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M. B. Sasongko, P. B. Aguirre, J. J. Wang, K. Donaghue, N. Cheung, A. Jenkins, T. Y. Wong; Retinal Vessel Tortuosity and Incidence of Diabetic Retinopathy in Type 1 Diabetes. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1240.
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Retinal vascular caliber changes have been associated with microvascular complications in type 1 diabetes (T1D). In this study, we aimed to examine the prospective association of retinal vessel tortuosity and other vascular morphological parameters with incident diabetic retinopathy (DR) in young people with T1D.
A cohort of 510 initially retinopathy-free patients with T1D, aged 12 to 20 years, were enrolled during 1990 to 2002 from a tertiary hospital in Sydney. Participants had 7-field stereoscopic retinal photographs of both eyes taken at baseline and follow-up. Incident DR was graded according to the modified Airlie House classification from follow-up photographs. Parameters of retinal vascular morphology including branching angle, tortuosity, optimality deviation, and length to diameter ratio (LDR) were quantitatively measured from baseline photographs using a computer-based program following a standardized protocol. Associations between these retinal vascular parameters with incident DR were assessed using multiple logistic regression, adjusted for relevant covariates.
Over 5 years of follow-up, 214 (41.9%) patients developed DR. Those who developed DR were generally older, had longer diabetes duration, and higher HbA1c at baseline. After adjusting for age and sex, each standard deviation (SD) increase of both arteriolar and venular tortuosity was associated with increased risk of developing DR within 5 years of follow-up (Odds Ratio 2.90 [95% CI 1.63 - 5.14] and 1.82 [1.11 - 2.96] respectively). Branching angle, optimality deviation, and LDR were not found to be associated with incident DR. Association of vessel tortuosity persisted after adjusting for BMI, cholesterol level, blood pressure, diabetes duration, HbA1c, vessel caliber, and other diabetic complications.
Retinal arteriolar and venular tortuosity was associated with the development of DR in T1D, independent of standard retinopathy risk factors. This suggests that abnormalities of retinal vascular morphology may represent early microvascular changes in the development of DR.
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