To evaluate ocular manifestations in primary hypertension

To evaluate ocular manifestations in primary severe hypertension.: A retrospective chart review of 100 eyes of 50 patients in age group 45-60 years diagnosed with primary severe hypertension (systolic blood pressure [SBP] ≥ 180 mm Hg and diastolic blood pressure [DBP] ≥ 110 mm of Hg) in a tertiary hospital in 6 months from December 2018 to May 2019. Vision with evaluated with Snellen’s chart, fundus was examined with IDO, DO, +90D, +20 D lens and OCT was done.: Mean age were found to be 51 years ±9.8 under treatment for essential hypertension. Fundus findings included Arteriolar Narrowing (both Focal and Generalized arteriolar Narrowing), Hard Exudates, Cotton Wool Patches, Flame Shaped Haemorrhages, Optic disc edema, Disc haemorrhages. OCT findings included Macular Oedema, Irregular reflection, Sub Retinal Fluid, Inner Retinal Fluid, Hyper Reflective Dots.: This study can be used as an early diagnostic tool in hypertension. Severe hypertension may lead to may exudative changes. With Arteriolar Narrowing and Hyperreflective Dots within retina as the most common findings. Awareness should be spread regarding ophthalmological examination among patients so that timely measures can be initiated to stop the progression of disease.

Blood Pressure Increase and Microvascular Dysfunction Accelerate Arterial Stiffening in Children: Modulation by Physical Activity

BackgroundAtherosclerotic remodeling starts early in life and can accelerate in the presence of cardiovascular risk (CV) factors. Regular physical activity (PA) can mitigate development of large and small artery disease during lifespan. We aimed to investigate the association of changes in body mass index (BMI), blood pressure (BP), PA behavior and retinal microvascular diameters with large artery pulse wave velocity (PWV) in prepubertal children over 4 years.MethodsThe school-based prospective cohort study included 262 children initially aged 6–8 years, assessing the above CV risk factors and retinal vessels by standardized procedures at baseline (2014) and follow-up (2018). PWV was assessed by an oscillometric device at follow-up.ResultsChildren with increased systolic BP over 4 years showed higher PWV at follow-up (β [95% CI] 0.006 [0.002 to 0.011] mmHg per unit, P = 0.002). In contrast, increased vigorous PA corresponded to a lower PWV at follow-up (β [95% CI] −0.009 [−0.018 to <0−0.001] 10 min/day per unit, P = 0.047). Progression of retinal arteriolar narrowing and venular widening were linked to a higher PWV after 4 years (β [95% CI] −0.014 [−0.023 to −0.004] 0.01 changes per unit, P = 0.003).ConclusionIncrease in systolic BP and progression of microvascular dysfunction were associated with higher PWV after 4 years. Children with increasing levels of vigorous PA were found to have lower PWV at follow-up. Habitual vigorous PA has the potential to decelerate the process of early vascular aging in children and may thus help counteract CV disease development later in life.Clinical Trial RegistrationClinicalTrials.gov, Identifier: NCT03085498.

Ocular siderosis: a misdiagnosed cause of visual loss due to ferrous intraocular foreign bodies—epidemiology, pathogenesis, clinical signs, imaging and available treatment options

Purpose The purpose of this paper is to provide a meaningful literature review about the epidemiology, pathogenesis, clinical signs, imaging and treatment of ocular siderosis (OS). Methods A computerized search from inception up to March 2020 of the online electronic database PubMed was performed using the following search strings: “ocular siderosis” and “siderosis bulbi”. The reference list in each article was analysed for additional relevant publications. Results OS is an uncommon cause of visual loss due to a retained ferrous intraocular foreign body (IOFB). It may develop from 18 days to years after a penetrating trauma that usually occurs during hammering. On average, patients are 22–25 years old, and the vast majority are male. The most common cause of OS development is delayed presentation by the patient or missed diagnosis of IOFB after trauma. The pathophysiology is not fully understood; nevertheless, iron deposition causes hydroxyl radical formation, which damages photoreceptors and retinal pigment epithelium. Moreover, iron damages retinal vessels with consequent inner retinal layers degeneration. The most frequent signs are iris heterochromia, pupillary mydriasis, cataract development and retinal arteriolar narrowing with pigmentary retinal degeneration. Electroretinogram signs, in particular, b-wave amplitude reduction, arise earlier than clinical signs. Orbital CT scans and ultrasonography play an essential role in detecting IOFBs. Treatment depends on the IOFB location and OS development. However, it is crucial to remove the IOFB after OS development because visual acuity and clinical signs may improve. Anterior segment IOFBs can be dislodged using an intraocular magnet (IOM) or forceps through limbal paracentesis. In contrast, posterior segment IOFBs require a pars plana vitrectomy and IOM or forceps to be removed through an enlarged sclerotomy or the limbus. Conclusion Recommending the usage of protective glasses and spreading knowledge about OS may further benefit patient care.

Abstract 01: Retinal Microvascular Signs and White Matter MRI Findings: The Atherosclerosis Risk in Communities Neurocognitive Study

Introduction: Cerebrovascular small vessel disease, seen on brain imaging as lacunes and white matter hyperintensities (WMH), is a substrate for dementia in older adults. Diffusion tensor imaging (DTI) is thought to provide early signs of loss of white matter (WM) integrity due to microvascular disease and predicts WM hyperintensity volume. Retinal fundus photography provides surrogate measures of cerebral microvasculature. No studies have quantified the long-term association between retinal signs and DTI measures. Hypothesis: Microvascular retinal signs measured in midlife are associated with small vessel disease measured on brain magnetic resonance imaging (MRI) 18 years later, including reduced WM microstructural integrity (lower fractional anisotrophy [FA] and greater mean diffusivity [MD] by DTI), greater WM hyperintensity volume and greater lacune prevalence. Methods: In a biracial prospective cohort study, retinal signs were measured using fundus photography (1993-1995) with 3-T magnetic resonance imaging conducted in 2011-13. Multivariable-adjusted linear regression was used to quantify the relationships of retinal signs with WM measures. Prevalence of lacunar infarcts by retinal sign status was estimated using log binomial regression. Analyses were adjusted for age [linear and quadratic terms], education, sex, race, intracranial volume, body mass index, smoking, diabetes, hypertension, and ≥1 APOE ε4 alleles. Results: In 1829 men and women (60% [N=1100] female, 27% [N=489] black race, aged 50-72 years when retinal signs were measured), a binary measure comprised of two retinal signs suggestive of arteriolar damage due to hypertension (focal arteriolar narrowing and/or arteriovenous nicking) was associated with worse (lower) FA (standardized β=-0.19, 95% confidence interval [CI]=-0.35, -0.02), worse (higher) MD (β=0.15, 95% CI=0.00, 0.30), greater WM hyperintensity volume (β=0.15, 95% CI=0.01, 0.30), and greater prevalence of lacunes (prevalence ratio=1.33, 95% CI: 0.99, 1.80). Generalized arteriolar narrowing, measured as the central retinal arteriolar equivalent (CRAE, narrowest quartile vs. widest three quartiles) was associated with worse FA (β=-0.13, 95% CI=-0.24, -0.01) and worse MD (β=0.12, 95% CI=0.01, 0.23). Results did not differ by sex, race, hypertension status or APOE ε4 genotype. No associations were found for retinopathy, but only 56 participants had retinopathy. Conclusions: Consistent with prior work, and as expected based on a common underlying pathology, retinal signs predicted WM disease and lacunar infarcts 18 years later. Novel to this study, we found that retinal signs related to arteriolar damage also predicted loss of white matter microvascular integrity measured using DTI.

Hypertensive Retinopathy

Hypertension (HT) affects several systems such as cardiovascular, renal, cerebrovascular, and retina. Fundus changes caused by HT include arteriolar narrowing, arteriovenous nicking, cotton-wool spots, intraretinal hemorrhage, and papilledema. These changes can be observed using various methods, including fundus examination, optical coherence tomography angiography (OCTA). OCTA is fast, quantitative, non-invasive, and easy to perform for examining hypertensive changes. Hypertensive changes can be grouped in hypertensive retinopathy (HR), hypertensive choroidopathy, and hypertensive optic neuropathy. HR acts as a predictor of systemic morbidity and mortality due to target-organ damage. Treatment of HR is mainly medical and should include evaluation of secondary causes.

Quantitative Measurements of Enlarged Perivascular Spaces in the Brain are Associated with Retinal Microvascular Parameters in Older Community-Dwelling Subjects

ABSTRACTBackgroundPerivascular Spaces (PVS) become increasingly visible with advancing age on brain MRI, yet their relationship to morphological changes in the underlying microvessels remains poorly understood. Retinal and cerebral microvessels share morphological and physiological properties. We compared computationally-derived PVS morphologies with retinal vessel morphologies in older people.MethodsWe analysed data from community-dwelling individuals who underwent multimodal brain MRI and retinal fundus camera imaging at mean age 72.55 years (SD=0.71). We assessed centrum semiovale PVS computationally to determine PVS total volume and count, and mean per-subject individual PVS length, width and size. We analysed retinal images using the VAMPIRE software suite, obtaining the Central Retinal Artery and Vein Equivalents (CRVE and CRAE), Arteriole-to-Venule ratio (AVR), and fractal dimension (FD) of both eyes. We investigated associations using general linear models, adjusted for age, gender, and major vascular risk factors.ResultsIn 381 subjects with all measures, increasing total PVS volume and count were associated with decreased CRAE in the left eye (volume β=-0.170, count β=-0.184, p<0.001). No associations of PVS with CRVE were found. The PVS total volume, individual width and size increased with decreasing FD of the arterioles (a) and venules (v) of the left eye (total volume: FDa β=-0.137, FDv β=-0.139, p<0.01; width: FDa β=-0.144, FDv β=-0.158, p<0.01; size: FDa β=-0.157, FDv β=-0.162, p<0.01).ConclusionsIncrease in PVS number and size visible on MRI reflect arteriolar narrowing and lower retinal arteriole and venule branching complexity, both markers of impaired microvascular health. Computationally-derived PVS metrics may be an early indicator of failing vascular health and should be tested in longitudinal studies.

Prevalence and Association of Retinal Vascular Abnormalities:a study among the Elderly in Rural Southwestern Harbin, China

Background: Data on the retinal vessel morphology in the north China are still scarce so far. The study aimed to evaluate retinal vascular abnormalities and their associations with self-reported diagnosis of cardiovascular and cerebrovascsular diseases in a rural adult population of northeast China. Methods: A population-based, cross-sectional study was conducted, using the cluster random sampling method. two 40° non-mydriatic retinal photographs of one eye from each participant was taken using a fundus camera. The main Outcome measures: the prevalence of focal and general arteriolar narrowing, arteriovenous nicking, arteriolar sheathing, and retinopathy. Clinical data including general parameters and system diseases were collected by physical and laboratory examination and standard questionnaires.The association between retinal vascular abnormalities and cardiovascular and cerebrovascsular diseases and their risk factors was determined using logistic regressions. Results: Among 6 267 participants with an age ≥50 years, photographs were obtained of 99.2%, with quality sufficient to perform retinal evaluations in 82.5% (from 5172 participants). Among them, 432 subjects had diabetes. The average age was 61.25±7.37 years. The prevalence of focal arteriolar narrowing, arteriovenous nicking, arteriolar sheathing, retinopathy and general arteriolar narrowing were 9.1%, 8.9 %, 5.0 %, 6.6 % and 6.2% respectively. All the retinal lesions were associated with hypertension (all P<0.01). No significant associations were found between the subjects with or without the presence of diabetes mellitus (P >0.05). After adjusting for age, gender and left/right eyes, hypertension, hyperlipidemia, diabetes mellitus, habits of past or current smoking and alcohol drinking, arteriovenous nicking was strongly associated with the self-reported histories of coronary heart diseases (OR, 1.44; 95% CI, 1.09, 1.89) and retinopathy was significantly associated with self-reported histories of stroke (OR, 2.05; 95% CI, 1.18, 3.57). Conclusions: Retinopathy is associated with self-reported diagnosis stroke while arteriovenous nicking is associated with the self-reported diagnosis of coronary heart diseases, but the rest retinal lesions are not consistently related to the self-reported diagnosis of coronary heart diseases. Thus, an examination of retinal microvascular characteristics may offer clues to the cardiovascular and cerebrovascsular diseases and could be a potentially novel risk marker.

Morphological and Otsu’s Thresholding-Based Retinal Blood Vessel Segmentation for Detection of Retinopathy

Retinal blood vessel segmentation is crucial as it is the earliest process in measuring various indicators of retinopathy sign such as arterial-venous nicking, and focal arteriolar and generalized arteriolar narrowing. The segmentation can be clinically used if its accuracy is close to 100%. In this study, a new method of segmentation is developed for extraction of retinal blood vessel. In this paper, we present a new automated method to extract blood vessels in retinal fundus images. The proposed method comprises of two main parts and a few subcomponents which include pre-processing and segmentation. The main focus for the segmentation part is two morphological reconstructions which are the morphological reconstructions followed by the morphological top-hat transform. Then the technique to classify the vessel pixels and background pixels is Otsu’s Thresholding. The image database used in this study is the High Resolution Fundus Image Database (HRFID). The developed segmentation method accuracies are 95.17%, 92.06% and 94.71% when tested on dataset of healthy, diabetic retinopathy (DR) and glaucoma patients respectively. Overall, the performance of the proposed method is comparable with existing methods with overall accuracies were more than 90 % for all three different categories: healthy, DR and glaucoma.