Patients with diabetic retinopathy have high retinal venous pressure

Anna K Cybulska-Heinrich, Michael Baertschi, Cay Christian Loesche, Andreas Schoetzau, Katarzyna Konieczka, Tatjana Josifova, Josef Flammer, Anna K Cybulska-Heinrich, Michael Baertschi, Cay Christian Loesche, Andreas Schoetzau, Katarzyna Konieczka, Tatjana Josifova, Josef Flammer

Abstract

Background: The introduction of ophthalmodynamometric measurement of retinal venous pressure (RVP) now permits the quantification, or at least an approximation, of the real pressure in the retinal veins.

Methods: We measured the RVP of healthy control subjects, patients with diabetes without diabetic retinopathy (nonDR) and patients with diabetes and diabetic retinopathy (DR).

Results: The mean ± SD RVP for the control, nonDR and DR groups were 23.4 ± 7.33, 22.5 ± 5.78 and 37.7 ± 10.1 mmHg, respectively. In the diabetes patients with DR, the RVP was markedly and significantly increased, and this result was significantly age dependent. RVP was not increased in the group of diabetes patients without DR. In our tested population, diabetes had a minor influence on intraocular pressure.

Conclusion: Regardless of the cause, a marked increase in RVP in diabetes patients with DR is clinically relevant, as it reduces perfusion pressure and increases transmural pressure. The reduced perfusion pressure contributes to hypoxia, and the increased transmural pressure can facilitate retinal edema. Diabetes is an increasing burden, and DR is one of its most severe complications. Strategies to recognize the risk for DR and to develop personalized prevention and therapy therefore have major implications.

Trial registration: ClinicalTrials.gov ID: NCT01771835.

Keywords: Contact lens dynamometer (CLD); Diabetic retinopathy (DR); Ocular dynamic force (ODF); Ophthalmodynamometry; Personalized prevention; Retinal venous pressure (RVP); Spontaneous venous pulsation.

Figures

Figure 1
Figure 1
Dependence of IOP on age for each study group (unmatched data). Scatter plot of the IOP (mmHg) of each study group (unmatched data) plotted versus the age (years) of the subjects. Straight lines indicate regression slopes. Black circle control group, red triangle nonDR group, green cross DR group. In all of the groups, IOP had only a very slight tendency to increase with age.
Figure 2
Figure 2
Dependence of RVP on age for each study group (unmatched data). Scatter plot of the RVP (mmHg) of each study group (unmatched data) plotted versus the age (years) of the subjects. Straight lines indicate regression slopes. Black circle control group, red triangle nonDR group, green cross DR group. RVP increased markedly in patients with DR, but not in diabetes patients without DR.
Figure 3
Figure 3
Dependence of IOP on age for each study group (age-matched data). Scatter plot of the IOP (mmHg) of each study group (matched data) plotted versus the age (years) of the subjects. Regression line is not shown as the slope was not significantly different from zero. Black circle control group, red triangle nonDR group, green cross DR group.
Figure 4
Figure 4
Dependence of RVP on age for each study group (age-matched data). Scatter plot of the RVP (mmHg) of each study group (matched data) plotted versus the age (years) of the subjects. Regression line is not shown as the slope was not significantly different from zero. Black circle control group, red triangle nonDR group, green cross DR group.

References

    1. Congdon NG, Friedman DS, Lietman T. Important causes of visual impairment in the world today. JAMA. 2003;290(15):2057–60. doi: 10.1001/jama.290.15.2057.
    1. Nguyen TT, Wang JJ, Wong TY. Retinal vascular changes in pre-diabetes and prehypertension: new findings and their research and clinical implications. Diabetes Care. 2007;30(10):2708–15. doi: 10.2337/dc07-0732.
    1. Klein R, Klein BE, Moss SE, Cruickshanks KJ. Relationship of hyperglycemia to the long-term incidence and progression of diabetic retinopathy. Arch Intern Med. 1994;154(19):2169–78. doi: 10.1001/archinte.1994.00420190068008.
    1. Klein R, Klein BE, Moss SE, Cruickshanks KJ. The Wisconsin epidemiologic study of diabetic retinopathy XIV Ten-year incidence and progression of diabetic retinopathy. Arch Ophthalmol. 1994;112(9):1217–28. doi: 10.1001/archopht.1994.01090210105023.
    1. Ergul A. Endothelin-1 and diabetic complications: focus on the vasculature. Pharmacol Res. 2011;63(6):477–82. doi: 10.1016/j.phrs.2011.01.012.
    1. Crosby-Nwaobi R, Heng LZ, Sivaprasad S. Retinal vascular calibre, geometry and progression of diabetic retinopathy in type 2 diabetes mellitus. Ophthalmologica. 2012;228(2):84–92. doi: 10.1159/000337252.
    1. Liew G, Mitchell P, Rochtchina E, Wong TY, Hsu W, Lee ML, et al. Fractal analysis of retinal microvasculature and coronary heart disease mortality. Eur Heart J. 2011;32(4):422–9. doi: 10.1093/eurheartj/ehq431.
    1. Roy MS, Klein R, Janal MN. Retinal venular diameter as an early indicator of progression to proliferative diabetic retinopathy with and without high-risk characteristics in African Americans with type 1 diabetes mellitus. Arch Ophthalmol. 2011;129(1):8–15. doi: 10.1001/archophthalmol.2010.340.
    1. Stodtmeister R. The pulsation and the pressure of the central retinal vein and their relation to glaucoma damage and therapy. Klin Monatsbl Augenheilkd. 2008;225(7):632–6. doi: 10.1055/s-2008-1027233.
    1. Meyer-Schwickerath R, Stodtmeister R, Hartmann K. Non-invasive determination of intracranial pressure. Physiological basis and practical procedure. Klin Monatsbl Augenheilkd. 2004;221(12):1007–11. doi: 10.1055/s-2004-813820.
    1. Kain S, Morgan WH, Yu DY. New observations concerning the nature of central retinal vein pulsation. Br J Ophthalmol. 2010;94(7):854–7. doi: 10.1136/bjo.2009.169813.
    1. Balaratnasingam C, Morgan WH, Hazelton ML, House PH, Barry CJ, Chan H, et al. Value of retinal vein pulsation characteristics in predicting increased optic disc excavation. Br J Ophthalmol. 2007;91(4):441–4. doi: 10.1136/bjo.2006.105338.
    1. Jonas JB. Central retinal artery and vein collapse pressure in eyes with chronic open angle glaucoma. Br J Ophthalmol. 2003;87(8):949–51. doi: 10.1136/bjo.87.8.949.
    1. Stodtmeister R, Ventzke S, Spoerl E, Boehm AG, Terai N, Haustein M, et al. Enhanced pressure in the central retinal vein decreases the perfusion pressure in the prelaminar region of the optic nerve head. Invest Ophthalmol Vis Sci. 2013;54(7):4698–704. doi: 10.1167/iovs.12-10607.
    1. Jonas JB, Harder B. Ophthalmodynamometric differences between ischemic vs nonischemic retinal vein occlusion. Am J Ophthalmol. 2007;143(1):112–6. doi: 10.1016/j.ajo.2006.09.019.
    1. Stodtmeister R, Oppitz T, Spoerl E, Haustein M, Boehm AG. Contact lens dynamometry: the influence of age. Invest Ophthalmol Vis Sci. 2010;51(12):6620–4. doi: 10.1167/iovs.09-4594.
    1. Sekhon JS. Multivariate and propensity score matching software with automated balance optimization: the matching package for R. J Stat Softw. 2011;42(7):1–52.
    1. RDC Team . R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2012.
    1. Jonas JB. Ophthalmodynamometric determination of the central retinal vessel collapse pressure correlated with systemic blood pressure. Br J Ophthalmol. 2004;88(4):501–4. doi: 10.1136/bjo.2003.030650.
    1. Flammer J, Konieczka K, Bruno RM, Virdis A, Flammer AJ, Taddei S. The eye and the heart. Eur Heart J. 2013;34(17):1270–8. doi: 10.1093/eurheartj/eht023.
    1. Flammer J, Konieczka K, Flammer AJ. The primary vascular dysregulation syndrome: implications for eye diseases. EPMA J. 2013;4(1):14. doi: 10.1186/1878-5085-4-14.
    1. Burgansky-Eliash Z, Nelson DA, Bar-Tal OP, Lowenstein A, Grinvald A, Barak A. Reduced retinal blood flow velocity in diabetic retinopathy. Retina. 2010;30(5):765–73. doi: 10.1097/IAE.0b013e3181c596c6.
    1. Burgansky-Eliash Z, Barak A, Barash H, Nelson DA, Pupko O, Lowenstein A, et al. Increased retinal blood flow velocity in patients with early diabetes mellitus. Retina. 2012;32(1):112–9. doi: 10.1097/IAE.0b013e31821ba2c4.
    1. Klein R, Klein BE, Moss SE, Wong TY, Sharrett AR. Retinal vascular caliber in persons with type 2 diabetes: the Wisconsin Epidemiological Study of Diabetic Retinopathy: XX. Ophthalmology. 2006;113(9):1488–98. doi: 10.1016/j.ophtha.2006.03.028.
    1. Kifley A, Wang JJ, Cugati S, Wong TY, Mitchell P. Retinal vascular caliber, diabetes, and retinopathy. Am J Ophthalmol. 2007;143(6):1024–6. doi: 10.1016/j.ajo.2007.01.034.
    1. Flammer J, Mozaffarieh M, Bebie H. Basic sciences in ophthalmology—physics and chemistry. Heidelberg: Springer; 2013.

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