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Relationship of Retinal Vascular Caliber With Diabetes and Retinopathy

The Multi-Ethnic Study of Atherosclerosis (MESA)

¹ Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
³ Department of Ophthalmology, University of Wisconsin Medical School Madison, Madison, Wisconsin
⁴ Division of Epidemiology and Clinical Research, National Eye Institute, National Institutes of Health, Bethesda, Maryland
⁵ Singapore Eye Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

Address correspondence and reprint requests to Tien Yin Wong, MD, PhD, Centre for Eye Research Australia, University of Melbourne, 32 Gisborne Street, Victoria 3002, Australia. E-mail: twong{at}unimelb.edu.au

OBJECTIVE—To examine the relationship of retinal vascular caliber with diabetes, glycemia, and diabetic retinopathy.

RESEARCH DESIGN AND METHODS—Population-based study using data from the Multi-Ethnic Study of Atherosclerosis (MESA), comprising 5,976 individuals (whites, blacks, Hispanics, and Chinese) residing in six U.S. communities who were free of clinical cardiovascular disease at baseline. Retinal vascular caliber was measured from digital retinal photographs.

RESULTS—There were 4,585 individuals with normal fasting glucose (NFG), 499 with impaired fasting glucose (IFG), 165 with diabetes with retinopathy signs, and 727 with diabetes without retinopathy signs. After multivariate analysis, retinal arteriolar caliber increased from 143.8 µm in subjects with NFG to 144.5 µm in IFG and 146.1 µm in diabetes (P < 0.001 for trend). Retinal venular caliber increased from 214.4 µm in NFG to 216.7 µm in IFG and 218.0 µm in diabetes (P < 0.001 for trend). Retinal venular caliber was significantly larger with increasing levels of fasting glucose and A1C. In a subgroup analysis by ethnicity, the association between wider arteriolar caliber and diabetes was evident in whites only, whereas wider venular caliber and diabetes was evident in Hispanics and Chinese only. In people with diabetes, eyes with retinopathy had larger retinal venular but not arteriolar caliber.

CONCLUSIONS—Retinal arteriolar and venular calibers are larger in individuals with diabetes, but the pattern of associations appears to vary by ethnicity. Retinal venular caliber is additionally associated with retinopathy signs. These findings add further to the concept that variations in retinal vascular caliber may reflect early diabetic microvascular damage.

Abbreviations: CRAE, central retinal artery equivalent • CRP, C-reactive protein • CRVE, central retinal vein equivalent • MESA, Multi-Ethnic Study of Atherosclerosis • NFG, normal fasting glucose • WESDR, Wisconsin Epidemiological Study of Diabetic Retinopathy

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