Retinal venular tortuosity and fractal dimension predict incident retinopathy in adults with type 2 diabetes: the Edinburgh Type 2 Diabetes Study.

Published on Jan 30, 2021in Diabetologia7.518
· DOI :10.1007/S00125-021-05388-5
Rachel Forster8
Estimated H-index: 8
(Edin.: University of Edinburgh),
Emmanuel Sandoval Garcia1
Estimated H-index: 1
(Edin.: University of Edinburgh)
+ 6 AuthorsEdinburgh type Diabetes Study Investigators3
Estimated H-index: 3
Source
Abstract
AIMS/HYPOTHESIS Our aim was to determine whether a range of prespecified retinal vessel traits were associated with incident diabetic retinopathy in adults with type 2 diabetes. METHODS In the prospective observational cohort Edinburgh Type 2 Diabetes Study of 1066 adults with type 2 diabetes, aged 60-75 years at recruitment, 718 were free from diabetic retinopathy at baseline. Baseline retinal traits including vessel widths, tortuosity (curvature) and fractal dimensions (network complexity), were quantified using fundus camera images and semiautomated software, and analysed using logistic regression for their association with incident diabetic retinopathy over 10 years. RESULTS The incidence of diabetic retinopathy was 11.4% (n = 82) over 10 years. After adjustment for a range of vascular and diabetes-related risk factors, both increased venular tortuosity (OR 1.51; 95% CI 1.15, 1.98; p = 0.003) and decreased fractal dimension (OR 0.75; 95% CI 0.58, 0.96; p = 0.025) were associated with incident retinopathy. There was no evidence of an association with arterial tortuosity, and associations between measurements of vessel widths and retinopathy lost statistical significance after adjustment for diabetes-related factors and vascular disease. Adding venular tortuosity to a model including established risk factors for diabetic retinopathy (HbA1c, BP and kidney function) improved the discriminative ability (C statistic increased from 0.624 to 0.640, p = 0.013), but no such benefit was found with fractal dimension. CONCLUSIONS/INTERPRETATION Increased retinal venular tortuosity and decreased fractal dimension are associated with incident diabetic retinopathy, independent of classical risk factors. There is some evidence that venular tortuosity may be a useful biomarker to improve the predictive ability of models based on established retinopathy risk factors, and its inclusion in further risk prediction modelling is warranted.
References38
Newest
#1Abirami Veluchamy (Dund.: University of Dundee)H-Index: 8
#2Lucia Ballerini (Dund.: University of Dundee)H-Index: 23
Last. Alex S. F. Doney (Dund.: University of Dundee)H-Index: 66
view all 22 authors...
Objective: The retina may provide readily accessible imaging biomarkers of global cardiovascular health. Increasing evidence suggests variation in retinal vascular traits is highly heritable. This ...
10 CitationsSource
#1Pablo Amil (UPC: Polytechnic University of Catalonia)H-Index: 5
#2Cesar F. Reyes-Manzano (IPN: Instituto Politécnico Nacional)H-Index: 2
Last. Cristina Masoller (UPC: Polytechnic University of Catalonia)H-Index: 36
view all 5 authors...
Retinal fundus imaging is a non-invasive method that allows visualizing the structure of the blood vessels in the retina whose features may indicate the presence of diseases such as diabetic retinopathy (DR) and glaucoma. Here we present a novel method to analyze and quantify changes in the retinal blood vessel structure in patients diagnosed with glaucoma or with DR. First, we use an automatic unsupervised segmentation algorithm to extract a tree-like graph from the retina blood vessel structur...
6 CitationsSource
#1Ronald Klein (UW: University of Wisconsin-Madison)H-Index: 215
#2Kristine E. Lee (UW: University of Wisconsin-Madison)H-Index: 61
Last. Barbara E. K. Klein (UW: University of Wisconsin-Madison)H-Index: 181
view all 9 authors...
Purpose To examine the relationships of retinal vessel geometric characteristics (RVGCs) to the incidence and progression of diabetic retinopathy (DR). Design Observational, prospective cohort study. Participants Nine hundred ninety-six persons with type 1 diabetes mellitus (T1DM) and 1370 persons with type 2 diabetes mellitus (T2DM) seen at a baseline examination who were eligible for follow-up examinations at subsequent 5-year intervals. A total of 3846 person-interval data from these follow-u...
13 CitationsSource
#1Adrián Colomer (Polytechnic University of Valencia)H-Index: 7
#2Valery Naranjo (Polytechnic University of Valencia)H-Index: 16
Last. Jose M. Mossi (Polytechnic University of Valencia)H-Index: 7
view all 4 authors...
Abstract This work investigates the characterization of bright lesions in retinal fundus images using texture analysis techniques. Exudates and drusen are evidences of retinal damage in diabetic retinopathy (DR) and age-related macular degeneration (AMD) respectively. An automatic detection of pathological tissues could make possible an early detection of these diseases. In this work, fractal analysis is explored in order to discriminate between pathological and healthy retinal texture. After a ...
6 CitationsSource
#1Sarah McGrory (Edin.: University of Edinburgh)H-Index: 9
#2Adele M. Taylor (Edin.: University of Edinburgh)H-Index: 18
Last. Tom MacGillivray (Edin.: University of Edinburgh)H-Index: 33
view all 13 authors...
Purpose: Semiautomated software applications derive quantitative retinal vascular parameters from fundus camera images. However, the extent of agreement between measurements from different applications is unclear. We evaluate the agreement between retinal measures from two software applications, the Singapore "I" Vessel Assessment (SIVA) and the Vessel Assessment and Measurement Platform for Images of the Retina (VAMPIRE), and examine respective associations between retinal and systemic outcomes...
26 CitationsSource
#1Yan Liu (PKU: Peking University)H-Index: 16
#1Yan Liu (PKU: Peking University)H-Index: 16
Last. Xuemin Li (PKU: Peking University)H-Index: 11
view all 7 authors...
Objective To explore the risk factors of diabetic retinopathy (DR) and sight-threatening diabetic retinopathy (STDR) among Chinese patients with diabetes. Design, setting and participants A cross-sectional investigation was performed in eight screening clinics in six provinces across mainland China. Information about the risk factors was recorded in screening clinics. Some risk factors (sex, age, diagnosis age, diabetes duration, systolic blood pressure (SBP), diastolic blood pressure, fasting b...
33 CitationsSource
#1Carol Y. Cheung (CUHK: The Chinese University of Hong Kong)H-Index: 64
#2Charumathi Sabanayagam (NUS: National University of Singapore)H-Index: 48
Last. Tien Yin Wong (NUS: National University of Singapore)H-Index: 178
view all 9 authors...
Aims/hypothesis We aimed to examine prospectively the association between a range of retinal vascular geometric variables measured from retinal photographs and the 6 year incidence and progression of diabetic retinopathy.
20 CitationsSource
#1Daniel Shu Wei Ting (NUS: National University of Singapore)H-Index: 21
#2Gavin Tan (NUS: National University of Singapore)H-Index: 30
Last. Tien Yin Wong (NUS: National University of Singapore)H-Index: 178
view all 10 authors...
Importance Optical coherence tomographic angiography (OCT-A) is able to visualize retinal microvasculature without the need for injection of fluorescein contrast dye. Nevertheless, it is only able to capture a limited view of macula and does not show leakage. Objectives To evaluate the retinal microvasculature using OCT-A in patients with type 2 diabetes as well as the association of OCT-A characteristics with diabetic retinopathy (DR) and systemic risk factors. Design, Setting, and Participants...
100 CitationsSource
#1Malin Lundberg Rasmussen (University of Southern Denmark)H-Index: 7
#2Rebecca Broe (University of Southern Denmark)H-Index: 9
Last. Jakob Grauslund (University of Southern Denmark)H-Index: 27
view all 7 authors...
Purpose To examine associations between retinal vascular geometry (tortuosity, branching coefficient [BC] and length–diameter ratio [LDR]) and diabetic proliferative retinopathy (PDR), nephropathy, and peripheral neuropathy in patients with type 1 diabetes mellitus (T1DM).
15 CitationsSource
#1WanFen Yip (NUS: National University of Singapore)H-Index: 8
#2Yih Chung Tham (NUS: National University of Singapore)H-Index: 22
Last. Carol Y. Cheung (CUHK: The Chinese University of Hong Kong)H-Index: 64
view all 9 authors...
PURPOSE: To compare three commonly used retinal vessel caliber measurement software systems, and propose an algorithm for conversion between measurement systems. METHODS: We used 120 retinal photographs to evaluate the agreement between three commonly used software (Retinal Analysis [RA], Integrative Vessel Analysis [IVAN], and Singapore I Vessel Assessment [SIVA]). Bland-Altman plots were used to evaluate agreement of retinal arteriolar (central retinal artery equivalent, CRAE) and venular (cen...
19 CitationsSource
Cited By1
Newest
#1Anchal Lal (Westmead Hospital)
#1Anchal Lal (USYD: University of Sydney)
Last. Aravinda Thiagalingam (Westmead Hospital)H-Index: 27
view all 7 authors...
Purpose/Aim of this study:Retinal vessel caliber is an independent risk marker of cardiovascular disease risk. However, variable mechanical delays in capturing retinal photographs and cardiac cycle-induced retinal vascular changes have shown to reduce the accuracy of retinal vessel caliber measurements, but this has only ever been investigated in healthy subjects. This cross-sectional study is the first study to investigate this issue in type 2 diabetes. The aim of this study was to determine wh...
Source