Retinal vessel caliber and tortuosity and prediction of 5-year incidence of hypertension.

PURPOSE: With arterial hypertension as a global risk factor for cerebrovascular and cardiovascular diseases, we examined whether retinal blood vessel caliber and tortuosity assessed by a vessel-constraint network model can predict the incidence of hypertension. METHODS: The community-based prospective study included 9230 individuals who were followed for 5 years. Ocular fundus photographs taken at baseline were analyzed by a vessel-constraint network model. RESULTS: Within the 5-year follow-up, 1279 (18.8%) and 474 (7.0%) participants out of 6813 individuals free of hypertension at baseline developed hypertension and severe hypertension, respectively. In multivariable analysis, a higher incidence of hypertension was related to a narrower retinal arteriolar diameter ( P  < 0.001), wider venular diameter ( P  = 0.005), and a smaller arteriole-to-venule diameter ratio ( P  < 0.001) at baseline. Individuals with the 5% narrowest arteriole or the 5% widest venule diameter had a 17.1-fold [95% confidence interval (CI):7.9, 37.2] or 2.3-fold (95% CI: 1.4, 3.7) increased risk for developing hypertension, as compared with those with the 5% widest arteriole or the 5% narrowest venule. The area under the receiver operator characteristic curve for predicting the 5-year incidence of hypertension and severe hypertension was 0.791 (95% CI: 0.778, 0.804) and 0.839 (95% CI: 0.821, 0.856), respectively. Although the venular tortuosity was positively associated with the presence of hypertension at baseline ( P  = 0.01), neither arteriolar tortuosity nor venular tortuosity was associated with incident hypertension (both P  ≥ 0.10). CONCLUSION AND RELEVANCE: Narrower retinal arterioles and wider venules indicate an increased risk for incident hypertension within 5 years, while tortuous retinal venules are associated with the presence rather than the incidence of hypertension. The automatic assessment of retinal vessel features performed well in identifying individuals at risk of developing hypertension.

Location of Parapapillary Gamma Zone and Vertical Fovea Location. The Beijing Eye Study 2011.

Purpose: To assess the spatial relationship between the locations of the parapapillary gamma zone and the fovea. Methods: In a non-glaucomatous subgroup of the population-based Beijing Eye Study population, we measured the mean angle between the optic disc-fovea line and the horizontal (disc-fovea angle), the vertical distance of the fovea from the horizontal through the optic disc center (fovea vertical distance), and the location and width of the widest part of parapapillary gamma zone. Results: The study included 203 individuals (203 eyes; mean axial length, 24.4 ± 1.5 mm; range, 22.03-28.87 mm). The widest gamma zone part was located most often temporal horizontally (51.7%), then inferiorly (43.8%), superiorly (2.5%), and nasally (2.0%). The disc-fovea angle (mean, 7.50° ± 4.00°; range, -6.30° to -23.25°) was significantly higher (P = 0.003; i.e., fovea located more inferiorly) in eyes with the widest gamma zone inferiorly (8.46° ± 4.37°) than in eyes with the widest gamma zone temporally (6.71° ± 3.46°) and in eyes with the widest gamma zone temporally, superiorly, or nasally combined (6.75° ± 3.53°; P = 0.003). The fovea vertical distance (mean, 0.65 ± 0.33 mm; range, -0.20 to 1.67 mm) was longer (P = 0.001; i.e., fovea located more inferiorly) in eyes with the widest gamma zone inferiorly (0.73 ± 0.33 mm) than in eyes with the widest gamma zone temporally (0.58 ± 0.30 mm) and in eyes with a temporal, superior, or nasal gamma zone combined (0.58 ± 0.31 mm; P = 0.001). The fovea vertical distance increased (multivariate analysis) with the widest gamma zone location inferiorly (ß = 0.25; P = 0.001) and wider width of the gamma zone (ß = 0.19; P = 0.01). Conclusions: An inferior fovea location is associated with a wider inferior gamma zone and vice versa, supporting the notion of an inferior shifting of Bruch's membrane as the cause for an inferior gamma zone.

Age-related changes in and determinants of macular ganglion cell-inner plexiform layer thickness in normal Chinese adults.

IMPORTANCE: Consideration of age-related changes in macular ganglion cell-inner plexiform layer (mGCIPL) thickness are important for glaucoma progression analysis. BACKGROUND: To report age-related changes in and the determinants of high-definition optical coherence tomography (HD-OCT) measurements of mGCIPL thickness. DESIGN: Cross-sectional study. PARTICIPANTS: 326 healthy adults. METHODS: All subjects underwent Cirrus HD-OCT measurements of mGCIPL. One-way analysis of variance (ANOVA) was used to compare mGCIPL thickness between 7 decades based age groups and macular sectors. Multiple regression analysis determined the association between mGCIPL thickness and age, gender, intraocular pressure (IOP), peripapillary retinal nerve fibre layer thickness (pRNFL) and spherical equivalent. MAIN OUTCOME MEASURES: Change in mGCIPL thickness and determinants of thickness. RESULTS: Mean mGCIPL thickness in 295 subjects was 80.80 ± 6.42 µm. Mean mGCIPL decreased by 0.12 µm (95% CI [confidence interval], 0.09-0.16) with every year of age; 1.61 µm (95% CI, 0.08-2.41) per decade. It showed two steep declines with age, first in the fifth and next in the seventh decade with relative stability between them. mGCIPL thickness was associated with pRNFL thickness (ß = 0.30, P < 0.001) and IOP (ß = -0.19, P = 0.03) but not with gender (ß = -1.09, P = 0.116) or spherical equivalent (ß = -0. 24, P = 0.145). CONCLUSIONS AND RELEVANCE: Mean mGCIPL thickness showed a small age-related linear decrease with two steep drops in the fifth and seventh decades. Thinner mGCIPL was independently associated with age, thinner pRNFL and higher IOP. These factors should be considered if using mGCIPL to detect progression of glaucoma and other optic neuropathies characterized by the loss of retinal ganglion cells.

Optic nerve head morphology in young patients after antiglaucomatous filtering surgery.

PURPOSE: To compare the optic nerve head appearance in glaucomatous eyes before and after marked reduction of intraocular pressure (IOP). METHODS: The hospital-based observational case-series study included selected glaucoma patients for whom optic disc photographs taken before and 1 week to 5 months after surgical reduction of IOP were morphometrically examined. RESULTS: The study included 23 eyes of 16 patients (mean age: 28.7 ± 6.0 years). Mean preoperative IOP was 31.6 ± 7.7 mmHg (22-52 mmHg), and mean IOP drop was 21.5 ± 8.4 mmHg (11-45 mmHg). The horizontal disc diameter decreased significantly (p < 0.001) after surgery, while the vertical disc diameter did not change markedly (p = 0.54). The width of the neuroretinal rim increased significantly in all disc quadrants (all p-values ≤ 0.01), optic cup depth decreased (p < 0.001), and reflectivity of the inner retinal surface increased significantly (p < 0.001). Some eyes showed a pronounced reduction in beta zone of parapapillary atrophy parallel to an increase in horizontal disc diameter, and some eyes showed an enlargement of beta zone parallel to a reduction in horizontal disc diameter. CONCLUSIONS: After marked reduction of high IOP, some eyes of young adult patients with glaucoma can show a horizontal shrinkage of the optic nerve head, in addition to a partial restoration of the neuroretinal rim and a flattening of the optic cup. In addition, beta zone of parapapillary atrophy can decrease or increase, complementarily to changes in the horizontal disc diameter. These findings may be of interest for the biomechanics of the optic nerve head and the precision of imaging techniques.

Parapapillary atrophy in patients with intracranial tumours.

PURPOSE: To examine size and frequency of parapapillary atrophy (beta zone) in patients with intrasellar or perisellar tumours and a glaucoma-like appearance of the intrapapillary optic disc region. METHODS: Thirty-four Chinese subjects with intrasellar or perisellar tumours and a glaucoma-like appearance of the intrapapillary optic disc region and 129 age-matched subjects randomly selected from the population-based Beijing Eye Study were enrolled. Beta zone was measured on fundus photographs. Size and location of the tumours were assessed on neuroradiological images. RESULTS: Beta zone was significantly more common (79 ± 7% versus 46 ± 4%; p = 0.001), and it was significantly larger in the tumour group than in the control group (circumferential extent: 135 ± 99 versus 57 ± 72; p < 0.001; relative area: 1856 ± 1923 versus 759 ± 1390; p = 0.002). The width of the intracerebral tumours was significantly associated with the circumferential extent of beta zone (r = 0.36, p = 0.039) and with the area of beta zone (r = 0.37, p = 0.032). Tumour width, height and depth were significantly (p = 0.001; p = 0.012; and p < 0.001, respectively) larger in the group of patients with beta zone than in the subgroup of patients without beta zone of parapapillary atrophy. CONCLUSIONS: Patients with large intrasellar or perisellar tumours and a glaucoma-like appearance of the intrapapillary region as compared with a population-based control group had a significantly larger and more frequently occurring beta zone of parapapillary atrophy. It suggests that large parasellar or suprasellar tumours can be associated with typical glaucomatous abnormalities in the parapapillary and intrapapillary region of the optic nerve head. It may give hints for the pathogenesis of glaucomatous optic neuropathy.

Frequency and associated factors of structural progression of open-angle glaucoma in the Beijing Eye Study.

BACKGROUND: To examine factors associated with progression of open-angle glaucoma in a population-based setting. METHODS: The population-based Beijing Eye Study, which included 4439 subjects with an age of 40+ years in the year 2001, was repeated in 2006. Optic disc photographs of the baseline examination versus follow-up examination were compared. RESULTS: Out of 111 open-angle glaucoma patients examined in 2001, 77 (69%) subjects participated in the follow-up examination and 16 (21%) eyes showed glaucoma progression. Glaucoma progression was associated with smaller rim area (p=0.001), larger ß zone (p=0.037), higher frequency of ß zone increase during follow-up (p=0.01), higher prevalence of disc haemorrhages (p=0.01) and higher single intraocular pressure (p=0.04). In multiple regression analysis, only smaller rim area remained significantly associated with glaucoma progression. Glaucoma progression was not associated with optic disc size (p=0.70), mean blood pressure (p=0.43), ocular perfusion pressure (p=0.96), retinal vessel diameter and retinal microvascular abnormalities (all p>0.10), prevalence of diabetes mellitus (p=0.75) and arterial hypertension (p=0.26), prevalence of dyslipidaemia (p=0.28), refractive error (p=0.69), and central corneal thickness (p=0.97). CONCLUSIONS: In a population-based setting in adult Chinese, factors showing an association with open-angle glaucoma progression were an advanced stage of the disease (ie, small rim), presence of disc haemorrhages, larger area of ß zone and higher frequency of ß zone increase, and higher intraocular pressure. Glaucoma progression was not significantly associated with optic disc size, central corneal thickness, retinal vessel diameter and retinal microvascular abnormalities, and systemic diseases such as diabetes mellitus and arterial hypertension.

Neuroretinal rim area and body mass index.

PURPOSE: To examine associations between neuroretinal rim area, pressure related factors and anthropometric parameters in a population-based setting. METHODS: The population-based cross-sectional Beijing Eye Study 2006 included 3251 subjects with an age of 45+ years. The participants underwent a detailed ophthalmic examination. Exclusion criteria for our study were high myopia of more than -8 diopters and angle-closure glaucoma. RESULTS: The study included 2917 subjects with a mean age of 59.8±9.8 years (range: 45-89 years). Mean neuroretinal rim area was 1.97±0.38 mm², mean intraocular pressure 15.6±3.0 mmHg, mean diastolic blood pressure 79.0±5.9 mm Hg, mean systolic blood pressure 133.5±11.1 mmHg, and mean body mass index was 25.5±3.7. In univariate analysis, neuroretinal rim area was significantly associated with optic disc size, open-angle glaucoma, refractive error, age and gender. After adjustment for these parameters in a multivariate analysis, a larger neuroretinal rim area was significantly correlated with a higher body mass index (P<0.001), in addition to be associated with a lower intraocular pressure (P = 0.004), lower mean blood pressure (P = 0.02), and higher ocular perfusion pressure. CONCLUSIONS: In a general population, neuroretinal rim as equivalent of the optic nerve fibers is related to a higher body mass index, after adjustment for disc area, refractive error, age, gender, open-angle glaucoma, intraocular pressure, blood pressure and ocular perfusion pressure. Since body mass index is associated with cerebrospinal fluid pressure, the latter may be associated with neuroretinal rim area. It may serve as an indirect hint for an association between cerebrospinal fluid pressure and glaucoma.

Prevalence and incidence of ocular trauma in North China: the Beijing Eye Study.

PURPOSE: To determine the prevalence and incidence of ocular trauma and proportion of trauma-related visual impairment in the population of Greater Beijing. METHODS: The population-based Beijing Eye Study included 4439 subjects in 2001, of whom 3251 subjects returned for follow-up examination in 2006 (response rate: 73.3%). The subjects underwent a comprehensive ocular evaluation. Prospective information on ocular trauma and type of treatment was recorded with questionnaires in face-to-face interviews. RESULTS: A history of ocular trauma was reported by 72 (1.6 ± 0.2%) subjects (age-standardized prevalence: 1.7 ± 0.01%). Prevalence of ocular trauma history was associated with male gender (p = 0.02), rural residence (p = 0.04) and alcohol consumption (p = 0.01). Trauma as underlying cause for visual impairment (best-corrected visual acuity < 20/60 and ≥ 20/400) was found in 4 (6.6%) eyes and as underlying cause for blindness (best-corrected visual acuity <20/400) in three eyes (4.2%). In the survey of 2006, 116 (3.6 ± 0.3%) participants had a self-reported history of ocular trauma, which was associated with male gender (p = 0.002), low income (p = 0.01) and alcohol consumption (p = 0.016). The 5-year incidence of ocular trauma was 2.6 ± 0.3%, which was associated with male gender (p = 0.02), younger age (p = 0.037) and lower income (p = 0.009). CONCLUSIONS: In the adult population of Greater Beijing with an age of 40+ years, the prevalence of ocular trauma was 1.6 ± 0.2% and was associated with male gender, rural residence and alcohol consumption. The age-standardized ocular trauma prevalence of 1.7 ± 0.01% was comparable with figures from Caucasian populations. The 5-year incidence of ocular trauma of 2.6 ± 0.3% was associated with male gender, younger age and lower income.

Prevalence of arterial hypertension in the adult population in rural and urban China: the Beijing eye study.

BACKGROUND: This study aimed to investigate the prevalence of arterial hypertension in China. METHODS: The Beijing Eye Study 2006 is a population-based investigation including 3,251 subjects aged 45+ years. Blood pressure measurements were performed for 3,222 (99.1%) subjects. Hypertension was defined as a systolic blood pressure > or =140 mm Hg and/or a diastolic blood pressure > or =90 mm Hg, and/or self-reported current treatment for hypertension. RESULTS: A diastolic blood pressure of >or =90 mm Hg was detected in 106 (3.3%) subjects, and a systolic blood pressure > or =140 mm Hg was measured in 866 (26.9%) subjects. Arterial hypertension was present in 1,500 (46.6%) subjects. Prevalence of arterial hypertension was significantly associated with age (P < 0.001), body mass index (P < 0.001), serum concentration of cholesterol (P = 0.02), diabetes mellitus (P < 0.001; odds ratio: 1.48), family history of hypertension (P < 0.001; odds ratio: 2.96), and rural region (P < 0.001; odds ratio: 2.27). Among the arterial hypertensive subjects, 82.7% were aware of the diagnosis. Awareness of hypertension was significantly associated with urban area, higher age, higher body mass index, and family history of hypertension. Out of the 1,500 hypertensive subjects, 1,106 (73.7%) were treated for arterial hypertension. Out of the treated subjects, 487 (44%) had abnormally high arterial blood pressure measurements. CONCLUSIONS: These survey results underscore the fact that hypertension is highly prevalent, relatively poorly treated, and an escalating health challenge in China. As in other studies, people in metropolitan areas had the highest rates of awareness, treatment, and control. It implies that effective public health measures are needed to enhance the treatment, and control rates in the Chinese population, particularly in the rural regions.

Retinal vein occlusions and mortality: the Beijing Eye Study.

PURPOSE: To assess the association between retinal vein occlusion (RVO) and mortality in a population-based setting. DESIGN: Population-based, longitudinal study. METHODS: At baseline in 2001, the Beijing Eye Study examined 4,335 subjects for RVO with a frequency of detected vein occlusions of 61 (1.4%) in 4,335 subjects. In 2006, all study participants were invited for a follow-up examination. RESULTS: Of the 4,335 subjects, 3,195 (73.7%) returned for follow-up examination, whereas 132 (3.0%) subjects had died and 1,008 (23.3%) subjects declined to be re-examined or had moved away. For the subjects younger than 70 years or than 65 years, respectively, RVO was associated significantly with an increased mortality rate (P = .05; 95% confidence interval [CI], 0.995 to 8.26; and P = .001; 95% CI, 2.11 to 18.73, respectively). CONCLUSIONS: RVO in relatively young persons may signal a significant risk of mortality.