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Review
. 2017:2017:2562759.
doi: 10.1155/2017/2562759. Epub 2017 Apr 13.

Noninvasive Retinal Markers in Diabetic Retinopathy: Advancing from Bench towards Bedside

Søren Leer Blindbæk  1   2 , Thomas Lee Torp  1   2 , Kristian Lundberg  1   2 , Kerstin Soelberg  1   3   4   5 , Anna Stage Vergmann  1   2 , Christina Døfler Poulsen  1   2   6 , Ulrik Frydkjaer-Olsen  1   2 , Rebecca Broe  1   2 , Malin Lundberg Rasmussen  1   2 , Jimmi Wied  1   2 , Majbrit Lind  1   2 , Anders Højslet Vestergaard  1   2 , Tunde Peto  2   7   8 , Jakob Grauslund  1   2
Affiliations
Review

Noninvasive Retinal Markers in Diabetic Retinopathy: Advancing from Bench towards Bedside

Søren Leer Blindbæk et al. J Diabetes Res. 2017.

Abstract

The retinal vascular system is the only part of the human body available for direct, in vivo inspection. Noninvasive retinal markers are important to identity patients in risk of sight-threatening diabetic retinopathy. Studies have correlated structural features like retinal vascular caliber and fractals with micro- and macrovascular dysfunction in diabetes. Likewise, the retinal metabolism can be evaluated by retinal oximetry, and higher retinal venular oxygen saturation has been demonstrated in patients with diabetic retinopathy. So far, most studies have been cross-sectional, but these can only disclose associations and are not able to separate cause from effect or to establish the predictive value of retinal vascular dysfunction with respect to long-term complications. Likewise, retinal markers have not been investigated as markers of treatment outcome in patients with proliferative diabetic retinopathy and diabetic macular edema. The Department of Ophthalmology at Odense University Hospital, Denmark, has a strong tradition of studying the retinal microvasculature in diabetic retinopathy. In the present paper, we demonstrate the importance of the retinal vasculature not only as predictors of long-term microvasculopathy but also as markers of treatment outcome in sight-threatening diabetic retinopathy in well-established population-based cohorts of patients with diabetes.

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Figures

Figure 1
Figure 1
Cropped retinal image (a) and the corresponding skeletonized image (b) where all vessels are traced. Processed by fractal analyzer.
Figure 2
Figure 2
Retinal image processed by SIVA and used for analysis of vascular caliber, fractal dimension, tortuosity, length-diameter ratio, and branching coefficients. Marked are zone A, zone B, and zone C, located 0–0.5, 0.5–1.0, and 0.5–2.0 disc diameters from the center of the disc. In zones B and C, retinal arterioles have been marked in red and venules in blue.
Figure 3
Figure 3
(a) Retinal image processed by Oxymap. (b) Vessels colored in accordance with the level of oxygen in the vessel.
Figure 4
Figure 4
Retinal images processed by IVAN and used for vascular caliber analysis. Images are divided into zone A and zone B located 0–0.5 and 0.5–1.0 disc diameters from the center. Arterioles are marked in red and venules in blue. (a) Regular IVAN, centered at the optic disc. (b) Modified IVAN, centered at the fovea.
See this image and copyright information in PMC

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