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ADAPTIVE OPTICS CAMERA ENABLES TO DESCRIBE DIFFERENT PATTERNS OF RETINAL VASCULATURE IN HYPERTENSION AND TYPE 2 DIABETES

Objective: Retinal vasculature is a well-known target of early organ damage in hypertension and diabetes. Adaptive optics, a totally noninvasive, accurate method, allows the precise evaluation of retinal arteriolar and venular networks. The aim of this study was to describe arteriolar and venular vasculature in hypertensive and diabetic subjects by comparison to controls using adaptive optics camera. Design and method: Hypertensive patients (group H), diabetic subjects without overt diabetic retinopathy (group D) and non-hypertensive non-diabetic control subjects (group C) were recruited. Adaptive Optics RTX1® Camera was used to capture three consecutive images along the supero-temporal arteriole and vein (avoiding any arterio-venous nicking) and measure arteriolar and venular internal diameter (ID) in order to calculate AVR. For arteries, Wall Thickness (WT) was also measured to calculate Wall-to-Lumen Ratio (WLR) and Wall Cross-Sectional Area (WCSA). Hypertension was defined according to the presence of any antihypertensive treatment, diabetes was defined by any antidiabetic treatment or HbA1c > 6.5% on two samples. Results: 129 patients were included (53 group H, 38 group D and group C). Despite the same BP levels in groups H and D, Hypertensive patients had a significant arteriolar narrowing and diabetics patients an arteriolar dilation (group H 85.4 ± 13 &mgr;m vs group D 97.7 ± 12 &mgr;m and group C 93.3 ± 12 &mgr;m, p = 0.015) but a similar venular ID was observed in all groups (group H 126.2 ± 17 &mgr;m vs group D 124.5 ± 18 &mgr;m vs group C 124.4 ± 18 &mgr;m).Hypertensive subjects had a lower AVR (0.68 vs group D 0.77 vs group C 0.76, p = 0.004) and a higher WLR (0.283 ± 0.04 group H, 0.258 ± 0.03 group D and 0.257 ± 0.04 group C).In diabetics, an increased WCSA was also observed (4327.2 &mgr;m2 group D vs 3823.7 &mgr;m2 group H vs 4008.0 group C), no differences were found in WT (23.6 ± 3 &mgr;m group H vs 24.9 ± 3 &mgr;m group D vs 24.2 ± 4 &mgr;m group C). Conclusions: Two different microvascular patterns were observed in this study: arteriolar inward remodeling characterizes hypertension and arteriolar eccentric hypertrophy is observed in diabetes. Adaptive Optics represents a powerful source of new microvascular markers and may contribute to a revival of the fundoscopy in hypertension and diabetes.