertension: roles of apoptosis, inflammation, and fibrosis. Hypertension 38:581–587

    Article  PubMed  CAS  Google Scholar 

  31. Schiffrin EL (2004) Remodeling of resistance arteries in essential hypertension and effects of antihypertensive treatment. Am J Hypertens 17:1192–1200

    Article  PubMed  CAS  Google Scholar 

  32. Park JB, Schiffrin EL (2001) Small artery remodeling is the most prevalent (earliest?) form of target organ damage in mild essential hypertension. J Hypertens 19:921–930

    Article  PubMed  CAS  Google Scholar 

  33. Hughes AD, Stanton AV, Jabbar AS et al (2008) Effect of antihypertensive treatment on retinal microvascular changes in hypertension. J Hypertens 26:1703–1707

    Article  PubMed  CAS  Google Scholar 

  34. Hughes AD, Martinez-Perez ME, Jabbar AS et al (2006) Quantification of topological changes in retinal vascular architecture in essenital and malignant hypertension. J Hypertens 24:889–894

    Article  PubMed  CAS  Google Scholar 

  35. Delles C, Michelson G, Harazny J et al (2004) Impaired endothelial function of the retinal vasculature in hypertensive patients. Stroke 35:1289–1293

    Article  PubMed  CAS  Google Scholar 

  36. Harazny JM, Ritt M, Baleanu D et al (2007) Increased wall:lumen ratio of retinal arterioles in male patients with a history of a cerebrovascular event. Hypertension 50:623–629

    Article  PubMed  CAS  Google Scholar 

  37. Ritt M, Harazny JM, Ott C et al (2008) Analysis of retinal arteriolar structure in never-treated patients with essential hypertension. J Hypertens 26:1427–1434

    Article  PubMed  CAS  Google Scholar 

  38. Perticone F, Ceravolo R, Pujia A et al (2001) Prognostic significance of endothelial dysfunction in hypertensive patients. Circulation 104:191–196

    Article  PubMed  CAS  Google Scholar 

  39. Heitzer T, Schlinzig T, Krohn K et al (2001) Endothelial dysfunction, oxidative stress, and risk of cardiovascular events in patients with coronary artery disease. Circulation 104:2673–2678

    Article  PubMed  CAS  Google Scholar 

  40. Schachinger V, Britten MB, Zeiher AM (2000) Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circulation 101:1899–1906

    Article  PubMed  CAS  Google Scholar 

  41. Mathiassen ON, Buus NH, Sihm I et al (2007) Small artery structure is an independent predictor of cardiovascular events in essential hypertension. J Hypertens 25:1021–1026

    Article  PubMed  CAS  Google Scholar 

  42. De Ciuceis C, Porteri E, Rizzoni D et al (2007) Structural alterations of subcutaneous small-resistance arteries may predict major cardiovascular events in patients with hypertension. Am J Hypertens 20:846–852

    Article  PubMed  Google Scholar 

  43. Rizzoni D, Porteri E, Boari GE et al (2003) Prognostic significance of small-artery structure in hypertension. Circulation 108:2230–2235

    Article  PubMed  Google Scholar 

  44. Michelson G, Schmauss B, Langhans MJ et al (1996) Principle, validity, and reliability of scanning laser Doppler flowmetry. J Glaucoma 5:99–105

    PubMed  CAS  Google Scholar 

  45. Kreis AJ, Nguyen T, Rogers S et al (2008) Reliability of different image analysis methods for scanning laser Doppler flowmetry. Curr Eye Res 33:493–499

    Article  PubMed  Google Scholar 

  46. Harazny JM, Raff U, Welzenbach J et al (2011) New software analyses increase the reliability of measurements of retinal arterioles morphology by scanning laser Doppler flowmentry in humans. J Hypertens 29:777–782

    Article  PubMed  CAS  Google Scholar 

  47. Ott C, Schlaich MP, Harazny J et al (2008) Effects of angiotensin II type 1-receptor blockade on retinal endothelial function. J Hypertens 26:516–522

    Article  PubMed  CAS  Google Scholar 

  48. Ritt M, Harazny JM, Ott C et al. (2012) Influence of blood flow on arteriolar wall-to-lumen ratio in the human retinal circulation in vivo. Microvasc Res, In Press

    Google Scholar 

  49. Ritt M, Harazny JM, Ott C et al (2011) Basal nitric oxide activity is an independent determinant of arteriolar structure in the human retinal circulation. J Hypertens 29:123–129

    Article  PubMed  CAS  Google Scholar 

  50. Heagerty AM, Aalkjaer C, Bund SJ et al (1993) Small artery structure in hypertension. Dual processes of remodeling and growth. Hypertension 21:391–397

    Article  PubMed  CAS  Google Scholar 

  51. Baumbach GL, Heistad DD (1989) Remodeling of cerebral arterioles in chronic hypertension. Hypertension 13:968–972

    Article  PubMed  CAS  Google Scholar 

  52. Wong TY, Klein R, Sharrett AR et al (2002) Cerebral white matter lesions, retinopathy, and incident clinical stroke. JAMA 288:67–74

    Article  PubMed  Google Scholar 

  53. Cooper LS, Wong TY, Klein R et al (2006) Retinal microvascular abnormalities and MRI-defined subclinical cerebral infarction: the atherosclerosis risk in communities study. Stroke 37:82–86

    Article  PubMed  Google Scholar 

  54. Wong TY, Klein R, Sharrett AR et al (2002) Retinal microvascular abnormalities and cognitive impairment in middle-aged persons: the atherosclerosis risk in communities study. Stroke 33:1487–1492

    Article  PubMed  Google Scholar 

  55. Baker ML, Marino Larsen EK, Kuller LH et al (2007) Retinal microvascular signs, cognitive function, and dementia in older persons: the cardiovascular health study. Stroke 38:2041–2047

    Article  PubMed  Google Scholar 

  56. Wong TY, Mosley TH Jr, Klein R et al (2003) Retinal microvascular changes and MRI signs of cerebral atrophy in healthy, middle-aged people. Neurology 61:806–811

    Article  PubMed  CAS  Google Scholar 

  57. Baleanu D, Ritt M, Harazny J et al (2009) Wall-to-lumen ratio of retinal arterioles and arteriole-to-venule ratio of retinal vessels in patients with cerebrovascular damage. Invest Ophthalmol Vis Sci 50:4351–4359

    Article  PubMed  Google Scholar 

  58. Breslin DJ, Gifford RW Jr, Fairbairn JF 2nd (1966) Essential hypertension a twenty-year follow-up study. Circulation 33:87–97

    Article  PubMed  CAS  Google Scholar 

  59. Tikellis G, Arnett DK, Skelton TN et al (2008) Retinal arteriolar narrowing and left ventricular hypertrophy in African Americans. The atherosclerosis risk in communities (ARIC) study. Am J Hypertens 21:352–359

    Article  PubMed  Google Scholar 

  60. Michelson EL, Morganroth J, Nichols CW et al (1979) Retinal arteriolar changes as an indicator of coronary artery disease. Arch Intern Med 139:1139–1141

    Article  PubMed  CAS  Google Scholar 

  61. Duncan BB, Wong TY, Tyroler HA et al (2002) Hypertensive retinopathy and incident coronary heart disease in high risk men. Br J Ophthalmol 86:1002–1006

    Article  PubMed  CAS  Google Scholar 

  62. Wong TY, Klein R, Sharrett AR et al (2002) Retinal arteriolar narrowing and risk of coronary heart disease in men and women. The atherosclerosis risk in communities study. JAMA 287:1153–1159

    Article  PubMed  Google Scholar 

  63. Gillum RF (1991) Retinal arteriolar findings and coronary heart disease. Am Heart J 122:262–263

    Article  PubMed  CAS  Google Scholar 

  64. Wong TY, Rosamond W, Chang PP et al (2005) Retinopathy and risk of congestive heart failure. JAMA 293:63–69

    Article  PubMed  CAS  Google Scholar 

  65. Wang L, Wong TY, Sharrett AR et al (2008) Relationship between retinal arteriolar narrowing and myocardial perfusion: multi-ethnic study of atherosclerosis. Hypertension 51:119–126

    Article  PubMed  CAS  Google Scholar 

  66. Wong TY, Coresh J, Klein R et al (2004) Retinal microvascular abnormalities and renal dysfunction: the atherosclerosis risk in communities study. J Am Soc Nephrol 15:2469–2476

    Article  PubMed  Google Scholar 

  67. Edwards MS, Wilson DB, Craven TE et al (2005) Associations between retinal microvascular abnormalities and declining renal function in the elderly population: the cardiovascular health study. Am J Kidney Dis 46:214–224

    Article  PubMed  Google Scholar 

  68. Ritt M, Harazny JM, Ott C et al (2009) Wall-to-lumen ratio of retinal arterioles is related with urinary albumin excretion and altered vascular reactivity to infusion of the nitric oxide synthase inhibitor N-monomethyl-l-arginine. J Hypertens 27:2201–2208

    Article  PubMed  CAS  Google Scholar 

  69. Liao D, Wong TY, Klein R et al (2004) Relationship between carotid artery stiffness and retinal arteriolar narrowing in healthy middle-aged persons. Stroke 35:837–842

    Article  PubMed  Google Scholar 

  70. Cheung N, Sharrett AR, Klein R et al (2007) Aortic distensibility and retinal arteriolar narrowing: the multi-ethnic study of atherosclerosis. Hypertension 50:617–622

    Article  PubMed  CAS  Google Scholar 

  71. Takiuchi S, Kamide K, Miwa Y et al (2004) Diagnostic value of carotid intima-media thickness and plaque score for predicting target organ damage in patients with essential hypertension. J Hum Hypertens 18:17–23

    Article  PubMed  CAS  Google Scholar 

  72. Frant R, Groen J (1950) Prognosis of vascular hypertension; a 9 year follow-up study of 418 cases. Arch Intern Med (Chic) 85:727–750

    CAS  Google Scholar 

  73. Breslin DJ, Gifford RW Jr, Fairbairn JF 2nd et al (1966) Prognostic importance of ophthalmoscopic findings in essential hypertension. JAMA 195:335–338

    Article  PubMed  CAS  Google Scholar 

  74. Breckenridge A, Dollery CT, Parry EH (1970) Prognosis of treated hypertension. Changes in life expectancy and causes of death between 1952 and 1967. Q J Med 39:411–429

    Google Scholar 

  75. Palmer RS, Loofbourow D, Doering CR (1948) Prognosis in essential hypertension: eight year follow-up study of 430 patients on conventional medical treatment. N Engl J Med 239:990

    Article  PubMed  CAS  Google Scholar 

  76. Shelbourne SA (1957) The retina in hypertensive diseases. Ann Intern Med 47:1154–1164

    Google Scholar 

  77. Svardsudd K, Wedel H, Aurell E et al (1978) Hypertensive eye ground changes. Prevalences, relation to blood pressure and prognostic significance. The study of men born in 1913. Acta Med Scand 204:159–167

    Article  PubMed  CAS  Google Scholar 

  78. Schouten EG, Vandenbroucke JP, Van der Heide-Wessel C et al (1986) Retinopathy as an indicator of all-causes mortality. Int J Epidemiol 15:234–236

    Article  PubMed  CAS  Google Scholar 

  79. Witt N, Wong TY, Hughes AD et al (2006) Abnormalities of retinal microvascular structure and risk of mortality from ischemic heart disease and stroke. Hypertension 47:975–981

    Article  PubMed  CAS  Google Scholar 

  80. Wong TY, Knudtson MD, Klein R et al (2004) A prospective cohort study of retinal arteriolar narrowing and mortality. Am J Epidemiol 159:819–825

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany

    Martin Ritt & Roland E. Schmieder

Authors
  1. Martin Ritt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roland E. Schmieder
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roland E. Schmieder .

Editor information

Editors and Affiliations

  1. , Internal Medicine, American University of Beirut Medical Ce, Riad El Solh, Beirut, 1107-2020, Lebanon

    Adel E. Berbari

  2. Clinica Medica, Ospedale S. Gerardo, Università di Milano-Bicocca, V .Donizetti 106, Milano, Monza, 20133, Italy

    Giuseppe Mancia

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag Italia

About this chapter

Cite this chapter

Ritt, M., Schmieder, R.E. (2012). The Optic Fundus and Retinal Circulation: New Technology for an Old Examination. In: Berbari, A., Mancia, G. (eds) Special Issues in Hypertension. Springer, Milano. https://doi.org/10.1007/978-88-470-2601-8_13

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2601-8_13

  • Published:

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2600-1

  • Online ISBN: 978-88-470-2601-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation