How did it all begin...

Transcription

1 Retinal Vascular Analysis Applications and Challenges Maged Habib Consultant Ophthalmologist Sunderland Eye Infirmary United Kingdom ARVO Egypt 2014 How did it all begin : Invention of ophthalmoscope H Von Helmholtz 1898: Retinal vessels and Stroke Robert Marcus Gunn 1974: Hypertensive retinopathy & Mortality 1

2 Digital retinal Imaging Hubbard & Parr Technique CRVA CRVE AVR Retinal vascular analysis systemic associations 2

3 Retinal vascular analysis Hypertension Retinal arteriolar narrowing: Increase in BP Precede HT development Smaller arteriolar caliber + AVR: Increased risk of incident HT 3-7 years later Retinal vascular analysis Diabetes AVR in non-diabetics had 50 70% higher risk of developing DM Progressive Wider Arteriolar and Venular diameter with DM and increased DR severity RVG alterations with progressive DR 3

4 Retinal vascular analysis Obesity Larger retinal veins related to BMI, dyslipidaemia. Large retinal venular caliber predict incidence of obesity over 5 years? Microvascular dysfunction in the pathogenesis of obesity? Inflammation? Exudative Stress Retinal vascular analysis Atherosclerosis Smaller AVR related to Carotid artery stiffness and plaques AVR = CRAE / CRVE??? Contradictory results Increase CRVE with endothelial dysfunction and inflammatory markers 4

5 Retinal vascular analysis Stroke Smaller AVR associated with increased risk of stroke (infarction) arteriolar caliber : 50% higher risk of stroke mortality venular caliber: 1.7 increase risk of stroke mortality venular caliber: 60-70% increased risk of sub-clinical infarctions Retinal vascular analysis Cognitive decline and Dementia venular caliber: increased risk of vascular dementia Inconclusive relationship with Alzheimer s disease 1.1 M ongoing study 5

6 Retinal vascular analysis CHD AVR (CRAE/CRVE): increased risk of incident CHD and myocardial infarction CRAE / CRVE: 30% higher risk of CHD (independent) fold increased risk of CHD mortality Retinal vascular analysis Ocular associations 6

7 Retinal vascular analysis ARMD Wide Venular caliber associated with ARMD Arteriolar focal narrowing and AV nicking associated with progression. Arteriolar wall opacification Altered vascular dynamic to flickering light Retinal vascular analysis ARMD RBZ treatment : Venular and Arteriolar diameter Large baseline retinal venular caliber associated with poor response to treatment 7

8 Retinal vascular analysis ARMD Future Research Hypothesis VEGF Altered NO vaso-dilating effect Dysfunctional vascular endotheluim Altered retinal network geometry Exploring role of RVG in Diagnosis of early ARMD Monitor response to treatment Predict response to treatment Funded research by Fight for Sight Retinal vascular analysis Glaucoma Smaller arteriolar caliber with POAG Vascular changes with decreased RNFL thickness 8

9 Retinal vascular analysis Glaucoma Altered blood flow with changes in vascular diameter in POAG Retinal vascular analysis Challenges 9

10 Image Acquisition Image Acquisition 10

11 Image Acquisition Variable Magnification Variable Resolution Variable field What we measure? What is Ground Truth? No actual Benchmarking What is Normal Measurable Precision not Accuracy 11

12 What we measure? Dynamic Variation in retinal vascular Network Cardiac Cycle Variation (15%) Variation with disease. Automated Vascular analysis Connectivity of vascular tree Identification of Arteries vs Veins 12

13 Further understanding of retinal vascular network Adaptive changes versus pathologic changes Further understanding of retinal vascular network Adaptive changes versus pathologic changes Functional versus structural retinal changes 13

14 Conclusion Over last decade, Development of reliable techniques for vascular analysis Large population studies demonstrating additional information on cerebral and systemic disease Further advancements in technology are needed to adopt vascular changes as novel non-invasive biomarkers to be utilised at individual level. Acknowledgments Mr David H Steel Consultant Ophthalmologist SEI Sunderland Professor Andrew Hunter Head of department of computing and informatics Vice Chancellor Lincoln University Dr Bashir Al-Diri Lecturer of computer science and informatics Lincoln University 14

15 Thank You 15