Weiler Danielle L, Engelke Carla B, Moore Anna L O, Harrison Wendy W
*OD, FAAO †OD ‡OD, PhD, FAAO Southern Arizona Veterans Affairs Health Care System, Tucson, Arizona (DLW, CBE, ALOM); Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California (DLW, CBE, ALOM); and Midwestern University, Arizona College of Optometry, Glendale, Arizona (WWH).
Optom Vis Sci. 2015 Mar;92(3):384-91. doi: 10.1097/OPX.0000000000000484.
Earlier identification of diabetic eye disease is an important research effort. Retinopathy is widely acknowledged but retinal vessel changes are not evaluated as stringently. Here, we create a multivariate model for the association between retinal vessel tortuosity (RVT) and other health factors in patients with diabetes.
Three hundred eyes of 150 patients with diabetes were included. Three investigators independently reviewed telemedicine fundus photographs and scored the level of diabetic retinopathy (DR) and RVT. These scores were evaluated for agreement and averaged. Also collected were age, duration of diabetes, presence or absence of diabetic nephropathy or neuropathy, blood pressure, total cholesterol, and hemoglobin A1c. A regression model evaluating the association of tortuosity with other factors was created.
There was very high agreement between the three graders for level of DR (κ = 0.84). Agreement between the three graders for RVT varied substantially: poor for venous tortuosity (κ = 0.23) and fair for arteriole tortuosity (κ = 0.44) and overall gut tortuosity (κ = 0.42). The overall gut tortuosity was the most reproducible for the graders with a correlation coefficient of 0.923. There were univariate associations between arteriole tortuosity and venous tortuosity, DR level, and cholesterol. The selected best multivariate model found arteriole tortuosity to be associated with DR and cholesterol levels.
First, RVT, particularly for venules, is difficult to grade consistently; therefore, future studies examining tortuosity should focus on arterioles. Second, the model indicates that there is an association between vessel changes, DR, and systemic cholesterol levels. Although DR and RVT are readily available to assess concurrently on a photograph, the addition of cholesterol to this model indicates that patients with RVT may warrant further follow-up on health factors, such as cholesterol levels.
早期识别糖尿病眼病是一项重要的研究工作。视网膜病变已得到广泛认可，但视网膜血管变化的评估并不那么严格。在此，我们建立了一个多变量模型，用于研究糖尿病患者视网膜血管迂曲度（RVT）与其他健康因素之间的关联。
纳入150例糖尿病患者的300只眼睛。三名研究人员独立审查远程医疗眼底照片，并对糖尿病视网膜病变（DR）水平和RVT进行评分。对这些评分进行一致性评估并取平均值。同时收集的信息还包括年龄、糖尿病病程、是否存在糖尿病肾病或神经病变、血压、总胆固醇和糖化血红蛋白A1c。建立了一个评估迂曲度与其他因素关联的回归模型。
三名分级人员对DR水平的一致性非常高（κ = 0.84）。三名分级人员对RVT的一致性差异很大：静脉迂曲度的一致性较差（κ = 0.23），小动脉迂曲度的一致性一般（κ = 0.44），总体血管迂曲度的一致性一般（κ = 0.42）。总体血管迂曲度对分级人员来说是最具可重复性的，相关系数为0.923。小动脉迂曲度与静脉迂曲度、DR水平和胆固醇之间存在单变量关联。所选的最佳多变量模型发现小动脉迂曲度与DR和胆固醇水平相关。
首先，RVT，尤其是静脉的RVT，难以进行一致的分级；因此，未来研究迂曲度时应侧重于小动脉。其次，该模型表明血管变化、DR和全身胆固醇水平之间存在关联。虽然DR和RVT可以在照片上同时方便地进行评估，但将胆固醇纳入该模型表明，RVT患者可能需要进一步随访健康因素，如胆固醇水平。
