Cited by 320Diabetes, Cardiovascular Risks, and LipoproteinsRetinal Diseases and TreatmentsRetinal Imaging and Analysis

The DOI matches its Crossref record; 32 of the 32 references it cites were found in a registry or an index.

Retinal Arteriolar Narrowing and Risk of Diabetes Mellitus in Middle-aged Persons

Wong, Tien Yin·2002·JAMA

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Abstract

CONTEXT: Microvascular processes have been hypothesized to play a role in the pathogenesis of type 2 diabetes mellitus, but prospective clinical data regarding this hypothesis are unavailable. OBJECTIVE: To examine the relation of retinal arteriolar narrowing, a marker of microvascular damage from aging, hypertension, and inflammation, to incident diabetes in healthy middle-aged persons. DESIGN, SETTING, AND PARTICIPANTS: The Atherosclerosis Risk in Communities Study, an ongoing population-based, prospective cohort study in 4 US communities that began in 1987-1989. Included in this analysis were 7993 persons aged 49 to 73 years without diabetes, of whom retinal photographs were taken during the third examination (1993-1995). MAIN OUTCOME MEASURES: Incident diabetes (defined as fasting glucose levels of > or =126 mg/dL [7.0 mmol/L], casual levels of > or =200 mg/dL [11.1 mmol/L], diabetic medications use, or physician diagnosis of diabetes at the fourth examination) by quartile of retinal arteriole-to-venule ratio (AVR). RESULTS: After a median follow-up of 3.5 years, 291 persons (3.6%) had incident diabetes. The incidence of diabetes was higher in persons with lower AVR at baseline (2.4%, 3.1%, 4.0%, and 5.2%, from highest to lowest AVR quartile; P for trend < .001). After controlling for fasting glucose and insulin levels, family history of diabetes, adiposity, physical activity, blood pressure, and other factors, persons in the lowest quartile of AVR were 71% more likely to develop diabetes than those in the highest quartile (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.13-2.57; P for trend =.002). This association persisted with different diagnostic criteria (OR, 1.92; 95% CI, 1.10-3.36; P for trend =.01, using a fasting glucose level of > or =141 mg/dL [7.8 mmol/L] as a cutoff), and was seen even in people at lower risk of diabetes, including those without a family history of diabetes, without impaired fasting glucose, and with lower measures of adiposity. CONCLUSIONS: Retinal arteriolar narrowing is independently associated with risk of diabetes, supporting a microvascular role in the development of clinical diabetes.

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Method
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BackgroundSelf-citation
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Background
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“Retina images allow noninvasive viewing of the in-vivo vessels and have been established as indicator for incidence of diabetic retinopathy [1, 2], early indicator of stroke [3, 4] and hypertension [5].”
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A PILOT STUDY USING ROPtool TO MEASURE RETINAL VASCULAR DILATION
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Tan, P., Hee, O. K., Cheung, C. Y.-L., Yeo, T. K., Agrawal, R. V., Ng, J., Lim, T. H., Wong, T. Y., & Teoh, S. C. B. (2013) · Investigative Ophthalmology & Visual Science · doi:10.1167/iovs.13-13081 · Cited by 21
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“Some studies (ARIC and Beaver Dam Eye) showed a link between the low AVR and the higher risk of developing Diabetes Mellitus independent of the cardiovascular risk factors [42].”
Background
Shifts in retinal vessel diameter and oxygen saturation in Chinese type 2 diabetes mellitus patients
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“7 Because retinal arteriolar narrowing is related to the risk of various systemic diseases including diabetes, 8 cardiovascular disease, 8,9 and cerebrovascular complications, 10 estimating AVR estimation has been a simpli ﬁ ed but useful clinical technique in routine ophthalmic practice.”
Background
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“In the Atherosclerosis Risk In Communities (ARIC) and Beaver Dam Eye Study (BDES) [9,10], after adjusting for baseline risk factors, persons with narrower, and not wider, retinal arterioles at baseline were more likely to subsequently develop diabetes over a median of 3.5 years (OR: 1.71; 95% CI: 1.13–2.57) and 10 yea…”
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“In the Singapore Malay Eye Study (SiMES), retinopathy was related to a decrease in eGFR and albuminuria.(7) In our analysis, we found a weaker association r filtration rate, SD1⁄4 standard deviation.”
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Intraretinal Fluid Pattern Characterization in Optical Coherence Tomography Images
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“, the Atherosclerosis Risk in Communities (ARIC) study (53), the Beaver Dam study (54) and Rotterdam study (22), have demonstrated that the AVR features have association with the development of type 2 diabetes and DR.”
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Retinal vascular signs in diabetes and hypertension - review
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“Understanding the relationship of these drugs to retinal arteriole narrowing and venule widening is important because the latter are thought to be markers of microvascular changes in the cerebral, coronary, peripheral, and renal circulations, and possibly of pathogenetic processes damaging to other targets of diabetic…”
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Deep learning for artery–vein classification in optical coherence tomography angiography
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“Correlations to diabetes (Wong et al., 2002) and obesity (Wang et al.”
Background

Authors: Wong, T. Y.
Affiliations: University of Wisconsin System (US)
Corresponding author: Wong, Tien Yin
ORCID: Wong, Tien Yin
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2002-05-15
Volume: 287
Issue: 19
Pages: 2528
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.287.19.2528
OpenAlex: W2087898657
Cited by: 320
References: 32
Citations by year: 2026: 11 · 2025: 5 · 2024: 11 · 2023: 7 · 2022: 9 · 2021: 13 · 2020: 9 · 2019: 13 · 2018: 12 · 2017: 14 · 2016: 5 · 2015: 12 · 2014: 9 · 2013: 16 · 2012: 18
FWCI: 7.03
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
National University of Singapore (submittedVersion)
Funders: National Institutes of Health (n01hc035126-003, n01hc55021-47-0-1, n01hc55020-39-0-0, n01hc55016-37-0-0, n01hc055022-024, n01hc035125-006, n01hc55019-35-0-1, n01hc55018-38-0-1, n01hc55015-48-0-1)
National Heart, Lung, and Blood Institute (N01-HC55022, N01-HC-55018, N01 HC 55020, N01 HC 55019, N01 HC-35125, NN01-HC-35126, N1-HC-55021, N01-HC55016, N01‐HC‐55015)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
Keywords: retinal arteriolar narrowing, type 2 diabetes, incident diabetes risk, microvascular damage, middle-aged adults, Atherosclerosis Risk in Communities Study, fundus images, hypertension, aging, family history of diabetes, impaired fasting glucose, adiposity, physical activity, blood pressure, fasting blood glucose, insulin levels, diabetes prevention
MeSH terms: Aged, Aging, Diabetes Mellitus, Female, Humans, Hypertension, Inflammation, Male, Microcirculation, Middle Aged, Photography, Prospective Studies, Retinal Vessels, Risk Factors, Retinal Artery Occlusion, Logistic Models

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Retinal Arteriolar Narrowing and Risk of Diabetes Mellitus in Middle-aged Persons

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