INCREASED RETINAL BLOOD FLOW VELOCITY IN PATIENTS WITH EARLY DIABETES MELLITUS

Purpose: To compare retinal blood flow velocity in small vessels of patients with early diabetes mellitus (DM), without any morphologic changes related to diabetic retinopathy, with that in a control group. Methods: The authors used the retinal function imager to measure blood flow velocities, from many small vessels, simultaneously. Twenty-three eyes of 14 patients with early DM and 51 eyes of 31 healthy subjects were enrolled. Differences between the patients and the control group were assessed by mixed linear models. Results: Venous average velocity significantly increased in the DM group (3.8 ± 1.2 vs. 2.9 ± 0.5 mm/second, P < 0.0001) than in the healthy subjects. Arterial velocity of DM patients was also significantly higher (4.7 ± 1.7 vs. 4.1 ± 0.9 mm/second, P = 0.03). There was no statistically significant difference between groups in age, gender, heart rate, and systolic blood pressure. The diastolic blood pressure in the DM patients was lower than that in the healthy group (P = 0.03). Conclusion: There was an increase in arterial and venous retinal blood flow velocities of patients with early DM with no diabetic retinopathy. These findings support the notion that abnormalities in vessel function exist in diabetic eyes before the development of structural changes. This noninvasive approach facilitated the assessment of early hemodynamic abnormalities and may assist in screening and monitoring.

[1]  S. Genuth,et al.  The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. , 1993, The New England journal of medicine.

[2]  A. Yoshida,et al.  Retinal blood flow changes in type I diabetes. A long-term follow-up study. , 1996, Investigative ophthalmology & visual science.

[3]  C. Riva,et al.  Prolongation of the retinal mean circulation time in diabetes. , 1982, Archives of ophthalmology.

[4]  M. Montenegro,et al.  Retinal blood flow in diabetes. , 1998, International ophthalmology clinics.

[5]  R. Devenyi,et al.  Retinal arteriolar diameter, blood velocity, and blood flow response to an isocapnic hyperoxic provocation in early sight-threatening diabetic retinopathy. , 2007, Investigative ophthalmology & visual science.

[6]  J. Cunha-Vaz,et al.  Nitric oxide synthase activity and L-arginine metabolism in the retinas from streptozotocin-induced diabetic rats. , 1998, General pharmacology.

[7]  Norman Fleischer,et al.  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. , 1993 .

[8]  M. Wolzt,et al.  Ocular blood flow and associated functional deviations in diabetic retinopathy , 1999, Diabetologia.

[9]  D. McMillan.  Rheological and Related Factors in Diabetic Retinopathy , 1978, International ophthalmology clinics.

[10]  B. Brenner,et al.  Pathogenesis of diabetic microangiopathy. The hemodynamic view. , 1986, The American journal of medicine.

[11]  S. Bursell,et al.  Retinal blood flow changes in patients with insulin-dependent diabetes mellitus and no diabetic retinopathy. , 1996, Investigative ophthalmology & visual science.

[12]  N. Lassen,et al.  Hemodynamic factors in the genesis of diabetic microangiopathy. , 1983, Metabolism: clinical and experimental.

[13]  Amiram Grinvald,et al.  Special report: Noninvasive multi-parameter functional optical imaging of the eye. , 2005, Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye.

[14]  L. M. Aiello,et al.  Perspectives on diabetic retinopathy. , 2003, American journal of ophthalmology.

[15]  D. McMillan.  Deterioration of the Microcirculation in Diabetes , 1975, Diabetes.

[16]  M. C. Leske,et al.  The prevalence of diabetic retinopathy among adults in the United States. , 2004, Archives of ophthalmology.

[17]  S. Sinclair,et al.  Macular retinal capillary hemodynamics in diabetic patients. , 1991, Ophthalmology.

[18]  Manabu Tanifuji,et al.  Intrinsic signal imaging in macaque retina reveals different types of flash-induced light reflectance changes of different origins. , 2007, Investigative ophthalmology & visual science.

[19]  E M Kohner,et al.  Long-term follow-up of retinal blood flow in diabetes using the blue light entoptic phenomenon. , 1989, The British journal of ophthalmology.

[20]  C E Riva,et al.  Retinal haemodynamics in patients with early diabetes mellitus. , 1996, The British journal of ophthalmology.

[21]  Joel Pokorny,et al.  Visual stimulus-induced changes in human near-infrared fundus reflectance. , 2006, Investigative ophthalmology & visual science.

[22]  C. Riva,et al.  Effect of an insulin-induced decrease in blood glucose on the human diabetic retinal circulation. , 1987, Ophthalmology.

[23]  M. Shiran,et al.  Retinal haemodynamics in individuals with well-controlled type 1 diabetes , 2007, Diabetologia.

[24]  K Miyamoto,et al.  In vivo demonstration of increased leukocyte entrapment in retinal microcirculation of diabetic rats. , 1998, Investigative ophthalmology & visual science.

[25]  E M Kohner,et al.  Measurement of retinal blood flow in diabetes by the blue-light entoptic phenomenon. , 1986, The British journal of ophthalmology.

[26]  The effect of intensive diabetes treatment on the progression of diabetic retinopathy in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial. , 1995, Archives of ophthalmology.

[27]  S. Bursell,et al.  Hemodynamic changes as early markers of diabetic retinopathy , 1996 .

[28]  A. Grinvald,et al.  REDUCED RETINAL BLOOD FLOW VELOCITY IN DIABETIC RETINOPATHY , 2010, Retina.

[29]  F Jung,et al.  Retinal microcirculation in patients with diabetes mellitus: dynamic and morphological analysis of perifoveal capillary network. , 1991, The British journal of ophthalmology.

[30]  E M Kohner,et al.  Role of Blood Flow and Impaired Autoregulation in the Pathogenesis of Diabetic Retinopathy , 1995, Diabetes.

[31]  J. Caprioli.  Ocular Pathology, Clinical Applications and Self-Assessment , 1985 .

[32]  Tien Yin Wong,et al.  Relationship of Retinal Vascular Caliber With Diabetes and Retinopathy , 2008, Diabetes Care.

[33]  T. Wiesel,et al.  Functional architecture of cortex revealed by optical imaging of intrinsic signals , 1986, Nature.

[34]  S. Bursell,et al.  Regulation of retinal hemodynamics in diabetic rats by increased expression and action of endothelin-1. , 1996, Investigative ophthalmology & visual science.

[35]  B. Polak,et al.  Retinal blood flow changes in diabetic retinopathy measured with the Heidelberg scanning laser Doppler flowmeter , 2000, Graefe's Archive for Clinical and Experimental Ophthalmology.

[36]  T. Sano,et al.  [Diabetic retinopathy]. , 2001, Nihon rinsho. Japanese journal of clinical medicine.

[37]  T. Curtis,et al.  Arteriolar Involvement in the Microvascular Lesions of Diabetic Retinopathy: Implications for Pathogenesis , 2007, Microcirculation.

[38]  John G Flanagan,et al.  Retinal hemodynamics in early diabetic macular edema. , 2006, Diabetes.

[39]  Amiram Grinvald,et al.  High-resolution functional optical imaging: from the neocortex to the eye. , 2004, Ophthalmology clinics of North America.

[40]  C. D. A. Stehouwer,et al.  Inflammation and endothelial dysfunction are associated with retinopathy: the Hoorn Study , 2005, Diabetologia.

[41]  S. Bursell,et al.  Characterization of retinal leukostasis and hemodynamics in insulin resistance and diabetes: role of oxidants and protein kinase-C activation. , 2003, Diabetes.

[42]  J. Cunha-Vaz,et al.  Alterations of retinal capillary blood flow in preclinical retinopathy in subjects with type 2 diabetes , 2003, Graefe's Archive for Clinical and Experimental Ophthalmology.