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      Retinal Microvascular Change in Hypertension as measured by Optical Coherence Tomography Angiography

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          Abstract

          Many studies have reported the effect of hypertension on microcirculation of the retina. Advance of optical coherence tomography angiography (OCTA) allows us more detailed observations of microcirculation of the retina. Therefore, we compared OCTA parameters between chronic hypertension (disease duration of at least 10 yrs; Group A, 45 eyes), relieved hypertensive retinopathy (grade IV HTNR < 1 yr prior; Group B, 40 eyes), and normal controls [Group C (50 eyes) ≥ 50 yrs old and Group D (50 eyes) < 50 yrs old]. A 3 × 3 mm macular scan was performed in each group by OCTA. In vessel density of 3 mm full, group A and B were significantly decreased compared to normal control group (Group A vs. C; 19.4 mm −1 vs. 20.1 mm −1, Group B vs. D; 19.8 mm −1 vs. 21.8 mm −1, all p < 0.05). In foveal avascular zone, group A and B were significantly increased compared to normal control group (Group A vs. C; 0.35 mm 2 vs. 0.30 mm 2, Group B vs. D; 0.36 mm 2 vs. 0.29 mm 2, all p < 0.05). OCTA is useful for examining retinal microcirculatory changes in hypertension and we confirmed that hypertension affects the OCTA parameters. Considering the effect of hypertension on the change of microvasculature, care is required in the interpretation of OCTA parameters in various ophthalmic condition.

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          2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension.

          Hypertension is estimated to cause 4.5% of current global disease burden and is as prevalent in many developing countries, as in the developed world. Blood pressure-induced cardiovascular risk rises continuously across the whole blood pressure range. Countries vary widely in capacity for management of hypertension, but worldwide the majority of diagnosed hypertensives are inadequately controlled. This statement addresses the ascertainment of overall cardiovascular risk to establish thresholds for initiation and goals of treatment, appropriate treatment strategies for non-drug and drug therapies, and cost-effectiveness of treatment. Since publication of the WHO/ISH Guidelines for the Management of Hypertension in 1999, more evidence has become available to support a systolic blood pressure threshold of 140 mmHg for even 'low-risk' patients. In high-risk patients there is evidence for lower thresholds. Lifestyle modification is recommended for all individuals. There is evidence that specific agents have benefits for patients with particular compelling indications, and that monotherapy is inadequate for the majority of patients. For patients without a compelling indication for a particular drug class, on the basis of comparative trial data, availability, and cost, a low dose of diuretic should be considered for initiation of therapy. In most places a thiazide diuretic is the cheapest option and thus most cost effective, but for compelling indications where other classes provide additional benefits, even if more expensive, they may be more cost effective. In high-risk patients who attain large benefits from treatment, expensive drugs may be cost effective, but in low-risk patients treatment may not be cost-effective unless the drugs are cheap.
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            A review of optical coherence tomography angiography (OCTA)

            Optical coherence tomography angiography (OCTA) is a new, non-invasive imaging technique that generates volumetric angiography images in a matter of seconds. This is a nascent technology with a potential wide applicability for retinal vascular disease. At present, level 1 evidence of the technology’s clinical applications doesn’t exist. In this paper, we introduce the technology, review the available English language publications regarding OCTA, and compare it with the current angiographic gold standards, fluorescein angiography (FA) and indocyanine green angiography (ICGA). Finally we summarize its potential application to retinal vascular diseases. OCTA is quick and non-invasive, and provides volumetric data with the clinical capability of specifically localizing and delineating pathology along with the ability to show both structural and blood flow information in tandem. Its current limitations include a relatively small field of view, inability to show leakage, and proclivity for image artifact due to patient movement/blinking. Published studies hint at OCTA’s potential efficacy in the evaluation of common ophthalmologic diseases such age related macular degeneration (AMD), diabetic retinopathy, artery and vein occlusions, and glaucoma. OCTA can detect changes in choroidal blood vessel flow and can elucidate the presence of choroidal neovascularization (CNV) in a variety of conditions but especially in AMD. It provides a highly detailed view of the retinal vasculature, which allows for accurate delineation of the foveal avascular zone (FAZ) in diabetic eyes and detection of subtle microvascular abnormalities in diabetic and vascular occlusive eyes. Optic disc perfusion in glaucomatous eyes is notable as well on OCTA. Further studies are needed to more definitively determine OCTA’s utility in the clinical setting and to establish if this technology may offer a non-invasive option of visualizing the retinal vasculature in detail.
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              Retinal arteriolar narrowing and risk of coronary heart disease in men and women. The Atherosclerosis Risk in Communities Study.

              Microvascular processes have been hypothesized to play a greater role in the development of coronary heart disease (CHD) in women than in men; however, prospective clinical data are limited. To examine the association between retinal arteriolar narrowing, a marker of microvascular damage from hypertension and inflammation, and incident CHD in healthy middle-aged women and men. The Atherosclerosis Risk in Communities Study, an ongoing prospective, population-based cohort study in 4 US communities initiated in 1987-1989. Retinal photographs were taken in 9648 women and men aged 51 to 72 years without CHD at the third examination (1993-1995). To quantify retinal arteriolar narrowing, the photographs were digitized, individual arteriolar and venular diameters were measured, and a summary arteriole-to-venule ratio (AVR) was calculated. Risk of CHD associated with retinal arteriolar narrowing. During an average 3.5 years of follow-up, 84 women and 187 men experienced incident CHD events. In women, after controlling for mean arterial blood pressure averaged over the previous 6 years, diabetes, cigarette smoking, plasma lipid levels, and other risk factors, each SD decrease in the AVR was associated with an increased risk of any incident CHD (relative risk [RR], 1.37; 95% confidence interval [CI], 1.08-1.72) and of acute myocardial infarction (RR, 1.50; 95% CI, 1.10-2.04). In contrast, AVR was unrelated to any incident CHD in men (RR, 1.00; 95% CI, 0.84-1.18) or to acute myocardial infarction (RR, 1.08; 95% CI, 0.85-1.38). Retinal arteriolar narrowing is related to risk of CHD in women but not in men, supporting a more prominent microvascular role in the development of CHD in women than in men. Future work is needed to confirm these findings.
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                Author and article information

                Contributors
                kimjy@cnu.ac.kr
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                17 January 2019
                17 January 2019
                2019
                : 9
                : 156
                Affiliations
                [1 ]ISNI 0000 0001 0722 6377, GRID grid.254230.2, Department of Ophthalmology, , Chungnam National University College of Medicine, ; Daejeon, Republic of Korea
                [2 ]ISNI 0000 0001 0722 6377, GRID grid.254230.2, Department of Cardiology in Internal Medicine, , Chungnam National University College of Medicine, ; Daejeon, Republic of Korea
                Author information
                http://orcid.org/0000-0003-3679-1310
                Article
                36474
                10.1038/s41598-018-36474-1
                6336859
                30655557
                d58ca2a6-b465-4951-bc6a-cae8f2c44ea4
                © The Author(s) 2019

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 16 August 2018
                : 25 November 2018
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