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01-05-2021 | Diabetic Retinopathy | Article

Retinal venular tortuosity and fractal dimension predict incident retinopathy in adults with type 2 diabetes: the Edinburgh Type 2 Diabetes Study

Authors: Rachel B. Forster, Emmanuel Sandoval Garcia, Anniek J. Sluiman, Sheila M. Grecian, Stela McLachlan, Tom J. MacGillivray, Mark W. J. Strachan, Jackie F. Price, on behalf of the Edinburgh Type 2 Diabetes Study (ET2DS) investigators

Published in: Diabetologia | Issue 5/2021

Abstract

Aims/hypothesis

Our aim was to determine whether a range of prespecified retinal vessel traits were associated with incident diabetic retinopathy in adults with type 2 diabetes.

Methods

In the prospective observational cohort Edinburgh Type 2 Diabetes Study of 1066 adults with type 2 diabetes, aged 60–75 years at recruitment, 718 were free from diabetic retinopathy at baseline. Baseline retinal traits including vessel widths, tortuosity (curvature) and fractal dimensions (network complexity), were quantified using fundus camera images and semiautomated software, and analysed using logistic regression for their association with incident diabetic retinopathy over 10 years.

Results

The incidence of diabetic retinopathy was 11.4% (n = 82) over 10 years. After adjustment for a range of vascular and diabetes-related risk factors, both increased venular tortuosity (OR 1.51; 95% CI 1.15, 1.98; p = 0.003) and decreased fractal dimension (OR 0.75; 95% CI 0.58, 0.96; p = 0.025) were associated with incident retinopathy. There was no evidence of an association with arterial tortuosity, and associations between measurements of vessel widths and retinopathy lost statistical significance after adjustment for diabetes-related factors and vascular disease. Adding venular tortuosity to a model including established risk factors for diabetic retinopathy (HbA_1c, BP and kidney function) improved the discriminative ability (C statistic increased from 0.624 to 0.640, p = 0.013), but no such benefit was found with fractal dimension.

Conclusions/interpretation

Increased retinal venular tortuosity and decreased fractal dimension are associated with incident diabetic retinopathy, independent of classical risk factors. There is some evidence that venular tortuosity may be a useful biomarker to improve the predictive ability of models based on established retinopathy risk factors, and its inclusion in further risk prediction modelling is warranted.

Graphical abstract

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Title: Retinal venular tortuosity and fractal dimension predict incident retinopathy in adults with type 2 diabetes: the Edinburgh Type 2 Diabetes Study
Authors: Rachel B. Forster
Emmanuel Sandoval Garcia
Anniek J. Sluiman
Sheila M. Grecian
Stela McLachlan
Tom J. MacGillivray
Mark W. J. Strachan
Jackie F. Price
on behalf of the Edinburgh Type 2 Diabetes Study (ET2DS) investigators
Publication date: 01-05-2021
Publisher: Springer Berlin Heidelberg
Keywords: Diabetic Retinopathy
Diabetic Retinopathy
Type 2 Diabetes
Published in: Diabetologia / Issue 5/2021
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-021-05388-5

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Conclusions/interpretation

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