Advertisement

Current Diabetes Reports

, Volume 9, Issue 4, pp 277–283 | Cite as

Retinal vascular changes and diabetic retinopathy

  • Thanh T. Nguyen
  • Tien Yin WongEmail author
Article

Abstract

Recent studies support the concept that the retinal vasculature may provide a summary measure of lifetime exposure to the effects of hyperglycemia. Advances in retinal photographic techniques and in image analysis have allowed objective and precise in vivo measurement of retinal vascular changes. In particular, quantitative assessment of retinopathy signs and measurement of retinal vascular caliber have greatly increased our knowledge of early microcirculatory alterations in prediabetes, diabetes, and diabetic micro- and macrovascular complications. Data from recent population-based studies suggest that retinal arteriolar and venular caliber changes reflect different pathophysiologic processes. Retinal arteriolar narrowing, for example, is associated with risk of diabetes and coronary artery disease, whereas retinal venular widening is associated with development and progression of diabetic retinopathy and risk of stroke. Studying these changes offers the potential to improve our understanding of the early pathophysiologic pathways of diabetes development and its complications. Future research will assess the ability of retinal vascular imaging to provide clinically useful prognostic information for patients with diabetes.

Keywords

Diabetic Retinopathy United Kingdom Prospective Diabetes Study Retinal Vascular Change Dynamic Vessel Analyzer Retinal Arteriolar Narrowing 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Mohamed Q, Gillies MC, Wong TY: Management of diabetic retinopathy: a systematic review. JAMA 2007, 298:902–916.PubMedCrossRefGoogle Scholar
  2. 2.
    Grading diabetic retinopathy from stereoscopic color fundus photographs-an extension of the modified Airlie House classification. ETDRS report number 10. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991, 98:786–806.Google Scholar
  3. 3.
    Wilkinson CP, Ferris FL 3rd, Klein RE, et al.: Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology 2003, 110:1677–1682.PubMedCrossRefGoogle Scholar
  4. 4.
    Tapp RJ, Shaw JE, Harper CA, et al.: The prevalence of and factors associated with diabetic retinopathy in the Australian population. Diabetes Care 2003, 26:1731–1737.PubMedCrossRefGoogle Scholar
  5. 5.
    Klein R, Klein BE, Moss SE, et al.: Glycosylated hemoglobin predicts the incidence and progression of diabetic retinopathy. JAMA 1988, 260:2864–2871.PubMedCrossRefGoogle Scholar
  6. 6.
    The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med 1993, 329:977–986.Google Scholar
  7. 7.
    The UK Prospective Diabetes Study Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998, 352:837–853.CrossRefGoogle Scholar
  8. 8.
    The UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998, 317:703–713.Google Scholar
  9. 9.
    Keech A, Simes RJ, Barter P, et al.: Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 2005, 366:1849–1861.PubMedCrossRefGoogle Scholar
  10. 10.
    Patel A, MacMahon S, Chalmers J, et al.: Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008, 358:2560–2572.PubMedCrossRefGoogle Scholar
  11. 11.
    Mitchell P, Wong TY: DIRECT new treatments for diabetic retinopathy. Lancet 2008, 372:1361–1363.PubMedCrossRefGoogle Scholar
  12. 12.
    Wong TY, Liew G, Tapp RJ, et al.: Relation between fasting glucose and retinopathy for diagnosis of diabetes: three population-based cross-sectional studies. Lancet 2008, 371:736–743.PubMedCrossRefGoogle Scholar
  13. 13.
    Cheung N, Wong TY: Diabetic retinopathy and systemic vascular complications. Prog Retin Eye Res 2008, 27:161–176.PubMedCrossRefGoogle Scholar
  14. 14.
    Klein R, Klein BE, Moss SE, et al.: Association of ocular disease and mortality in a diabetic population. Arch Ophthalmol 1999, 117:1487–1495.PubMedGoogle Scholar
  15. 15.
    Nguyen TT, Wong TY: Retinal vascular manifestations of metabolic disorders. Trends Endocrinol Metab 2006, 17:262–268.PubMedCrossRefGoogle Scholar
  16. 16.
    Wong TY, Klein R, Sharrett AR, et al.: Cerebral white matter lesions, retinopathy, and incident clinical stroke. JAMA 2002, 288:67–74.PubMedCrossRefGoogle Scholar
  17. 17.
    Klein R, Marino EK, Kuller LH, et al.: The relation of atherosclerotic cardiovascular disease to retinopathy in people with diabetes in the Cardiovascular Health Study. Br J Ophthalmol 2002, 86:84–90.PubMedCrossRefGoogle Scholar
  18. 18.
    Edwards MS, Wilson DB, Craven TE, et al.: Associations between retinal microvascular abnormalities and declining renal function in the elderly population: the Cardiovascular Health Study. Am J Kidney Dis 2005, 46:214–224.PubMedCrossRefGoogle Scholar
  19. 19.
    Nguyen TT, Wang JJ, Wong TY: Retinal vascular changes in pre-diabetes and prehypertension: new findings and their research and clinical implications. Diabetes Care 2007, 30:2708–2715.PubMedCrossRefGoogle Scholar
  20. 20.
    Wong TY, Duncan BB, Golden SH, et al.: Associations between the metabolic syndrome and retinal microvascular signs: the Atherosclerosis Risk In Communities study. Invest Ophthalmol Vis Sci 2004, 45:2949–2954.PubMedCrossRefGoogle Scholar
  21. 21.
    Kawasaki R, Tielsch JM, Wang JJ, et al.: The metabolic syndrome and retinal microvascular signs in a Japanese population: the Funagata study. Br J Ophthalmol 2008, 92:161–166.PubMedCrossRefGoogle Scholar
  22. 22.
    Klein R, Klein BE, Mos SE, et al.: The relationship of retinopathy in persons without diabetes to the 15-year incidence of diabetes and hypertension: Beaver Dam Eye Study. Trans Am Ophthalmol Soc 2006, 104:98–107.PubMedGoogle Scholar
  23. 23.
    Wong TY, Mohamed Q, Klein R, et al.: Do retinopathy signs in non-diabetic individuals predict the subsequent risk of diabetes? Br J Ophthalmol 2006, 90:301–303.PubMedCrossRefGoogle Scholar
  24. 24.
    Hubbard LD, Brothers RJ, King WN, et al.: Methods for evaluation of retinal microvascular abnormalities associated with hypertension/sclerosis in the Atherosclerosis Risk in Communities Study. Ophthalmology 1999, 106:2269–2280.PubMedCrossRefGoogle Scholar
  25. 25.
    Liew G, Sharrett AR, Kronmal R, et al.: Measurement of retinal vascular caliber: issues and alternatives to using the arteriole to venule ratio. Invest Ophthalmol Vis Sci 2007, 48:52–57.PubMedCrossRefGoogle Scholar
  26. 26.
    Dorner GT, Garhofer G, Kiss B, et al.: Nitric oxide regulates retinal vascular tone in humans. Am J Physiol Heart Circ Physiol 2003, 285:H631–H636.PubMedGoogle Scholar
  27. 27.
    Delles C, Michelson G, Harazny J, et al.: Impaired endothelial function of the retinal vasculature in hypertensive patients. Stroke 2004, 35:1289–1293.PubMedCrossRefGoogle Scholar
  28. 28.
    Mandecka A, Dawczynski J, Blum M, et al.: Influence of flickering light on the retinal vessels in diabetic patients. Diabetes Care 2007, 30:3048–3052.PubMedCrossRefGoogle Scholar
  29. 29.
    Skovborg F, Nielsen AV, Lauritzen E, et al.: Diameters of the retinal vessels in diabetic and normal subjects. Diabetes 1969, 18:292–298.PubMedGoogle Scholar
  30. 30.
    Nguyen TT, Wang JJ, Sharrett AR, et al.: Relationship of retinal vascular caliber with diabetes and retinopathy: the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care 2008, 31:544–549.PubMedCrossRefGoogle Scholar
  31. 31.
    Wong TY, Klein R, Sharrett AR, et al.: Retinal arteriolar narrowing and risk of diabetes mellitus in middle-aged persons. JAMA 2002, 287:2528–2533.PubMedCrossRefGoogle Scholar
  32. 32.
    Wong TY, Shankar A, Klein R, et al.: Retinal arteriolar narrowing, hypertension, and subsequent risk of diabetes mellitus. Arch Intern Med 2005, 165:1060–1065.PubMedCrossRefGoogle Scholar
  33. 33.
    Nguyen TT, Wang JJ, Islam FM, et al.: Retinal arteriolar narrowing predicts incidence of diabetes: the Australian Diabetes, Obesity and Lifestyle (AusDiab) Study. Diabetes 2008, 57:536–539.PubMedCrossRefGoogle Scholar
  34. 34.
    Ikram MK, Janssen JA, Roos AM, et al.: Retinal vessel diameters and risk of impaired fasting glucose or diabetes: the Rotterdam study. Diabetes 2006, 55:506–510.PubMedCrossRefGoogle Scholar
  35. 35.
    Wong TY, Islam FM, Klein R, et al.: Retinal vascular caliber, cardiovascular risk factors, and inflammation: the Multi-Ethnic Study of Atherosclerosis (MESA). Invest Ophthalmol Vis Sci 2006, 47:2341–2350.PubMedCrossRefGoogle Scholar
  36. 36.
    Serne EH, de Jongh RT, Eringa EC, et al.: Microvascular dysfunction: a potential pathophysiological role in the metabolic syndrome. Hypertension 2007, 50:204–211.PubMedCrossRefGoogle Scholar
  37. 37.
    Meigs JB, Hu FB, Rifai N, et al.: Biomarkers of endothelial dysfunction and risk of type 2 diabetes mellitus. JAMA 2004, 291:1978–1986.PubMedCrossRefGoogle Scholar
  38. 38.
    Cheung N, Rogers SL, Donaghue KC, et al.: Retinal arteriolar dilation predicts retinopathy in adolescents with type 1 diabetes. Diabetes Care 2008, 31:1842–1846.PubMedCrossRefGoogle Scholar
  39. 39.
    Rogers SL, Tikellis G, Cheung N, et al.: Retinal arteriolar caliber predicts incident retinopathy: The Australian Diabetes, Obesity and Lifestyle (AusDiab) Study. Diabetes Care 2008, 31:761–763.PubMedCrossRefGoogle Scholar
  40. 40.
    Klein R, Moss SE, Klein BE: Author reply. Ophthalmology 2007, 114:2099.CrossRefGoogle Scholar
  41. 41.
    Klein R, Klein BE, Moss SE, et al.: The relation of retinal vessel caliber to the incidence and progression of diabetic retinopathy: XIX: the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Arch Ophthalmol 2004, 122:76–83.PubMedCrossRefGoogle Scholar
  42. 42.
    Klein R, Klein BE, Moss SE, et al.: Retinal vessel caliber and microvascular and macrovascular disease in type 2 diabetes: XXI: the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Ophthalmology 2007, 114:1884–1892.PubMedCrossRefGoogle Scholar
  43. 43.
    Wong TY, Shankar A, Klein R, et al.: Retinal vessel diameters and the incidence of gross proteinuria and renal insufficiency in people with type 1 diabetes. Diabetes 2004, 53:179–184.PubMedCrossRefGoogle Scholar
  44. 44.
    Rogers SL, Tikellis G, Cheung N, et al.: Retinal arteriolar caliber predicts incident retinopathy: the Australian Diabetes, Obesity and Lifestyle (AusDiab) study. Diabetes Care 2008, 31:761–763.PubMedCrossRefGoogle Scholar
  45. 45.
    McGeechan K, Liew G, Macaskill P, et al.: Risk prediction of coronary heart disease based on retinal vascular caliber (from the Atherosclerosis Risk In Communities [ARIC] Study). Am J Cardiol 2008, 102:58–63.PubMedCrossRefGoogle Scholar
  46. 46.
    Wang JJ, Liew G, Wong TY, et al.: Retinal vascular calibre and the risk of coronary heart disease-related death. Heart 2006, 92:1583–1587.PubMedCrossRefGoogle Scholar
  47. 47.
    Wong TY, Kamineni A, Klein R, et al.: Quantitative retinal venular caliber and risk of cardiovascular disease in older persons: the Cardiovascular Health Study. Arch Intern Med 2006, 166:2388–2394.PubMedCrossRefGoogle Scholar
  48. 48.
    Tamai K, Matsubara A, Tomida K, et al.: Lipid hydroperoxide stimulates leukocyte-endothelium interaction in the retinal microcirculation. Exp Eye Res 2002, 75:69–75.PubMedCrossRefGoogle Scholar
  49. 49.
    Kolodjaschna J, Berisha F, Lung S, et al.: LPS-induced microvascular leukocytosis can be assessed by blue-field entoptic phenomenon. Am J Physiol Heart Circ Physiol 2004, 287:H691–H694.PubMedCrossRefGoogle Scholar
  50. 50.
    Chester AH, Borland JA, Buttery LD, et al.: Induction of nitric oxide synthase in human vascular smooth muscle: interactions between proinflammatory cytokines. Cardiovasc Res 1998, 38:814–821.PubMedCrossRefGoogle Scholar
  51. 51.
    Klein R, Klein BE, Knudtson MD, et al.: Are inflammatory factors related to retinal vessel caliber? The Beaver Dam Eye Study. Arch Ophthalmol 2006, 124:87–94.PubMedCrossRefGoogle Scholar
  52. 52.
    Klein R, Sharrett AR, Klein BE, et al.: Are retinal arteriolar abnormalities related to atherosclerosis?: The Atherosclerosis Risk in Communities Study. Arterioscler Thromb Vasc Biol 2000, 20:1644–1650.PubMedGoogle Scholar
  53. 53.
    Witt N, Wong TY, Hughes AD, et al.: Abnormalities of retinal microvascular structure and risk of mortality from ischemic heart disease and stroke. Hypertension 2006, 47:975–981.PubMedCrossRefGoogle Scholar
  54. 54.
    Tillin T, Evans RM, Witt NW, et al.: Ethnic differences in retinal microvascular structure. Diabetologia 2008, 51:1719–1722PubMedCrossRefGoogle Scholar
  55. 55.
    Cheung N, Donaghue KC, Liew G, et al.: Quantitative assessment of early diabetic retinopathy using fractal analysis. Diabetes Care 2009, 32:106–110.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  1. 1.Centre for Eye Research AustraliaUniversity of MelbourneVictoriaAustralia

Personalised recommendations