Abstract
Aims
To determine if a range of pre-specified retinal vessel traits were associated with incident diabetic retinopathy in adults with type 2 diabetes.
Methods
In the prospective observational cohort Edinburgh Type 2 Diabetes Study of 1066 adults with type 2 diabetes, aged 60-75 years at recruitment, 718 were free from diabetic retinopathy at baseline. Baseline retinal traits included vessel widths, tortuosity (curvature), and fractal dimensions (network complexity), were quantified using fundus camera images and semi-automated software, and analysed using logistic regression for their association with incident diabetic retinopathy over 10-years.
Results
The incidence of diabetic retinopathy was 11.4% (n = 82) over 10 years. After adjustment for a range of vascular and diabetes-related risk factors, both increased venular tortuosity (odds ratio 1.51, 95% confidence interval 1.15 to 1.98, p = 0.003), and decreased fractal dimension (odds ratio 0.75, 95% confidence interval 0.58 to 0.96, p = 0.025) were associated with incident retinopathy. There was no evidence of an association with arterial tortuosity and associations between measurements of vessel widths and retinopathy lost statistical significance after adjustment for diabetes related factors and vascular disease. Adding venular tortuosity to a model including established risk factors for diabetic retinopathy (HbA1c, blood pressure and kidney function) improved the discriminative ability (c-statistic increased from 0.624 to 0.640, p = 0.013), but no such benefit was found with fractal dimension.
Conclusions
Increased retinal venular tortuosity and decreased fractal dimension are associated with incident diabetic retinopathy, independent of classical risk factors. There is some evidence that venular tortuosity may be a useful biomarker to improve the predictive ability of models based on established retinopathy risk factors, and its inclusion in further risk prediction modelling is warranted.
To determine if a range of pre-specified retinal vessel traits were associated with incident diabetic retinopathy in adults with type 2 diabetes.
Methods
In the prospective observational cohort Edinburgh Type 2 Diabetes Study of 1066 adults with type 2 diabetes, aged 60-75 years at recruitment, 718 were free from diabetic retinopathy at baseline. Baseline retinal traits included vessel widths, tortuosity (curvature), and fractal dimensions (network complexity), were quantified using fundus camera images and semi-automated software, and analysed using logistic regression for their association with incident diabetic retinopathy over 10-years.
Results
The incidence of diabetic retinopathy was 11.4% (n = 82) over 10 years. After adjustment for a range of vascular and diabetes-related risk factors, both increased venular tortuosity (odds ratio 1.51, 95% confidence interval 1.15 to 1.98, p = 0.003), and decreased fractal dimension (odds ratio 0.75, 95% confidence interval 0.58 to 0.96, p = 0.025) were associated with incident retinopathy. There was no evidence of an association with arterial tortuosity and associations between measurements of vessel widths and retinopathy lost statistical significance after adjustment for diabetes related factors and vascular disease. Adding venular tortuosity to a model including established risk factors for diabetic retinopathy (HbA1c, blood pressure and kidney function) improved the discriminative ability (c-statistic increased from 0.624 to 0.640, p = 0.013), but no such benefit was found with fractal dimension.
Conclusions
Increased retinal venular tortuosity and decreased fractal dimension are associated with incident diabetic retinopathy, independent of classical risk factors. There is some evidence that venular tortuosity may be a useful biomarker to improve the predictive ability of models based on established retinopathy risk factors, and its inclusion in further risk prediction modelling is warranted.
| Original language | English |
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| Journal | Diabetologia |
| DOIs | |
| Publication status | Published - 30 Jan 2021 |