Skip to main content
SpringerLink
Log in

Retinal Circulation in Arterial Disease

  • Chapter
  • First Online:
Arterial Disorders

Abstract

Hypertension provokes structural and functional alterations of the retinal vasculature. The analysis of retinal vasculature provides the unique opportunity to examine microvascular changes noninvasively in humans. Large epidemiological studies using retinal photographs have assessed the association between vascular alterations of the retinal circulation and blood pressure, target organ damage, and cardiovascular events. Nowadays, innovative methods (e.g., scanning laser Doppler flowmetry) enable the assessment of the arteriolar wall directly (i.e., vascular remodeling) as well as changes of vascular tone (i.e., endothelial function). Based on such an assessment of early vascular remodeling processes, it may be possible in future to individualize antihypertensive therapy of patients. Since the retinal circulation is thought to mirror the cerebral circulation, these innovative approaches to measure vascular changes in hypertension early and individually may lead to more effective strategies to prevent cerebrovascular events.

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

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 149.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
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. Schiffrin EL (2004) Remodeling of resistance arteries in essential hypertension and effects of antihypertensive treatment. Am J Hypertens 17:1192–1200

    Article  CAS  PubMed  Google Scholar 

  2. Mulvany MJ (2008) Small artery remodelling in hypertension: causes, consequences and therapeutic implications. Med Biol Eng Comput 46:461–467

    Article  PubMed  Google Scholar 

  3. Feihl F, Liaudet L, Levy BI, Waeber B (2008) Hypertension and microvascular remodelling. Cardiovasc Res 78:274–285

    Article  CAS  PubMed  Google Scholar 

  4. 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 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  7. Downie LE, Hodgson LA, Dsylva C et al (2013) Hypertensive retinopathy: comparing the Keith-Wagener-Barker to a simplified classification. J Hypertens 31:960–965

    Article  CAS  PubMed  Google Scholar 

  8. Mancia G, Fagard R, Narkiewicz K et al.; Task Force Members (2013) 2013 ESH/ESC 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 31:1281–1357

    Google Scholar 

  9. 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  CAS  PubMed  Google Scholar 

  10. 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  CAS  PubMed  Google Scholar 

  11. 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

    PubMed  Google Scholar 

  12. Wong TY, Klein R, Sharrett AR et al.; Atherosclerosis Risk in Communities Study (2004) Retinal arteriolar diameter and risk for hypertension. Ann of Intern Med 140:248–255

    Google Scholar 

  13. 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 

  14. Yatsuya H, Folsom AR, Wong TY, Investigators AS et al (2010) Retinal microvascular abnormalities and risk of lacunar stroke: Atherosclerosis Risk in Communities Study. Stroke 41:1349–1355

    Article  PubMed Central  PubMed  Google Scholar 

  15. 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 

  16. Wong TY, Klein R, Klein BE et al (2003) Retinal vessel diameters and their associations with age and blood pressure. Invest Ophthalmol Vis Sci 44:4644–4650

    Article  PubMed  Google Scholar 

  17. Wong TY, Shankar A, Klein R et al (2004) Prospective cohort study of retinal vessel diameters and risk of hypertension. BMJ 329:79

    Article  PubMed Central  PubMed  Google Scholar 

  18. Wang JJ, Liew G, Klein R et al (2007) Retinal vessel diameter and cardiovascular mortality: pooled data analysis from two older populations. Eur Heart J 28:1984–1992

    Article  CAS  PubMed  Google Scholar 

  19. Leung H, Wang JJ, Rochtchina E et al (2003) Relationships between age, blood pressure, and retinal vessel diameters in an older population. Invest Ophthalmol Vis Sci 44:2900–2904

    Article  PubMed  Google Scholar 

  20. Leung H, Wang JJ, Rochtchina E et al (2004) Impact of current and past blood pressure on retinal arteriolar diameter in an older population. J Hypertens 22:1543–1549

    Article  CAS  PubMed  Google Scholar 

  21. Smith W, Wang JJ, Wong TY et al (2004) Retinal arteriolar narrowing is associated with 5-year incident severe hypertension: the Blue Mountains Eye Study. Hypertension 44:442–447

    Article  CAS  PubMed  Google Scholar 

  22. Wang JJ, Liew G, Wong TY et al (2006) Retinal vascular calibre and the risk of coronary heart disease-related death. Heart 92:1583–1587

    Article  PubMed Central  CAS  PubMed  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 Central  CAS  PubMed  Google Scholar 

  24. Wong TY, Kamineni A, Klein R et al (2006) Quantitative retinal venular caliber and risk of cardiovascular disease in older persons: the cardiovascular health study. Arch Intern Med 166:2388–2394

    Article  PubMed  Google Scholar 

  25. Wong TY, Islam FM, Klein R et al (2006) Retinal vascular caliber, cardiovascular risk factors, and inflammation: the multi-ethnic study of atherosclerosis (mesa). Invest Ophthalmol Vis Sci 47:2341–2350

    Article  PubMed Central  PubMed  Google Scholar 

  26. Kawasaki R, Cheung N, Wang JJ et al (2009) Retinal vessel diameters and risk of hypertension: the multiethnic study of atherosclerosis. J Hypertens 27:2386–2393

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. Yau JW, Xie J, Kawasaki R et al (2011) Retinal arteriolar narrowing and subsequent development of CKD stage 3: the multi-ethnic study of atherosclerosis (MESA). Am J Kidney Dis 58:39–46

    Article  PubMed Central  PubMed  Google Scholar 

  28. 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 

  29. Ikram MK, Witteman JC, Vingerling JR et al (2006) Retinal vessel diameters and risk of hypertension: the Rotterdam Study. Hypertension 47:189–194

    Article  CAS  PubMed  Google Scholar 

  30. Ikram MK, de Jong FJ, Bos MJ et al (2006) Retinal vessel diameters and risk of stroke: the Rotterdam Study. Neurology 66:1339–1343

    Article  CAS  PubMed  Google Scholar 

  31. Wieberdink RG, Ikram MK, Koudstaal PJ et al (2010) Retinal vascular calibers and the risk of intracerebral hemorrhage and cerebral infarction: the Rotterdam Study. Stroke 41:2757–2761

    Article  PubMed  Google Scholar 

  32. 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 

  33. Sabanayagam C, Shankar A, Koh D et al (2009) Retinal microvascular caliber and chronic kidney disease in an Asian population. Am J Epidemiol 169:625–632

    Article  PubMed  Google Scholar 

  34. Jeganathan VS, Sabanayagam C, Tai ES et al (2009) Effect of blood pressure on the retinal vasculature in a multi-ethnic Asian population. Hypertens Res 32:975–982

    Article  PubMed  Google Scholar 

  35. Sabanayagam C, Tai ES, Shankar A et al (2009) Retinal arteriolar narrowing increases the likelihood of chronic kidney disease in hypertension. J Hypertens 27:2209–2217

    Article  CAS  PubMed  Google Scholar 

  36. Mitchell P, Cheung N, de Haseth K et al (2007) Blood pressure and retinal arteriolar narrowing in children. Hypertension 49:1156–1162

    Article  CAS  PubMed  Google Scholar 

  37. Ding J, Wai KL, McGeechan K et al (2014) Retinal vascular caliber and the development of hypertension: a meta-analysis of individual participant data. J Hypertens 32:207–215

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  38. Masaidi M, Cuspidi C, Giudici V et al (2009) Is retinal arteriolar-venular ratio associated with cardiac and extracardiac organ damage in essential hypertension? J Hypertens 27:1277–1283

    Article  CAS  PubMed  Google Scholar 

  39. McGeechan K, Liew G, Macaskill P et al (2009) Meta-analysis: retinal vessel caliber and risk for coronary heart disease. Ann Int Med 151:404–413

    Article  PubMed Central  PubMed  Google Scholar 

  40. Cheung CY, Tay WT, Mitchell P et al (2011) Quantitative and qualitative retinal microvascular characteristics and blood pressure. J Hypertens 29:1380–1391

    Article  CAS  PubMed  Google Scholar 

  41. Sng CC, Wong WL, Cheung CY et al (2013) Retinal vascular fractal and blood pressure in a multiethnic population. J Hypertens 31:2036–2042

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  43. 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 flowmetry in humans. J Hypertens 29:777–782

    Article  CAS  PubMed  Google Scholar 

  44. Harazny JM, Schmieder RE, Welzenbach J, Michelson G (2013) Local application of tropicamide 0.5% reduces retinal capillary blood flow. Blood Press 22:371–376

    Article  CAS  PubMed  Google Scholar 

  45. Patton N, Aslam T, Macgillivray T et al (2005) Retinal vascular image analysis as a potential screening tool for cerebrovascular disease: a rationale based on homology between cerebral and retinal microvasculatures. J Anat 206:319–348

    Article  PubMed Central  PubMed  Google Scholar 

  46. Oehmer S, Harazny J, Delles C et al (2006) Valsartan and retinal endothelial function in elderly hypertensive patients. Blood Press 15:185–191

    Article  CAS  PubMed  Google Scholar 

  47. 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  CAS  PubMed  Google Scholar 

  48. 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  CAS  PubMed  Google Scholar 

  49. 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 

  50. 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 83:111–117

    Article  PubMed  Google Scholar 

  51. Raff U, Harazny JM, Titze SI et al (2012) Salt intake determines retinal arteriolar structure in treatment resistant hypertension independent of blood pressure. Atherosclerosis 222:235–240

    Article  CAS  PubMed  Google Scholar 

  52. Ritt M, Harazny JM, Ott C et al (2012) Impaired increase of retinal capillary blood flow to flicker light exposure in arterial hypertension. Hypertension 60:871–876

    Article  CAS  PubMed  Google Scholar 

  53. Ott C, Raff U, Harazny JM et al (2013) Central pulse pressure is an independent determinant of vascular remodeling in the retinal circulation. Hypertension 61:1340–1345

    Article  CAS  PubMed  Google Scholar 

  54. Harazny JM, Ott C, Raff U et al (2014) First experience in analysing pulsatile retinal capillary flow and arteriolar structural parameters measured noninvasively in hypertensive patients. J Hypertens 32:2246–2252

    Article  CAS  PubMed  Google Scholar 

  55. Schmieder RE, Ott C, Uder M et al (2014) Retinal microperfusion one year after renal artery denervation in treatment resistant hypertensive patients. J Hypertens 32 (Suppl 1): e69

    Google Scholar 

  56. 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  CAS  PubMed  Google Scholar 

  57. Wohlfahrt P, Krajcoviechova A, Jozifova M et al (2014) Large artery stiffness and carotid flow pulsatility in stroke survivors. J Hypertens 32:1097–1103; discussion 1103

    Article  CAS  PubMed  Google Scholar 

  58. Laurent S, Katsahian S, Fassot C et al (2003) Aortic stiffness is an independent predictor of fatal stroke in essential hypertension. Stroke 34:1203–1206

    Article  PubMed  Google Scholar 

  59. Rizzoni D, Porteri E, Duse S et al (2012) Relationship between media-to-lumen ratio of subcutaneous small arteries and wall-to-lumen ratio of retinal arterioles evaluated noninvasively by scanning laser Doppler flowmetry. J Hypertens 30:1169–1175

    Article  CAS  PubMed  Google Scholar 

  60. Koch E, Rosenbaum D, Brolly A et al (2014) Morphometric analysis of small arteries in the human retina using adaptive optics imaging: relationship with blood pressure and focal vascular changes. J Hypertens 32:890–898

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  61. Muraoka Y, Tsujikawa A, Kumagai K et al (2013) Age- and hypertension-dependent changes in retinal vessel diameter and wall thickness: an optical coherence tomography study. Am J Ophthalmol 156:706–714

    Article  PubMed  Google Scholar 

  62. Rosenbaum D, Koch E, Girerd X et al (2013) Imaging of retinal arteries with adaptative optics, feasibility and reproducibility. Ann Cardiol Angeiol 62:184–188

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Ulmenweg 18, Erlangen, 91054, Germany

    Christian Ott & Roland E. Schmieder

Authors
  1. Christian Ott
    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. American University of Beirut Medical Center, Beirut, Lebanon

    Adel Berbari

  2. University of Milano Bicocca IRCCS Istituto Auxologico Italiano, Milan, Italy

    Giuseppe Mancia

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Ott, C., Schmieder, R.E. (2015). Retinal Circulation in Arterial Disease. In: Berbari, A., Mancia, G. (eds) Arterial Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-14556-3_28

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-14556-3_28

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-14555-6

  • Online ISBN: 978-3-319-14556-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation