Biomedical subjects

Larry D Hubbard

Publications and source records attributed to Larry D Hubbard.

At least 19 recordsLinked to original sources

PubMed2007

Apolipoprotein e gene and age-related maculopathy in older individuals: the cardiovascular health study.

OBJECTIVE: To examine the association between the apolipoprotein E (APOE) gene and age-related maculopathy (ARM) in an older population. METHODS: Two thousand one hundred seventy persons 65 years and older sampled from 4 US communities had ARM signs assessed from retinal photographs using a modified Wisconsin Age-Related Maculopathy Grading System. DNA extracted from blood samples was analyzed for common APOE alleles. RESULTS: After controlling for age, sex, cigarette smoking, and other factors, white participants carrying the epsilon2 allele had an increased risk of late ARM (odds ratio, 2.53 [95% confidence interval, 1.08-5.90]) while carriers of the epsilon4 allele had a lower risk of late ARM (odds ratio, 0.69 [95% confidence interval, 0.19-2.50]). There were too few late ARM cases in African American individuals for analysis. CONCLUSION: APOE polymorphism is associated with late ARM in older white persons 65 years and older. Consistent with previous studies, the APOE epsilon2 allele is associated with a significant increased risk of late ARM development, whereas the epsilon4 allele may confer some protection.

Black or African American↗

PubMed2006

Age-related macular degeneration and risk for stroke.

BACKGROUND: Age-related macular degeneration (AMD) affects 7 million persons 40 years of age and older in the United States. Risk factors for the disease are similar to those for stroke. OBJECTIVE: To determine what relationship, if any, exists between AMD and incident clinical stroke. DESIGN: Prospective cohort study. SETTING: The population-based Atherosclerosis Risk in Communities Study, which was conducted in Minnesota, Maryland, Mississippi, and North Carolina. PATIENTS: 10 405 persons between 49 and 73 years of age who had no history of stroke or coronary heart disease. MEASUREMENTS: Participants had retinal photographs taken between 1993 and 1995. A standardized protocol was used to evaluate the photographs for the presence of drusen and other signs of AMD. Incident stroke events were identified and validated by reviewing case records. RESULTS: There were 498 early-stage and 10 late-stage cases of AMD in the cohort (n = 508). Over a 10-year period, 241 persons had an incident stroke event. After adjusting for age, sex, ethnicity, and site, the authors found that persons with early-stage AMD had a higher cumulative incidence of stroke than those without the disease (4.08% vs. 2.14%). The presence of early-stage AMD was associated with a higher adjusted risk for stroke (hazard ratio, 1.87 [95% CI, 1.21 to 2.88]). Further adjustment for systolic blood pressure, diabetes, cigarette smoking, and use of antihypertensive medications did not substantially alter this association (hazard ratio, 1.85 [CI, 1.19 to 2.87]). The authors found that the association between early-stage AMD and stroke varied by study site and patient ethnicity. Multivariable-adjusted hazard ratios were 3.15 and 1.07 in samples of white patients in Minnesota and Maryland, respectively; 3.77 in a sample of African-American patients in Mississippi; and 0.33 in a sample of mostly white patients (91%) in North Carolina. No site included sufficient numbers of both African-American and white patients to determine whether ethnicity contributed to the observed differences by study site. LIMITATIONS: There were few cases of late-stage AMD, and the cohort assembly method prohibited full understanding of variation by ethnicity and site. CONCLUSION: Middle-aged persons with signs of early-stage AMD have a higher risk for stroke independent of traditional stroke risk factors.

Aged↗

PubMed2006

Dietary glycemic index and carbohydrate in relation to early age-related macular degeneration.

BACKGROUND: Several dietary factors have been linked to age-related maculopathy (ARM), the early form of age-related macular degeneration, and there is reason to think that dietary carbohydrate may play a role in the development of ARM. OBJECTIVE: The purpose of the present study was to examine the relation between dietary carbohydrate quality, as measured by dietary glycemic index (GI) or total carbohydrate intake, and ARM. DESIGN: From the Nurses' Health Study, 1036 eyes from 526 Boston-area participants without a previous ARM diagnosis were included in the present study. The presence and degree of ARM were classified by the Age-Related Eye Diseases Study system. Long-term dietary information was based on data from an average of 4 food-frequency questionnaires collected over a 10-y period before the assessment of ARM. With eyes as the unit of analysis, we used a generalized estimating approach to logistic regression to estimate the odds ratios for ARM in a manner that accounted for the lack of independence between the 2 eyes from the same subject. RESULTS: After multivariate adjustment, dietary GI was related to ARM (specifically to retinal pigmentary abnormalities), whereas total carbohydrate intake was not. The odds ratio for ARM being in the highest tertile of dietary GI (> or =77.0) versus the lowest (<74.6) was 2.71 (95% CI: 1.24, 5.93; P for trend = 0.01). Neither dietary GI nor total carbohydrate intake was related to drusen. CONCLUSION: Our results suggest that dietary GI may be an independent risk factor for ARM.

Aged↗

PubMed2005

Retinal microvascular abnormalities and MRI-defined subclinical cerebral infarction: the Atherosclerosis Risk in Communities Study.

BACKGROUND AND PURPOSE: Retinal microvascular abnormalities reflect cumulative small vessel damage from elevated blood pressure and may reflect subclinical cerebral microvascular changes. We examined their associations with MRI-defined cerebral infarcts. METHODS: Population-based, cross-sectional study of 1684 persons 55 to 74 years of age without a history of clinical stroke, sampled from 2 US southeastern communities. Retinal photographs were obtained and graded for presence of retinal microvascular abnormalities, including arteriovenous nicking, focal arteriolar narrowing, retinal hemorrhages, soft exudates and microaneurysms. Photographs were also digitized, and retinal vessel diameters were measured and summarized as the arteriole-to-venule ratio (AVR). Cerebral MRI scans were graded for presence of cerebral infarct, defined as a lesion > or =3 mm diameter in a vascular distribution with typical imaging characteristics. RESULTS: There were a total of 183 MRI cerebral infarcts. After adjustment for age, gender, race, 6-year mean arterial blood pressure, diabetes, and other stroke risk factors, cerebral infarcts were associated with retinal microvascular abnormalities, with odds ratios 1.90 (95% CI, 1.25 to 2.88) for arteriovenous nicking, 1.89 (95% CI, 1.22 to 2.92) for focal arteriolar narrowing, 2.95 (95% CI, 1.30 to 6.71) for blot hemorrhages, 2.08 (95% CI, 0.69, 6.31) for soft exudates, 3.17 (95% CI, 1.05 to 9.64) for microaneurysms, and 1.74 (95% CI, 0.95 to 3.21) for smallest compared with largest AVR. In stratified analyses, these associations were only present in persons with hypertension. CONCLUSIONS: Retinal microvascular abnormalities are associated with MRI-defined subclinical cerebral infarcts independent of stroke risk factors. These data suggest that retinal photography may be useful for studying subclinical cerebrovascular disease in population-based studies.

Aged↗

PubMed2005

Retinal arteriolar narrowing, hypertension, and subsequent risk of diabetes mellitus.

BACKGROUND: Microvascular disease and hypertension have been linked with risk of diabetes mellitus. We examined the association of retinal arteriolar narrowing, a marker of chronic hypertension, with incident diabetes. METHODS: Prospective cohort study of 3251 nondiabetic persons aged 43 to 86 years living in Wisconsin. The diameters of retinal vessels were measured from baseline retinal photographs of participants. Retinal measurements were summarized as the retinal arteriole-to-venule ratio, with smaller ratios indicating narrower arteriolar diameters. Incident diabetes cases were ascertained at the 5-year and 10-year follow-up examinations. RESULTS: There were 249 incident diabetes cases. Participants with narrower retinal arteriolar diameters had a higher incidence of diabetes (cumulative incidences of 5.1%, 7.0%, 9.2%, and 11.7%, comparing decreasing quartiles of arteriole-to-venule ratio). After controlling for baseline casual blood glucose level, glycosylated hemoglobin level, body mass index, and other risk factors, retinal arteriolar narrowing was significantly associated with risk of incident diabetes (multivariable-adjusted relative risk, 1.53; 95% confidence interval, 1.03-2.27; comparing smallest to largest arteriole-to-venule ratio quartiles). Participants with both hypertension and retinal arteriolar narrowing had a 3-fold higher risk of incident diabetes (multivariable-adjusted relative risk, 3.41; 95% confidence interval, 1.66-6.98) than normotensive participants without arteriolar narrowing. CONCLUSIONS: Retinal arteriolar narrowing is related to risk of incident diabetes. These data suggest a possible link between systemic arteriolar narrowing associated with hypertension and diabetes development.

Adult↗

PubMed2005

Retinopathy and risk of congestive heart failure.

CONTEXT: Congestive heart failure (CHF) affects a substantial proportion of adults including those without preexisting coronary heart disease. The pathogenesis of CHF is uncertain, but microvascular disease has been hypothesized as a possible factor. OBJECTIVE: To determine the relationship of retinopathy, a marker of systemic microvascular disease, to risk of CHF. DESIGN, SETTING, AND PARTICIPANTS: Population-based, prospective 7-year cohort study in 4 US communities using the Atherosclerosis Risk in Communities Study database. Participants (n = 11,612, aged 49 to 73 years) had retinal photographs taken between 1993 and 1995. The photographs were graded according to a standardized protocol for the presence of retinopathy (eg, microaneurysms, retinal hemorrhages, soft exudates), arteriovenous nicking, focal arteriolar narrowing, and generalized arteriolar narrowing. MAIN OUTCOME MEASURES: Association between retinopathy and incident CHF, identified from hospitalization and death records. RESULTS: The 7-year cumulative incidence of CHF was 5.4% (492 events). Participants with retinopathy had a higher incidence of CHF compared with those without retinopathy (15.1% vs 4.8%, P<.001). After controlling for age, sex, race, preexisting coronary heart disease, mean arterial blood pressure, diabetes, glucose level, cholesterol level, smoking, body mass index, and study site, the presence of retinopathy was associated with a 2-fold higher risk of CHF (relative risk, 1.96; 95% confidence interval, 1.51-2.54). Among participants without preexisting coronary heart disease, diabetes, or hypertension, retinopathy was associated with a 3-fold higher risk of CHF (relative risk, 2.98; 95% confidence interval, 1.50-5.92). CONCLUSIONS: Retinopathy is an independent predictor of CHF, even in persons without preexisting coronary heart disease, diabetes, or hypertension. This suggests that microvascular disease may play an important role in the development of heart failure in the general population. Some asymptomatic persons with retinopathy on an ophthalmologic examination may benefit from further assessment of CHF risk.

Adult↗

PubMed2005

The Age-Related Eye Disease Study severity scale for age-related macular degeneration: AREDS Report No. 17.

OBJECTIVE: To develop a fundus photographic severity scale for age-related macular degeneration (AMD). METHODS: In the Age-Related Eye Disease Study, stereoscopic color fundus photographs were taken at baseline, at the 2-year follow-up visit, and annually thereafter. Photographs were graded for drusen characteristics (size, type, area), pigmentary abnormalities (increased pigment, depigmentation, geographic atrophy), and presence of abnormalities characteristic of neovascular AMD (retinal pigment epithelial detachment, serous or hemorrhagic sensory retinal detachment, subretinal or sub-retinal pigment epithelial hemorrhage, subretinal fibrous tissue). Advanced AMD was defined as presence of 1 or more neovascular AMD abnormalities, photocoagulation for AMD, or geographic atrophy involving the center of the macula. We explored associations among right eyes of 3212 participants between severity of drusen characteristics and pigmentary abnormalities at baseline and development of advanced AMD within 5 years of follow-up. RESULTS: A 9-step severity scale that combines a 6-step drusen area scale with a 5-step pigmentary abnormality scale was developed, on which the 5-year risk of advanced AMD increased progressively from less than 1% in step 1 to about 50% in step 9. Among the 334 eyes that had at least a 3-step progression on the scale between the baseline and 5-year visits, almost half showed stepwise progression through intervening severity levels at intervening visits. Replicate gradings showed agreement within 1 step on the scale in 87% of eyes. CONCLUSIONS: The scale provides convenient risk categories and has acceptable reproducibility. Progression along it may prove to be useful as a surrogate for progression to advanced AMD.

Atrophy↗

PubMed2005

Medication use and retinal vessel diameters.

PURPOSE: To study the influence of different medications on retinal vessel diameters. DESIGN: Cross-sectional study. METHODS: Retinal photographs in the Beaver Dam Eye Study (n = 4926, aged 43 to 84 years) were digitized, and the diameters of retinal vessels were measured. Participants' current medications were recorded at the examination. RESULTS: There were few significant associations between medication use and retinal vessel diameters. After adjusting for age, blood pressure, and other factors, participants who were using topical beta-blocker eyedrops had narrower retinal arteriolar (P = .05) and venular (P = .006) diameters than nonusers. Systemic beta-blocker was not associated with retinal vessel diameter size. CONCLUSION: We found few associations between current medication use and retinal vessel diameter. Retinal vessels were narrowed in those taking antiglaucoma medications, most strikingly in those prescribed topical beta-blockers, although such a relationship could not be established among those using systemic beta-blockers.

Adult↗

PubMed2005

Cardiovascular risk factors for retinal vein occlusion and arteriolar emboli: the Atherosclerosis Risk in Communities & Cardiovascular Health studies.

OBJECTIVE: To examine the associations of retinal vein occlusion and arteriolar emboli with cardiovascular disease. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Pooled from the Atherosclerosis Risk in Communities Study (n = 12,642; mean age, 60 years) and the Cardiovascular Health Study (n = 2824; mean age, 79 years). METHODS: Retinal vein occlusion and arteriolar emboli were identified from a single nonmydriatic retinal photograph using a standardized protocol. Photographs were also graded for arteriovenous nicking and focal arteriolar narrowing. All participants had a comprehensive systemic evaluation, including standardized carotid ultrasonography. MAIN OUTCOME MEASURES: Retinal vein occlusion and arteriolar emboli. RESULTS: Prevalences of retinal vein occlusion and arteriolar emboli were 0.3% (n = 39 cases) and 0.2% (n = 34 cases), respectively. After adjusting for age, retinal vein occlusion was associated with hypertension (odds ratio [OR], 2.96; 95% confidence interval [CI], 1.43-6.14), systolic blood pressure (BP) (OR, 4.12; 95% CI, 1.40-12.16; highest quartile vs. lowest), diastolic BP (OR, 2.64; 95% CI, 1.07-6.46; highest quartile vs. lowest), carotid artery plaque (OR, 5.62; 95% CI, 2.60-12.16), body mass index (OR, 3.88; 95% CI, 1.23-12.18; highest quartile vs. lowest), plasma fibrinogen (OR, 3.29; 95% CI, 1.08-10.02; highest quartile vs. lowest), arteriovenous nicking (OR, 4.09; 95% CI, 2.00-8.36), and focal arteriolar narrowing (OR, 5.17; 95% CI, 2.59-10.29). After adjusting for age, retinal arteriolar emboli were associated with hypertension (OR, 3.14; 95% CI, 1.44-6.84), systolic BP (OR, 3.46; 95% CI, 1.13-10.65; highest quartile vs. lowest), prevalent coronary heart disease (OR, 2.33; 95% CI, 1.01-5.42), carotid artery plaque (OR, 4.62; 95% CI, 1.85-11.57), plasma lipoprotein (a) (OR, 3.69; 95% CI, 1.20-11.41; highest quartile vs. lowest), plasma fibrinogen (OR, 3.09; 95% CI, 0.98-9.76; highest quartile vs. lowest), and current cigarette smoking (OR, 3.08; 95% CI, 1.47-6.47). Approximately a quarter of participants with retinal vein occlusion and arteriolar emboli had evidence of carotid artery plaque as defined from ultrasound. CONCLUSIONS: Retinal vein occlusion and retinal arteriolar emboli are associated with carotid artery disease, hypertension, and other cardiovascular risk factors.

Aged↗

PubMed2005

Estrogen replacement therapy and retinal vascular caliber.

OBJECTIVE: It is unclear if estrogen replacement therapy (ERT) has an effect on the retinal circulation. In the current study, we examine the association of ERT, female reproductive factors, and retinal vascular caliber. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Women participants aged 43 to 84 years living in Beaver Dam, Wisconsin. METHODS: Retinal photographs of participants taken at the baseline examination were digitized, and the diameters of arterioles and venules were measured using a well-established technique. Estrogen replacement therapy and female reproductive factors were ascertained by interview. MAIN OUTCOME MEASURES: Retinal arteriolar and venular diameters. RESULTS: Of the 2469 women participants with data for analysis, 10.5% were current users of ERT and 7.4% were past users. After adjusting for age, blood pressure (BP), body mass index, smoking, and other factors, women who were current users of ERT had narrower retinal arteriolar and venular diameters than those who were past users or never used, with mean arteriolar diameters of 167.6 microm for current users, 170.8 microm for past users, and 170.9 microm for those who never used (P = 0.009) and mean venular diameters of 239.9 microm for current users, 244.0 microm for past users, and 243.9 microm for those who never used (P = 0.02). There was a significant trend of increasing narrowing for both arterioles (P trend, 0.01) and venules (P trend, 0.007) with increasing duration of ERT. Associations were somewhat stronger in younger women and women without a history of hypertension and cigarette smoking. Female reproductive factors (e.g., age of menarche and pregnancy) were not associated with retinal vessel diameters. CONCLUSIONS: Estrogen replacement therapy is associated with narrower retinal vessel diameters, independent of BP and other vascular factors.

Adult↗

PubMed2005

Clinician versus reading center assessment of cytomegalovirus retinitis lesion size.

PURPOSE: To compare clinician and fundus photograph reading center assessments of the cytomegalovirus (CMV) retinitis area and change in the CMV retinitis area over time, and to investigate how these assessments correlate with the visual field (VF) of eyes with CMV retinitis. DESIGN: Analysis of pooled data from 2 multicenter randomized clinical trials and 1 prospective multicenter epidemiologic study. PARTICIPANTS: Ninety-five eyes of 79 patients. At baseline, each eye had CMV retinitis restricted to zone 1 and/or zone 2 (approximately the photographable postequatorial retina), as assessed by the evaluating clinician. METHODS: Comparison of CMV retinitis area, change in area over time as assessed by clinicians and a fundus photograph reading center, and correlation of these assessments with VF measurement. MAIN OUTCOME MEASURES: Cytomegalovirus retinitis area, change in CMV retinitis area over time, and VF score. RESULTS: Baseline assessments of the mean retinitis area were, by clinicians, 12.8% of the total retinal area and, by the reading center, 6.3% of the total retinal area (P<0.001). There was a positive correlation between clinician and reading center assessments of retinitis area at baseline (rho = 0.77 and P<0.0001 by Pearson correlation and rho = 0.54 and P<0.001 by concordance). Both clinician and reading center size measures correlated negatively with VF (Spearman correlation rhos = -0.38 and -0.52, respectively; P<0.001 each). Mean changes in area over a 3-month interval were, by clinicians, +1.2% and, by the reading center, +1.1% (P = 0.68). Regression analysis showed a positive concordance (rho = 0.42, P<0.001). Change in VF over a 3-month interval did not correlate with change in retinitis area as assessed by clinicians or the reading center. CONCLUSIONS: Awareness of the similarities and differences between clinician and reading center assessments of CMV retinitis area should permit clinicians to apply research data to clinical practice more effectively. Clinician assessment of retinitis area correlates negatively with VF, a clinically meaningful visual outcome in patients with CMV retinitis.

AIDS-Related Opportunistic Infections↗

PubMed2005

Retinal vessel diameters and incident open-angle glaucoma and optic disc changes: the Rotterdam study.

PURPOSE: It remains unclear whether reduced retinal blood flow and smaller arterioles, reported to exist in patients with open-angle glaucoma (OAG), are a cause or a consequence of ganglion cell loss. We examined whether baseline retinal vessel diameters were related to incident (i)OAG or incident optic disc changes in a population-based sample. METHODS: In the prospective population-based Rotterdam Study, baseline diameters of retinal arterioles and venules (1990-1993) were measured in digitized images of 3469 persons (aged 55 years and older) at risk for OAG. The follow-up examinations took place from 1997 to 1999. iOAG was based on the presence of incident glaucomatous visual field loss and/or incident glaucomatous optic neuropathy. Changes in neuroretinal rim, cup area, or vertical cup-to-disc ratio were calculated with a semiautomated image analyzer in 2782 persons. RESULTS: After a mean follow-up time of 6.5 years, 74 participants had iOAG. At baseline, the mean arteriolar diameter was 147.5 +/- 14.2 microm (SD) and the venular, 222.9 +/- 20.0 microm. Neither arteriolar diameters (odds ratio [OR] per SD decrease: 0.82; 95% confidence interval [CI]: 0.66-1.03) nor venular ones (OR per SD increase: 1.20; 95% CI: 0.95-1.53) were significantly related to iOAG. Baseline retinal vessel diameters did not predict changes in the optic disc. Additional adjustment for cardiovascular risk factors did not alter these results. CONCLUSIONS: The data show that baseline retinal vessel diameters did not influence the risk of iOAG or incident optic disc changes. These data provide no evidence for a retinal vascular role in the pathogenesis of OAG.

Aged↗

PubMed2004

Prospective cohort study of retinal vessel diameters and risk of hypertension.

OBJECTIVE: To examine the relation between diameters of the retinal arterioles and 10 year incidence of hypertension. DESIGN: Population based prospective cohort study. SETTING: Beaver Dam eye study. PARTICIPANTS: 2451 normotensive people aged 43 to 84 years. MAIN OUTCOME MEASURES: Diameters of retinal arterioles and venules measured from digitised photographs of the retina taken at baseline. Measurements summarised as the arteriole:venule ratio, with a lower ratio indicating smaller arteriolar diameters. Incident hypertension, defined as systolic blood pressure > or =140 mm Hg, diastolic blood pressure > or =90 mm Hg, or use of antihypertensive drugs during follow up. RESULTS: 721 participants developed hypertension over a 10 year period. Those with lower arteriole:venule ratio had a higher cumulative incidence of hypertension (incidences of 17.4%, 24.1%, 31.0%, and 45.1%, respectively, for decreasing quarters of distribution of arteriole:venule ratio). After adjustment for age and sex, participants with arteriole:venule ratios in the lowest quarter had a threefold higher risk of hypertension (odds ratio 2.95, 95% confidence interval 2.77 to 3.88) than those with ratios in the highest quarter. This association remained significant after further adjustment for baseline systolic and diastolic blood pressure and other risk factors (1.82, 1.39 to 2.40, for lowest versus highest ratio quarters). CONCLUSIONS: Narrowed retinal arterioles are associated with long term risk of hypertension, suggesting that structural alterations of the microvasculature may be linked to the development of hypertension.

Adult↗

PubMed2004

A prospective cohort study of retinal arteriolar narrowing and mortality.

The authors examined the relation of narrowed retinal arteriolar diameters, a marker of hypertensive damage, to mortality in a population-based cohort of 4,926 persons aged 43-84 years living in Wisconsin. A computer-assisted method was used to measure retinal vessel diameters from digitized retinal photographs taken at the baseline examination (1988-1990). These measurements were summarized as the retinal arteriole-to-venule ratio (AVR), with a smaller AVR indicating narrower arterioles compared with venules. Its relation to 10-year mortality was analyzed by using Cox proportional hazards models, adjusting for age, gender, blood pressure, diabetes, and other risk factors. No relation was found between smaller AVR and increased mortality. In relation to the largest AVR quartile, the adjusted relative risks of all-cause mortality were 0.93 for the smallest AVR quartile, 0.71 for the second AVR quartile, and 0.80 for the third AVR quartile. Results were largely similar in analyses of cause-specific mortality (vascular disease and non-vascular-disease mortality) and in subgroups stratified by age, gender, and diabetes and hypertension status. These data contrast with recent studies showing a relation between narrowed retinal arterioles and increased cardiovascular risk, suggesting that further research is needed to understand the systemic associations of retinal microvascular changes.

Adult↗

PubMed2004

Retinal arteriolar diameter and risk for hypertension.

BACKGROUND: Narrowing of the small arterioles has been hypothesized to contribute to the pathogenesis of hypertension, but prospective clinical data are lacking. OBJECTIVE: To examine the relation of retinal arteriolar narrowing to incident hypertension in healthy middle-aged persons. DESIGN: Prospective cohort study. SETTING: The population-based Atherosclerosis Risk in Communities Study, conducted in 4 U.S. communities. PARTICIPANTS: 5628 persons 49 to 73 years of age without preexisting hypertension. MEASUREMENTS: Diameters of retinal vessels were measured from digitized retinal photographs. A summary arteriole-to-venule ratio was computed as an indicator of generalized arteriolar narrowing; a lower ratio indicated greater narrowing. Areas of focal arteriolar narrowing were defined from photographs by using a standard protocol. Incident hypertension, defined as systolic blood pressure of 140 mm Hg or higher, diastolic blood pressure of 90 mm Hg or higher, or use of antihypertensive medication, was identified from the cohort. RESULTS: After 3 years of follow-up, 811 (14.4%) persons had developed hypertension. The incidence of hypertension was higher in persons with lower arteriole-to-venule ratios (incidence of 8.9%, 12.3%, 13.7%, 14.3%, and 22.3%, comparing decreasing quintiles of the ratio) and in persons with focal arteriolar narrowing than in those without focal arteriolar narrowing (25.1% vs. 13.0%). After the authors controlled for the average systolic and diastolic blood pressures over the preceding 6 years, body mass index, waist-to-hip ratio, and other risk factors, the odds of developing hypertension were approximately 60% higher in persons with lower arteriole-to-venule ratios (odds ratio, 1.62 [95% CI, 1.21 to 2.18] comparing lowest to highest quintile; P = 0.006 for trend) and focal arteriolar narrowing (odds ratio, 1.61 [CI, 1.27 to 2.04]; P < 0.001). CONCLUSIONS: Smaller retinal arteriolar diameters are independently associated with incident hypertension, which suggests that arteriolar narrowing may be linked to the occurrence and development of hypertension.

Aged↗

PubMed2004

Comparability of two fundus photograph reading centers in grading cytomegalovirus retinitis progression.

PURPOSE: To compare grading of cytomegalovirus retinitis progression by two different fundus photograph reading centers (FPRCs). DESIGN: Patients with AIDS followed in an ophthalmology service were enrolled in a prospective epidemiologic study of the prevalence and incidence of resistant cytomegalovirus in vitro. METHODS: We compared masked replicate gradings by two different FPRCs of monthly fundus photographs for retinitis progression (onset of a separate new lesion or expansion of an existing lesion by > or =one-half disk diameter). RESULTS: For 77 patients, Kaplan-Meier plots of progression over time were similar between FPRCs (median time to progression, 65 vs 69 days). Agreement between FPRCs was 51% (kappa [kappa] =.37, "fair") on exact visit of progression (28 patients) or on absence of progression through follow-up (11 patients) and 62% (kappa =.38) on progression visit +/- 1 month. Eight of 12 patients with progression graded as more than 1 month apart were only 2 months apart. Considering each monthly visit as a choice point, overall agreement on progression was 78% (kappa =.55, "moderate"). Baseline evaluation of retinitis showed 95% agreement on presence/absence and a concordance correlation coefficient of.75 for extent in combined zones 1 and 2. Rates of retinal loss over follow-up were estimated as 2.8%/month vs 2.0%/month (P =.015). CONCLUSIONS: By adopting similar protocols and procedures, different FPRCs can achieve good agreement on presence and extent of cytomegalovirus retinitis. Further efforts to harmonize evaluation through ongoing comparison of gradings would likely improve agreement on retinitis progression.

AIDS-Related Opportunistic Infections↗

PubMed2004

Computer-assisted measurement of retinal vessel diameters in the Beaver Dam Eye Study: methodology, correlation between eyes, and effect of refractive errors.

OBJECTIVE: Narrowed retinal arterioles may independently predict cardiovascular disease. We describe a computer-assisted method to measure retinal vessel diameters from digitized fundus photographs in a large population, and examine the correlation of retinal vessel diameters between eyes and whether refractive errors affect these measurements. DESIGN AND POPULATION: Population-based, cross-sectional study in Beaver Dam, Wisconsin (n = 4926; age, 43-84 years). METHODS: Retinal photographs were digitized, and all arterioles and venules located in an area 0.5 to 1 disc diameter from the optic disc were measured with the aid of computer software. MAIN OUTCOME MEASURES: Summary of retinal arteriolar and venular diameters, and the ratio of their diameters (arteriole:venule ratio [AVR]). RESULTS: Correlation between right and left eyes was substantial for retinal arteriolar diameters (Pearson correlation coefficient, rho = 0.71) and venular diameters (rho = 0.74), and moderate for the AVR (rho = 0.49). The inverse association of higher blood pressure and smaller retinal arteriolar diameters was similar using data from either one eye or two eyes; arteriolar diameters decreased by 4.1 microm (right eyes), 4.0 microm (left eyes), and 4.0 microm (mean of both eyes) with each 10-mmHg increase in mean arterial blood pressure. A myopic refraction was associated with smaller retinal vessel diameters; arteriolar diameters decreased by 2.8 microm and venular diameters by 3.3 microm with each -1.0-diopter shift towards myopia. However, the pattern and strength of the association of blood pressure and retinal vessel diameters were not altered by variations in refractive errors. CONCLUSIONS: There is good correlation of retinal vessel diameters between eyes. A myopic refraction is associated with smaller retinal vessel diameters. The association of retinal arteriolar diameters and blood pressure seems similar using data from either one eye or two eyes, and is minimally affected by refraction. These data suggest that measurement of retinal vessel diameters from one eye without regard to its refractive status may provide adequate information indicative of a person's retinal vessel caliber if information from two eyes and refraction is unavailable.

Adult↗

PubMed2004

Retinal microvascular abnormalities and renal dysfunction: the atherosclerosis risk in communities study.

Microvascular disease has been linked with renal dysfunction in patients with diabetes. The aim of this study was to examine the association of retinal microvascular abnormalities to renal dysfunction among participants of the Atherosclerosis Risk in Communities Study, a population-based investigation in four U.S. communities. At the third examination (1993 to 1995), retinal photography was performed and the presence of retinal microvascular abnormalities was documented using a standard grading protocol. Renal dysfunction was defined as an increase in serum creatinine of at least 0.4 mg/dl or a death or hospitalization as a result of chronic kidney disease between the second (1990 to 1992) and fourth (1996 to 1998) examinations. Among 10,056 people who were included in the study, 270 (2.7%) developed renal dysfunction. After controlling for age, gender, race, diabetes, BP, and other risk factors, individuals with retinopathy (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.4 to 2.8), microaneurysms (OR, 2.0; 95% CI, 1.3 to 3.1), retinal hemorrhages (OR, 2.6; 95% CI, 1.6 to 4.0), soft exudates (OR, 2.7; 95% CI, 1.6 to 4.8), and arteriovenous nicking (OR, 1.4; 95% CI, 1.0 to 1.9) were more likely to develop renal dysfunction than individuals without these abnormalities. Retinal microvascular abnormalities are associated with renal dysfunction, suggesting that common systemic microvascular processes may underlie the development of microvascular damage in the eye and kidneys.

Arteriosclerosis↗