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Wendy Watkins Harrison, Danielle Weiler, Carla B Engelke, Matthew Rhodes, Camille Bishop; The relationship between arteriole tortuosity and retinopathy in type II diabetic patients with peripheral neuropathy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6352.
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© ARVO (1962-2015); The Authors (2016-present)
Tortuosity is an often overlooked sign of retinal changes in diabetes (DM). Previously our group evaluated the relationship between diabetic retinopathy (DR) and arteriole tortuosity in type II DM patients. Here we look at this relationship in DM patients with diagnosed peripheral neuropathy (PN). PN is a complication of DM that affects millions of Americans and commonly occurs concurrently with DR and other ocular and retinal neuron changes.
Retinal photographs of 248 eyes of 124 patients (aged 62.8 ± 7.9 years) with type II DM were included. They were selected sequentially using ICD-9 codes for PN from the VA telemedicine database. Almost all were male (96.8%). Health factors were also gathered and included: age, race, gender, HbA1c, blood pressure, duration of DM, number and classes of medications, HDL, LDL and total cholesterol levels. Three graders, masked to each other and the health test results, evaluated and graded arteriole tortuosity in the photos on a scale of 1-3, along with the standard ETDRS grading of DR. These 3 scores were averaged together to give a DR score and an arteriole tortuosity score for each patient. Using a general estimating equation for correlated eyes, multivariate regression models for both DR and tortuosity were developed. For collinear factors, one was selected, so each model entered 8 possible associated factors.
41% of the eyes had DR and 59% did not. The average tortuosity score was 1.59 ± 0.63 indicating mild to moderate changes for most eyes, 8.6% were graded tortuous (2.667 and above). The selected regression model of DR found DR to be associated with tortuosity, HbA1c, LDL, and insulin treatment. The model for tortuosity included only HbA1c and DR.
It is clear there is a relationship between the arteriole tortuosity and DR in patients who have PN. As expected a high percentage of patients with PN and DR showed tortuous arteriole changes. These results align with work which shows DR is associated with HbA1c and insulin use in DM patients with and without PN. This is also in line with our previous work that found a link between tortuosity, retinopathy and cholesterol levels in a large group with DM. More follow up is needed to determine specific differences between groups with and without PN.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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