Retinal Arterial Tortuosity In Young Indians: A Cross Sectional Study

摘要

Background/aims:To assess the retinal arterial tortuosity and the association between tortuosity and certain health indices in healthy young to middle aged Indians.Methods:This cross-sectional study included 80 fundus (right and left eyes) of 40 healthy adults aged 18 to 45 years, (18 M, 22 F; mean age 35.1yrs) who were characterized by determination of retinal arterial tortuosity using a three-level grading scale (straight, wavy, tortuous),after screening for arterial blood pressure and diabetes.Results:Higher grades of tortuosity were common among the study subjects, 20 (25 %) had straight retinal arteries, 24 (30 %) had wavy arteries and 36(45%) had tortuous arteries when reported as the average of right and left eyes because the correspondence between right and left eyes was high. Increasing values of mean arterial blood pressure were associated with decreasing levels of retinal arterial tortuosity even in pre-hypertensive individuals while age, sex and gender did not significantly contribute towards dimorphism.Conclusion:Considerable variations in retinal vasculature in terms of tortuosity can be observed among young healthy subjects. Determinants of disparities in retinal arterial layout are mainly associated with blood pressure levels while age, gender and right vs left laterality do not appear to much affect the wavy patterns of vessels in this study population. Assessment of retinal vascular tortuosity can provide a means of monitoring systemic health to recognize what determines how retinal vessels are laid out early in life, before systemic risk factors and clinical disease have developed. Introduction Considerable variations in retinal vasculature in terms of waviness or tortuosity can be observed in young healthy subjects. Even though there is little evidence to support the prognostic value of a single fundoscopic examination ,incidental observations of remarkable degrees of straightness or tortuosity of retinal blood vessels may be considered as potential signs of morbidity. (Cheung et al.,2011) Decreased retinal arterial tortuosity has frequently been associated with hypertension. (Hayreh et al.,1989) Recent studies have demonstrated that less tortuous retinal arteries are linked with increased risk of death from ischaemic heart disease, independent of systolic blood pressure.( Witt et al.,2006) Few studies have been performed on the normal variation in retinal vessel tortuosity and its association with fitness and well being. The relative contribution of demographic and health indices on retinal vessel tortuosity, and the association between retinal vascular morphology and development of systemic risk factors in healthy adults can serve as a means of monitoring health before clinical disease outcomes Methods Participants The cross-sectional study comprised of 80 Fundus (Right and Left eye) of 40 adults of north Indian origin (18 M, 22 F ; aged 18 to 45 years; mean age 35.1years ) who reported at ophthalmology dept of BHU ,Varanasi, UP, India during the period of June to August, 2012. Systemic exclusion criteria were known diabetes, hypertension or cardiovascular disease. Ophthalmic exclusion criteria included cataract and lens opacities near the optical axis of the eye and other manifest eye diseases. To avoid confounding of undiagnosed diabetes or residual hypertension, all participants underwent screening through an oral glucose tolerance test and Blood Pressure (BP) evaluation using digital monitors. Hypertension was defined as systolic BP >/=140 mmHg or diastolic BP >/=90 mmHg and /or current use of antihypertensive medicine. Individuals with systolic BP 120 Results All eyes included had a visual acuity of at least 0.9. Retinal arterial tortuosity grading demonstrated that 10(25%) subjects had predominantly straight arteries (grade1), 12(30%) had wavy arteries (grade 2), and 18 (45%) had tortuous arteries (grade 3). (Table 1)