Quantitative Retinal Vascular Caliber Changes as Potential Biomarkers for Diabetes， Diabetic Retinopathy and Cataracts

Jie Jin Wang

Westmead Millennium Institute University of Sydney

Microvascular disease has been indicated to play an important role in the development of the diabetes， the metabolic syndrome and diabetic retinopathy. In recent years， research conducted in population-based studies has shown that quantitative assessment of retinal vascular caliber may provide information for risks of systemic and ocular conditions. However， there remains inconsistency in the direction and patterns of associations of retinal vascular caliber changes. It appears that impaired autoregulation of small arterioles， indicated by retinal arteriolar and venular caliber changes， operates during the early phase of diabetes onset； while wider retinal venules may be an indicator of various pathological processes leading to the development of impaired fasting glucose， and also a subsequent sign of established diabetes and diabetic microvascular complications. These retinal vessel structural changes could be biomarkers of microvascular dysfunction during the development and the course of diabetes and diabetic complications.Cataract has been linked with cigarette smoking， metabolic abnormalities (e.g.， diabetes， steroid use) possibly related to changes in nitric oxide metabolism. However， there are few data of a potential association of retinal vascular caliber with cataract. in the BMES， we found significant associations between either narrower retinal arterioles or narrower venules and higher risk of posterior sub-capsular (PSC) cataract or cataract surgery. These associations became attenuated or non-significant when both vessel calibers were included in the same model， though such an approach would over-adjust the underlying factors if both vessel calibers represent the same underlying risk factor(s). Therefore， we speculate that common factors link to both retinal vessel narrowing and the development of either PSC or nuclear cataract， and that retinal vessel narrowing could be a biomarker for cataract development. However， the exact pathophysiological mechanisms linking retinal narrowing and cataract are unclear. In summary， the examples above suggest that vessel caliber might be used as a clinical biomarker of diabetic retinopathy and cataract， and quantitative assessment of retinal vessel caliber might be a useful clinical investigation tool.

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