Document Detail

Methods for evaluation of retinal microvascular abnormalities associated with hypertension/sclerosis in the Atherosclerosis Risk in Communities Study.
MedLine Citation:
PMID:  10599656     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To develop protocols to photograph and evaluate retinal vascular abnormalities in the Atherosclerosis Risk in Communities (ARIC) Study; to test reproducibility of the grading system; and to explore the relationship of these microvascular changes with blood pressure. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: Among 4 examination centers, 11,114 participants (48-73 years of age) at their third triennial examination, after excluding persons with diabetes from this analysis. METHODS: One eye of each participant was photographed by technicians with nonmydriatic fundus cameras. Reading center graders evaluated focal arteriolar narrowing, arteriovenous (AV) nicking, and retinopathy by examining slides on a light box and measured diameters of all vessels in a zone surrounding the optic disc on enhanced digitized images. To gauge generalized narrowing, vessel diameters were combined into central arteriolar and venular equivalents with formulas adjusting for branching, and the ratio of equivalents (A/V ratio) was calculated. MAIN OUTCOME MEASURES: Retinal vascular abnormalities, mean arteriolar blood pressure (MABP). RESULTS: Among 11,114 participants, photographs were obtained of 99%, with quality sufficient to perform retinal evaluations in 81%. In the 9040 subjects with usable photographs, A/V ratio (lower values indicate generalized arteriolar narrowing) ranged from 0.57 to 1.22 (median = 0.84, interquartile range = 0.10), focal arteriolar narrowing was found in 7%, AV nicking in 6%, and retinopathy in 4%. Because of attrition of subjects and limitation of methods, prevalence of abnormality was likely underestimated. Controlling for gender, race, age, and smoking status, these retinal changes were associated with higher blood pressure. For every 10-mmHg increase in MABP, A/V ratio decreased by 0.02 unit (P < 0.0001), focal arteriolar narrowing had an odds ratio (OR) of 2.00 (95% confidence interval [CI] = 1.87-2.14), AV nicking had an OR of 1.25 (95% CI = 1.16-1.34), and retinopathy had an OR of 1.25 (95% CI = 1.15-1.37). For any degree of generalized narrowing, individuals with focal narrowing had MABP approximately 8 mmHg higher than those without (P < 0.0001). Masked replicate assessment of a sample found the following reproducibility: for A/V ratio, correlation coefficient = 0.79 and median absolute difference = 0.03; for focal arteriolar narrowing, kappa = 0.45; for AV nicking, kappa = 0.61; and for retinopathy, kappa = 0.89. CONCLUSION: Protocols have been developed for nonmydriatic fundus photography and for evaluation of retinal vascular abnormalities. Several microvascular changes were significantly associated with higher blood pressure; follow-up will show whether these are predictive of later cerebrovascular or cardiovascular disease independently of other known risk factors.
L D Hubbard; R J Brothers; W N King; L X Clegg; R Klein; L S Cooper; A R Sharrett; M D Davis; J Cai
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Ophthalmology     Volume:  106     ISSN:  0161-6420     ISO Abbreviation:  Ophthalmology     Publication Date:  1999 Dec 
Date Detail:
Created Date:  1999-12-21     Completed Date:  1999-12-21     Revised Date:  2010-01-13    
Medline Journal Info:
Nlm Unique ID:  7802443     Medline TA:  Ophthalmology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  2269-80     Citation Subset:  IM    
ARIC Retinal Reading Center, Department of Ophthalmology & Visual Sciences, University of Wisconsin-Madison, 53705-2397, USA.
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MeSH Terms
Blood Pressure
Capillaries / pathology
Coronary Artery Disease / complications*,  epidemiology
Cross-Sectional Studies
Diagnostic Techniques, Ophthalmological*
Fundus Oculi
Hypertension / complications*
Image Processing, Computer-Assisted / methods
Middle Aged
Photography / methods
Reproducibility of Results
Retinal Diseases / classification,  diagnosis*,  etiology
Retinal Vessels / pathology*
Risk Factors
Sclerosis / complications
United States / epidemiology
Grant Support
Comment In:
Prehosp Disaster Med. 2009 Sep-Oct;24(5):395-7   [PMID:  20066640 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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