Retinal Vascular Imaging: A New Tool in Microvascular Disease Research

The microcirculation is relatively inaccessible to direct visualization and investigation. Recent methods have been developed which use advanced retinal photographic imaging techniques and computer-assisted image analysis to characterize, measure and quantify subtle variations and abnormalities in the retinal vasculature. These quantitative and qualitative assessments demonstrate a close association of retinal vascular signs to both clinical and subclinical cerebrovascular, cardiovascular and metabolic outcomes. Retinal vascular imaging may thus offer potential as a noninvasive research tool to probe the role and pathophysiology of the microvasculature, and as a cardiovascular risk prediction tool. Key areas where retinal vascular imaging has contributed to increased understanding of microvascular pathology and major areas of current and new research are discussed in this review.

[1]  J. Stam,et al.  Retinal arterial changes correlate with cerebral small-vessel disease , 2002, Neurology.

[2]  R. Klein,et al.  Abnormalities of Retinal Microvascular Structure and Risk of Mortality From Ischemic Heart Disease and Stroke , 2006, Hypertension.

[3]  N. Samani,et al.  Early narrowed afferent arteriole is a contributor to the development of hypertension. , 1994, Hypertension.

[4]  D. Levy,et al.  Prediction of coronary heart disease using risk factor categories. , 1998, Circulation.

[5]  A. Pries,et al.  Microcirculation in Hypertension: A New Target for Treatment? , 2001, Circulation.

[6]  Ian J. Deary,et al.  Retinal image analysis: concepts, applications and potential , 2006 .

[7]  A. Folsom,et al.  Prospective study of hemostatic factors and incidence of coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) Study. , 1997, Circulation.

[8]  M Zamir,et al.  Optimality principles in arterial branching. , 1976, Journal of theoretical biology.

[9]  M. Tso,et al.  Pathophysiology of hypertensive retinopathy. , 1982, Ophthalmology.

[10]  R. Klein,et al.  Relationship Between Retinal Arteriolar Narrowing and Myocardial Perfusion: Multi-Ethnic Study of Atherosclerosis , 2008, Hypertension.

[11]  M. Mulvany.  Are Vascular Abnormalities a Primary Cause or Secondary Consequence of Hypertension? , 1991, Hypertension.

[12]  R. Klein,et al.  Quantitative retinal venular caliber and risk of cardiovascular disease in older persons: the cardiovascular health study. , 2006, Archives of internal medicine.

[13]  C. Gieger,et al.  Genomewide association analysis of coronary artery disease. , 2007, The New England journal of medicine.

[14]  Tien Yin Wong,et al.  Associations between findings on cranial magnetic resonance imaging and retinal photography in the elderly: the Cardiovascular Health Study. , 2006, American journal of epidemiology.

[15]  A. Hofman,et al.  Arteriolar oxygen saturation, cerebral blood flow, and retinal vessel diameters. The Rotterdam Study. , 2008, Ophthalmology.

[16]  Ikuogoto,et al.  Pathological Studies on the Intracerebral and Retinal Arteries in Cerebrovascular and Noncerebrovascular Diseases , 1975 .

[17]  Ronald Klein,et al.  Genome-Wide Linkage Study of Retinal Vessel Diameters in the Beaver Dam Eye Study , 2006, Hypertension.

[18]  G. Michelson,et al.  MORPHOMETRIC AGE-RELATED EVALUATION OF SMALL RETINAL VESSELS BY SCANNING LASER DOPPLER FLOWMETRY: Determination of a Vessel Wall Index , 2007, Retina.

[19]  Tien Yin Wong,et al.  Retinal Arteriolar Diameter and Risk for Hypertension , 2004, Annals of Internal Medicine.

[20]  R. Klein,et al.  Prospective cohort study of retinal vessel diameters and risk of hypertension , 2004, BMJ : British Medical Journal.

[21]  E. Alegrı́a,et al.  Sex differences and cardiovascular risk , 2006, Heart.

[22]  M. Matsuda,et al.  Quantitative analysis of narrowings of intramyocardial small arteries in normal hearts, hypertensive hearts, and hearts with hypertrophic cardiomyopathy. , 1987, Circulation.

[23]  Tien Y Wong,et al.  Hypertensive retinopathy. , 2004, The New England journal of medicine.

[24]  T. Wong,et al.  Retinal vascular manifestations of metabolic disorders , 2006, Trends in Endocrinology & Metabolism.

[25]  Paul Mitchell,et al.  The eye in hypertension , 2007, The Lancet.

[26]  Tien Yin Wong,et al.  Is retinal photography useful in the measurement of stroke risk? , 2004, The Lancet Neurology.

[27]  R. Schneider,et al.  Lacunar Infarcts and White Matter Attenuation Ophthalmologic and Microcirculatory Aspects of the Pathophysiology , 1993, Stroke.

[28]  Circulatory parameters of the retina in patients with lacunar stroke , 1986, Journal of Neurology.

[29]  Barbara E K Klein,et al.  Relation of retinopathy to coronary artery calcification: the multi-ethnic study of atherosclerosis. , 2007, American journal of epidemiology.

[30]  J. Sundberg,et al.  Role of COL4A1 in small-vessel disease and hemorrhagic stroke. , 2006, The New England journal of medicine.

[31]  T. Sørensen,et al.  Heritability of retinal vessel diameters and blood pressure: a twin study. , 2006, Investigative ophthalmology & visual science.

[32]  R. Schmieder,et al.  Increased Wall: Lumen Ratio of Retinal Arterioles in Male Patients With a History of a Cerebrovascular Event , 2007, Hypertension.

[33]  R. Klein,et al.  Methods for evaluation of retinal microvascular abnormalities associated with hypertension/sclerosis in the Atherosclerosis Risk in Communities Study. , 1999, Ophthalmology.

[34]  R. Klein,et al.  Retinal vessel diameter and cardiovascular mortality: pooled data analysis from two older populations. , 2007, European heart journal.

[35]  A. Hofman,et al.  Retinal vessel diameters and risk of impaired fasting glucose or diabetes: the Rotterdam study. , 2006, Diabetes.

[36]  R. Touyz.  Vascular remodeling, retinal arteries, and hypertension. , 2007, Hypertension.

[37]  Albert Hofman,et al.  Retinal Vessel Diameters and Risk of Hypertension: The Rotterdam Study , 2006 .

[38]  Charles E. Riva,et al.  Visually evoked hemodynamical response and assessment of neurovascular coupling in the optic nerve and retina , 2005, Progress in Retinal and Eye Research.

[39]  E. Michelson,et al.  Retinal arteriolar changes as an indicator of coronary artery disease. , 1979, Archives of internal medicine.

[40]  C. Johnston.  Renovascular Hypertension Structural Changes in the Renal Vasculature , 2000 .

[41]  R Nick Bryan,et al.  Retinal Microvascular Abnormalities and MRI-Defined Subclinical Cerebral Infarction: The Atherosclerosis Risk in Communities Study , 2006, Stroke.

[42]  R. Klein,et al.  Risk prediction of coronary heart disease based on retinal vascular caliber (from the Atherosclerosis Risk In Communities [ARIC] Study). , 2008, The American journal of cardiology.

[43]  A. Hughes,et al.  Rationale and design of the AdRem study: evaluating the effects of blood pressure lowering and intensive glucose control on vascular retinal disorders in patients with type 2 diabetes mellitus. , 2007, Contemporary clinical trials.

[44]  G. V. van Montfrans,et al.  Value of routine funduscopy in patients with hypertension: systematic review , 2005, BMJ : British Medical Journal.

[45]  Martin A Mainster,et al.  The fractal properties of retinal vessels: Embryological and clinical implications , 1990, Eye.

[46]  T. MacGillivray,et al.  Fractal analysis of the retinal vascular network in fundus images , 2007, 2007 29th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[47]  P. Mitchell,et al.  The long-term relation among retinal arteriolar narrowing, blood pressure, and incident severe hypertension. , 2008, American journal of epidemiology.

[48]  Ž. Reiner,et al.  Relation of atherosclerotic changes in retinal arteries to the extent of coronary artery disease. , 2005, The American journal of cardiology.

[49]  Ronald Klein,et al.  Are inflammatory factors related to retinal vessel caliber? The Beaver Dam Eye Study. , 2006, Archives of ophthalmology.

[50]  R. Klein,et al.  Cerebral white matter lesions, retinopathy, and incident clinical stroke. , 2002, JAMA.