Hypertension and the eye

Effects of Cost Sharing on Ophthalmic Care Utilization in the Affordable Care Act Marketplace

PURPOSE

To determine the distribution and quantity of ophthalmic care consumed on Affordable Care Act (ACA) plans, the demographics of the population utilizing these services, and the relationship between ACA insurance coverage plan tier, cost sharing, and total cost of ophthalmic care consumed.

METHODS

This cross-sectional study analyzed ACA individual and small group market claims data from the Wakely Affordable Care Act (WACA) 2018 dataset, which contains detailed claims, enrollment, and premium data from Edge Servers for 3.9 million individual and small group market lives. We identified all enrollees with ophthalmology-specific billing, procedure, and national drug codes. We then analyzed the claims by plan type and calculated the total cost and out-of-pocket (OOP) cost.

RESULTS

Among 3.9 million enrollees in the WACA 2018 dataset, 538,169 (13.7%) had claims related to ophthalmology procedures, medications, and/or diagnoses. A total of $203 million was generated in ophthalmology-related claims, with $54 million in general services, $42 million in medications, $20 million in diagnostics and imaging, and $86 million in procedures. Average annual OOP costs were $116 per member, or 30.9% of the total cost, and were lowest for members with platinum plans (16% OOP) and income-driven cost sharing reduction (ICSR) subsidies (17% OOP). Despite stable ocular disease distribution across plan types, beneficiaries with silver ICSR subsidies consumed more total care than any other plan, higher than platinum plan enrollees and almost 1.5× the cost of bronze plan enrollees.

CONCLUSIONS

Ophthalmic care for enrollees on ACA plans generated substantial costs in 2018. Plans with higher OOP cost sharing may result in lower utilization of ophthalmic care.

Computer-aided diagnostic system for hypertensive retinopathy: A review

Hypertensive Retinopathy (HR) is a retinal disease caused by elevated blood pressure for a prolonged period. There are no obvious signs in the early stages of high blood pressure, but it affects various body parts over time, including the eyes. HR is a biomarker for several illnesses, including retinal diseases, atherosclerosis, strokes, kidney disease, and cardiovascular risks. Early microcirculation abnormalities in chronic diseases can be diagnosed through retinal examination prior to the onset of major clinical consequences. Computer-aided diagnosis (CAD) plays a vital role in the early identification of HR with improved diagnostic accuracy, which is time-efficient and demands fewer resources. Recently, numerous studies have been reported on the automatic identification of HR. This paper provides a comprehensive review of the automated tasks of Artery-Vein (A/V) classification, Arteriovenous ratio (AVR) computation, HR detection (Binary classification), and HR severity grading. The review is conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The paper discusses the clinical features of HR, the availability of datasets, existing methods used for A/V classification, AVR computation, HR detection, and severity grading, and performance evaluation metrics. The reviewed articles are summarized with classifiers details, adoption of different kinds of methodologies, performance comparisons, datasets details, their pros and cons, and computational platform. For each task, a summary and critical in-depth analysis are provided, as well as common research issues and challenges in the existing studies. Finally, the paper proposes future research directions to overcome challenges associated with data set availability, HR detection, and severity grading.

Aging Biomarker Consortium, Zhang L, Guo J, Liu Y, Sun S, Liu B, Yang Q, Tao J, Tian XL, Pu J, Hong H, Wang M, Chen HZ, Ren J, Wang X, Liang Z, Wang Y, Huang K, Zhang W, Qu J, Ju Z, Liu GH, Pei G, Li J, Zhang C. A framework of biomarkers for vascular aging: a consensus statement by the Aging Biomarker Consortium

Aging of the vasculature, which is integral to the functioning of literally all human organs, serves as a fundamental physiological basis for age-related alterations as well as a shared etiological mechanism for various chronic diseases prevalent in the elderly population. China, home to the world's largest aging population, faces an escalating challenge in addressing the prevention and management of these age-related conditions. To meet this challenge, the Aging Biomarker Consortium of China has developed an expert consensus on biomarkers of vascular aging (VA) by synthesizing literature and insights from scientists and clinicians. This consensus provides a comprehensive assessment of biomarkers associated with VA and presents a systemic framework to classify them into three dimensions: functional, structural, and humoral. Within each dimension, the expert panel recommends the most clinically relevant VA biomarkers. For the functional domain, biomarkers reflecting vascular stiffness and endothelial function are highlighted. The structural dimension encompasses metrics for vascular structure, microvascular structure, and distribution. Additionally, proinflammatory factors are emphasized as biomarkers with the humoral dimension. The aim of this expert consensus is to establish a foundation for assessing the extent of VA and conducting research related to VA, with the ultimate goal of improving the vascular health of the elderly in China and globally.

Biomarkers of aging

Aging biomarkers are a combination of biological parameters to (i) assess age-related changes, (ii) track the physiological aging process, and (iii) predict the transition into a pathological status. Although a broad spectrum of aging biomarkers has been developed, their potential uses and limitations remain poorly characterized. An immediate goal of biomarkers is to help us answer the following three fundamental questions in aging research: How old are we? Why do we get old? And how can we age slower? This review aims to address this need. Here, we summarize our current knowledge of biomarkers developed for cellular, organ, and organismal levels of aging, comprising six pillars: physiological characteristics, medical imaging, histological features, cellular alterations, molecular changes, and secretory factors. To fulfill all these requisites, we propose that aging biomarkers should qualify for being specific, systemic, and clinically relevant.

Tear And Serum Superoxide Dismutase And Catalase Activities In Hypertensive Retinopathy

The objective was to determine the changes in SOD and catalase activity, markers of oxidative stress/antioxidant balance in serum and tear of patients with hypertensive retinopathy and to identify whether there was a correlation between their levels and HR degree of hypertensive retinopathy (HR). Material and Methods — 90 hypertensive patients were divided in three groups, according to the Keith-Wagener classification: GI-36, GII-35 and GIII-19. SOD was assessed using the Dubinina and Matyushin method and catalase according to Koroliuk, both in modification of Gudumac V. The results were presented by median and interquartile range. The groups were compared using Kruskal-Wallis and Mann-Whitney nonparametric tests, and the Spearman correlation coefficient was calculated (SPSS 23.0). Results — Showed a statistically significant difference of SOD in serum (p=0.035) and tear (p=0.027) between groups. SOD decreased from GI until GIII in serum (-8%, p=0.032) and tear (-16%, p=0.031). In addition, it showed a weak significant negative correlation with the HR degree both in serum (r=-0.246, p=0.019) and tear (r=-0.284, p=0.007), while the correlation attested between serum and tear SOD levels was significant moderate and positive (r=0.336, p=0.001). It was noted a significant catalase elevation in the tear (p=0.033). In serum it was not correlated with HR degree, while in tear showed a significant weak strength, positive correlation (r=0.261, p=0.013). No correlations were found between serum and tear catalase levels. Conclusion — A progressive significant decrease in SOD levels and a tendency to increase of catalase activity was identified as HR advanced both in serum and in tear. The enhancement in the severity of HR was correlated with decreased SOD activity in tear and serum and increased catalase level in tear.

Targeting the Angiopoietin/Tie Pathway: Prospects for Treatment of Retinal and Respiratory Disorders

Anti-angiogenic approaches have significantly advanced the treatment of vascular-related pathologies. The ephemeral outcome and known side effects of the current vascular endothelial growth factor (VEGF)-based anti-angiogenic treatments have intensified research on other growth factors. The angiopoietin/Tie (Ang/Tie) family has an established role in vascular physiology and regulates angiogenesis, vascular permeability, and inflammatory responses. The Ang/Tie family consists of angiopoietins 1-4, their receptors, tie1 and 2 and the vascular endothelial-protein tyrosine phosphatase (VE-PTP). Modulation of Tie2 activation has provided a promising outcome in preclinical models and has led to clinical trials of Ang/Tie-targeting drug candidates for retinal disorders. Although less is known about the role of Ang/Tie in pulmonary disorders, several studies have revealed great potential of the Ang/Tie family members as drug targets for pulmonary vascular disorders as well. In this review, we summarize the functions of the Ang/Tie pathway in retinal and pulmonary vascular physiology and relevant disorders and highlight promising drug candidates targeting this pathway currently being or expected to be under clinical evaluation for retinal and pulmonary vascular disorders.

Study of ischemia modified albumin (IMA) as a biomarker in hypertensive retinopathy

Background

Hypertension (HTN) is one of the leading causes of morbidity and mortality worldwide. A prompt diagnosis and treatment of hypertensive retinopathy (HR), the leading complication of HTN is pivotal for a better visual outcome. Increased blood pressure on its own cannot fully clarify the development of retinal alterations, therefore an additional pathogenetic mechanism, such as oxidative stress, might be inquired.

The aim of the study was to evaluate the changes in the level of ischemia modified albumin (IMA) in the serum and tears of HR patients in order to establish the predictive value of IMA for the HR progression.

Methods

Serum and tear samples for the measurement of IMA were collected from 90 patients detected primarily with HR, who were not taking any antihypertensive or other drug that could influence the results of the study, divided according to the Keith-Wagener classification into GI – 36 patients with HR grade I, GII – 35 with HR grade II and GIII – 19 with HR grade III. Serum and tear IMA levels were assessed using the Co²⁺ binding method and expressed as median and interquartile range. Kruskal-Wallis and Mann-Whitney nonparametric tests were used to compare the groups and the Spearman correlation coefficient was calculated (SPSS 23.0), with p<0.05 being statistically significant.

Results

The groups showed a statistically significant difference in serum IMA (p=0.006), the values increasing in parallel with the progression of HR. The serum IMA level in GII increased compared to GI (+3%; 239.06 μM/L (IQR 75.58) vs 231.77 μM/L (IQR 104.09), p=1.00), as well as in GIII patients compared to GII (+17%; 277.67 μM/L (IQR 88.72) vs 239.06 μM/L (IQR 75.58), p=0.04). There were no differences in IMA content (p=0.160), between groups in the tears. No correlations were found between serum and tear IMA levels (p=0.134), but serum IMA showed a significant moderate strength, positive correlation with the degree of HR (r=0.307, p=0.003).

Conclusion

A progressive enhancement in serum IMA level as HR advanced was identified. Thereby, the results suggest the potential relevance of serum IMA as a sensitive and early biomarker useful for grading and optimal treatment of the patients with HR.

Retinal Vessel Functionality Is Linked With ARMS2 A69S and CFH Y402H Polymorphisms and Choroidal Status in AMD Patients

Purpose

We aimed to investigate the reactivity of retinal vessels to a flickering stimulus in patients with age-related macular degeneration (AMD) and healthy participants. We also assessed whether the parameters of retinal vessels are dependent on genetic predisposition.

Methods

A total of 354 patients with AMD and 121 controls were recruited for the study. All participants underwent thorough ophthalmologic examination and static and dynamic retinal vessel analysis. AMD risk polymorphisms were genotyped in the CFH and ARMS2 genes.

Results

We found no differences between the AMD group and controls in central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), arteriovenous ratio (AVR), dynamic analysis of arteries (DAAs), or dynamic analysis of veins (DAVs). Eyes with early AMD presented with significantly higher AVR values than eyes with late AMD. In the AMD group, DAA correlated positively with both choroidal thickness (Rs = 0.14, P = 0.00096) and choroidal volume (Rs = 0.23, P < 0.0001), and no such associations were observed in the controls. We found significantly lower DAA (1.47 ± 1.50) in TT homozygotes for the ARMS2 A69S polymorphism in comparison with GG homozygotes (2.38 ± 1.79) and patients with GG + GT genotypes (2.28 ± 1.84). We also observed less prominent DAV (3.24 ± 1.71) in patients with TC + CC genotypes in the CFH Y402H polymorphism compared with TT homozygotes (3.83 ± 1.68).

Conclusions

Our findings suggest that retinal microcirculation appears to be associated with the genetic background, choroidal parameters, and clinical features of the patients with AMD.

Glutathione-related antioxidant defense system in patients with hypertensive retinopathy

Objective: To analyze the glutathione antioxidant defense system changes in the tear and serum of patients with hypertensive retinopathy (HR) and to establish whether there is an interdependence between their levels and HR degree. Methods: 90 patients were split into three groups according to the Keith-Wagner-Barker grading of HR: GI-36 patients; GII-35 patients; GIII-19 patients. The concentration of reduced glutathione (GSH) and activities of glutathione peroxidase (GPx) and glutathione reductase (GR) in tear and serum were measured. Results were analyzed by ANOVA, followed by Bonferroni post hoc test. The Spearman correlation coefficient was calculated (p≤0.05 statistically significant). Results: In serum, the GSH level and GPx activity were not statistically changed between groups with HR degree advancement, unlike the GR activity that was statistically diminished (p=0.018). The values of the studied markers in the tear showed a decrease with the progression of the HR degree. Only serum GSH level correlated with the tear one (r=-0.361, p=0.000), while the enzymes activity did not. A correlation of GPx and GR activity (r=0.417, p=0.000) was identified in tear, while in serum - of GPx activity and GSH level (r=409, p=0.000). Tear GPx and GR levels correlated significantly but with low power with HR degree (r=0.299, p=0.004/ r=0.299, p=0.004). Conclusion: Statistically significant elevation in tear GPx and GR activity and a tendency of GSH level increase was revealed, being attested, and a direct correlation between GPx and GR activity, as well as of their activity with the HR degree. In serum, the GSH level and the GPx activity did not change accurately, while the GR activity diminished significantly, the identified decrease being correlated with the HR degree. Abbreviations: HR = hypertensive retinopathy, HTN = hypertension, GSH = reduced glutathione, GPx = glutathione peroxidase, GR = glutathione reductase, GGR = gamma-glutamyl transferase, ROSs = reactive species of oxygen, OS = oxidative stress.

Subretinal Deposits in Pre-eclampsia and Malignant Hypertension: Implications for Age-Related Macular Degeneration

PURPOSE

To describe the incidence of subretinal deposits that are similar in structure and stage on OCT imaging to subretinal drusenoid deposits (SDDs) in age-related macular degeneration (AMD) in patients with hypertensive choroidopathy secondary to severe pre-eclampsia and malignant hypertension (MHT) and the implications of this ischemic choroidopathy for the pathophysiologic characteristics of SDDs in AMD.

DESIGN

Retrospective cross-sectional study.

PARTICIPANTS

Thirty-three pre-eclampsia patients and 25 MHT patients with serous retinal detachment (SRD) in at least 1 eye were included.

METHODS

Serial multimodal images, including enhanced depth imaging spectral-domain OCT of eyes with hypertensive choroidopathy secondary to pre-eclampsia and MHT, were reviewed at 2 time points, the acute phase (within 4 weeks of initial hypertensive insult) and the recovery phase (beyond 4 weeks).

MAIN OUTCOME MEASURES

Incidence of SDD-like lesions in patients with hypertensive choroidopathy secondary to pre-eclampsia and MHT.

RESULTS

Subretinal drusenoid deposit-like lesions were observed exclusively in eyes with SRD. Serous retinal detachment occurred in 87.87% of eyes of pre-eclampsia patients and in 94% of eyes of MHT patients. Subretinal drusenoid deposit-like lesions occurred in 28.57% of all eyes with SRD, in 32.76% of eyes with SRD from the pre-eclampsia group, and in 23.40% of eyes with SRD from the MHT group. Vascular imaging suggested underlying choroidal ischemia in all patients (12 eyes) in which it was performed.

CONCLUSIONS

Choroidal ischemia may be the underlying mechanism of SDD-like lesions in patients with pre-eclampsia and MHT choroidopathy. These findings potentially are of utmost importance in understanding the mechanism of the reticular macular disease subtype of AMD. Reticular macular disease is characterized by the known association of choroidal insufficiency and SDD, with choroidal insufficiency postulated, but not proven, to be causative. Pre-eclampsia and MHT choroidopathy seems to be a model for lesions similar to SDD in AMD developing based on choroidal insufficiency and, as such, may offer further insights into the pathoetiologic features of SDD in AMD.

Retinoprotective Effect of Wild Olive (Acebuche) Oil-Enriched Diet against Ocular Oxidative Stress Induced by Arterial Hypertension

Oxidative stress plays an important role in the pathogenesis of ocular diseases, including hypertensive eye diseases. The beneficial effects of olive oil on cardiovascular diseases might rely on minor constituents. Currently, very little is known about the chemical composition and/or therapeutic effects of the cultivated olive tree’s counterpart, wild olive (also known in Spain as acebuche—ACE). Here, we aimed to analyze the antioxidant and retinoprotective effects of ACE oil on the eye of hypertensive mice made hypertensive via administration of NG-nitro-L-arginine-methyl-ester (L-NAME), which were subjected to a dietary supplementation with either ACE oil or extra virgin olive oil (EVOO) for comparison purposes. Deep analyses of major and minor compounds present in both oils was accompanied by blood pressure monitoring, morphometric analyses, as well as different determinations of oxidative stress-related parameters in retinal layers. Aside from its antihypertensive effect, an ACE oil-enriched diet reduced NADPH (nicotinamide adenine dinucleotide phosphate) oxidase activity/gene/protein expression (with a major implication of NADPH oxidase (NOX)2 isoform) in the retinas of hypertensive mice. Supplementation with ACE oil in hypertensive animals also improved alterations in nitric oxide bioavailability and in antioxidant enzyme profile. Interestingly, our findings show that the use of ACE oil resulted in better outcomes, compared with reference EVOO, against hypertension-related oxidative retinal damage.

Is kidney function associated with primary open-angle glaucoma? Findings from the Asian Eye Epidemiology Consortium

AIM

To comprehensively examine the association between kidney function and primary open angle glaucoma (POAG) in a large consortium of multiple Asian population-based studies.

METHODS

28 925 participants (57 340 eyes) from 9 population-based studies (from China, Hong Kong, India, Korea, Russia, Singapore) of the Asian Eye Epidemiology Consortium were included. Across all studies, POAG was defined based on the International Society of Geographical and Epidemiological Ophthalmology criteria. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine. Chronic kidney disease (CKD) was defined as eGFR<60 mL/min/1.73 m2. Eye-specific data were pooled from each study. Multivariable regression analysis with generalised estimating equation models was performed to evaluate the associations between kidney function with POAG and intraocular pressure (IOP).

RESULTS

After adjusting for age, gender, study group, hypertension, diabetes, hyperlipidaemia, body mass index, smoking status and IOP, lower eGFR (per 10 mL/min/1.73 m2 decrease) was not significantly associated with POAG (OR=1.01; p=0.77). Presence of CKD was also not significantly associated with POAG (OR=1.01; p=0.739). Furthermore, lower eGFR and presence of CKD were not associated with IOP (all p≥0.12), However, in the subgroup of combined Korean and Chinese individuals, significant associations between lower eGFR (OR=1.09; 95% CI 1.00 to 1.18; p=0.048) and severe kidney function decline (<45 mL/min/1.73 m2; OR=2.57; 95% CI 1.34 to 4.93; p=0.004) with POAG, were observed.

CONCLUSION

In this large pooled-analysis of multiple Asian population-based studies, our findings suggest that the association between CKD and POAG may only be present in East Asians specifically but not in the overall Asian population. Further evaluation in Japanese population is warranted to confirm this observation.

Window to the circulatory system: Ocular manifestations of cardiovascular diseases

The changes in the cardiovascular system are associated with ocular manifestations, often as a consequence of pathological alteration in the ocular vasculature. The ease of visualization of these retinal changes makes the eye a window to the cardiovascular system. Certain congenital cardiac defects lead to changes in the retinal vascularity due to increased tortuosity and dilatation. In adults, the arterial dissection of internal carotid and vertebral arteries present as amaurosis fugax with or without oculo-sympathetic palsy. The patients with untreated infective endocarditis present with Roth spots, retinitis, embolic retinopathy, or sub-retinal abscesses. Hypoperfusive, hypertensive, or "mixed" retinopathy is a hallmark sign in patients of untreated infective endocarditis. Giant cell arteritis can present with ischemic ocular symptoms that may precipitate in irreversible vision loss. Systemic vascular manifestations such as coronary artery disease may manifest in a wide range of symptoms from amaurosis fugax to vision loss depending upon the size and location of retinal emboli. Rare cardio-oncological pathologies such as myxomas result in vision loss secondary to central retinal artery occlusion. A high clinical suspicion in patients with history of cardiovascular diseases can help in early diagnosis and management of impending, adverse cardiovascular and cerebrovascular events. In this review, we comprehensively discuss the spectrum of cardiac and vascular diseases with ocular manifestations as well as highlight the typical ocular presentations associated with these pathologies.

SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY EVALUATION OF CHORIORETINAL CHANGES IN HYPERTENSIVE CHOROIDOPATHY RELATED TO HELLP SYNDROME

PURPOSE

To report a case of hypertensive choroidopathy with detailed chorioretinal images obtained using swept source optical coherence tomography.

METHODS

We report the case of a 36-year-old pregnant woman who presented with extensive bilateral exudative retinal detachments (visual acuity of hands movement bilaterally), high blood pressure, and severe alteration of the laboratory test results resulting in the diagnosis of HELLP syndrome. The baby was delivered by emergency cesarean section and the patient was hospitalized in the intensive care unit.

RESULTS

Two weeks later, exudative retinal detachments improved substantially and bilateral Elschnig spots were present in the posterior fundus. Swept source optical coherence tomography revealed serous retinal detachment, multiple pigmentary epithelial detachments (PEDs), a thickened subfoveal choroid (437 and 466 μm), and fibrinous material between the neurosensory retina and retinal pigment epithelium in the B-scans of both eyes. En face swept source optical coherence tomography allowed a more precise evaluation of the multiple and confluent PEDs. Six weeks later, despite some focal areas of thickened retinal pigment epithelium, the serous retinal detachment, PEDs, and fibrinous material resolved bilaterally and visual acuity and choroidal thickness returned to normal range (361 and 366 μm). En face swept source optical coherence tomography revealed a dramatic improvement of PEDs in terms of extension and distribution.

CONCLUSION

Swept source optical coherence tomography detected serous retinal detachment, PEDs, increased subfoveal choroidal thickness, and fibrinous material under the neurosensory retina in the acute phase of hypertensive choroidopathy. En face OCT is useful for monitoring the evolution of confluent PEDs in hypertensive choroidopathy.

Retinal vessel metrics: normative data and their use in systemic hypertension: results from the Gutenberg Health Study

PURPOSE OF REVIEW

In-vivo measurement of retinal vascular calibers may be used as a tool to study the pathophysiology and clinical status of the microvasculature of the retina. The aim of this study was to generate normative data for retinal vessel parameters, and to evaluate the clinical relevance in systemic hypertension.

METHODS

Fundus photographs from 4309 participants of the Gutenberg Health Study were assessed using the 'retinal vessel analyzer' software (IMEDOS). We generated age and sex-specific nomograms in a disease-free subpopulation of 890 participants for determining the central retinal arteriolar equivalent (CRAE), the central retinal venular equivalent, and the arteriovenous ratio (AVR).

RESULTS

Women had higher values of CRAE, central retinal venular equivalent, and AVR than men, and the decrease in measures with increasing age was less steep in women than in men. Systemic hypertension was associated with lower values [odds ratio (OR), 95% confidence interval (CI) referring to area below the 5% percentile] of AVR (men: OR 2.41, 95% CI 1.669-3.490, P < 0.001; women: OR 3.01, 95% CI 2.126-4.268, P < 0.001) and CRAE (men: OR 2.60, 95% CI 1.563-4.326, P < 0.001, women: OR 3.00, 95% CI 2.004-4.487, P < 0.001). Both median CRAE and AVR were lower in participants with uncontrolled hypertension (172.28, range 83.05-251.04; and 0.81, range 0.56-1.04) versus those with screening-detected hypertension (175.72, range 101.23-222.09, P < 0.001; and 0.82, range 0.64-1.05, P = 0.001), and versus those with controlled (179.10, range 108.19-221.92, P < 0.001; and 0.84, range 0.60-1.08, P < 0.001) hypertension.

CONCLUSION

The study provides sex and age-specific normative data for retinal vasculature. Persons with untreated or insufficiently treated hypertension are more likely to have retinal vessel equivalents outside the reference range.

Correlation between Flicker-Induced Retinal Vessel Vasodilatation and Plasma Biomarkers of Endothelial Dysfunction in Hypertensive Patients

PURPOSE

Hypertension (HT) strongly affects the vascular endothelium, resulting in chronic inflammatory disease. Dynamic vessel analysis (DVA) is a modern methodological approach to analyze vascular function in the retinal microcirculation. The aim of this study was to examine whether a defective retinal vessels response is associated with HT-induced endothelial dysfunction.

MATERIALS AND METHODS

Retinal vessel reactions to flicker stimulation were examined by DVA in both eyes of 37 hypertensive and 41 healthy control subjects. Plasma concentrations of C-reactive protein (CRP), interleukin-6, and tumor necrosis factor alpha (TNFɑ) were measured using the enzyme-linked immunosorbent assay.

RESULTS

Both arterial and vein responses to flicker stimulation were significantly decreased in patients with HT compared with the healthy controls (dilatation of the arteries was lower in the HT group by, on average, 1.31, p = 0.001 and dilatation of the veins was lower in the HT group by, on average, 1.32, p = 0.002) after independent adjustment for age, sex, body mass index, and pressure values. In the hypertensive group, there was a negative correlation between the arterial response to flicker stimulation and the plasma CRP concentration (Spearman's Rank-order Coefficient (Rs) = -0.29, p = 0.07). Similarly, the plasma TNFα concentrations negatively correlated with the arterial response to flicker stimulation (Rs = -0.39, p = 0.02).

CONCLUSIONS

Our results indicate that DVA directly reflects the actual metabolic status of the retinal endothelium. DVA might be used as an early noninvasive screening tool to detect vascular dysregulation and pan-endothelial dysfunction in patients with HT.

The Effect of Magnesium on Visual Evoked Potentials in L-NAME-Induced Hypertensive Rats

In the literature, although there are many studies regarding complications of hypertension, information concerning its influence on visual evoked potentials (VEPs) is limited. This study aims to clarify the possible therapeutic effects of the preferential magnesium (Mg) treatment on VEPs in an experimental hypertension model. Rats were divided into four groups as follows: control, Mg treated (Mg), N(omega)-nitro-L-arginine methyl ester (L-NAME) hypertension, and L-NAME hypertension + Mg treated (L-NAME + Mg). Hypertension was induced by L-NAME which was given to rats orally over 6 weeks (25 mg/kg/day in drinking water). A magnesium-enriched diet (0.8 g/kg) was given to treatment groups for 6 weeks. Systolic blood pressure (SBP) was determined by using the tail-cuff method. Flash VEPs were recorded. Our results revealed that the SBP was significantly increased in the L-NAME group compared to control. Magnesium treatment significantly attenuated SBP in the hypertensive rats compared to the L-NAME group. The mean latencies of P1, N1, P2, N2, and P3 components were significantly prolonged in hypertensive rats compared to control. Treatment with Mg provided a significant decrease in the latencies of P1, N1, P2, N2, and P3 potentials in the L-NAME + Mg group compared to the L-NAME group. Plasma Mg levels were increased in the L-NAME + Mg group compared to the L-NAME group. No change was detected in the Mg levels of the brains in all experimental groups. Magnesium treatment had no effect on the brain nitrate/nitrite and thiobarbituric acid-reactive substances (TBARS) levels in hypertensive rats compared to non-treated rats. There was a positive correlation between the brain TBARS levels and SBP of the rats. The present study suggests that Mg supplementation has the potential to prevent VEP changes in the L-NAME-induced hypertension model.

Bilateral retinal pigment epithelial rips in hypertensive choroidopathy

Severe systemic hypertension can cause significant damage to the eye. Although hypertensive retinopathy is a well-known complication, hypertensive optic neuropathy and hypertensive choroidopathy are much less common. The aim of this article is to report an unusual case of hypertensive choroidopathy with bullous exudative retinal detachments in both eyes. The retinal detachments spontaneously resolved after blood pressure was controlled. However, multiple large retinal pigment epithelial (RPE) rips were found in both eyes. These RPE rips may be related to severe choroidal ischemia, and their locations may be compatible with the watershed zones of the choroidal perfusions.

Dysfunctional information processing during an auditory event-related potential task in individuals with Internet gaming disorder

Internet gaming disorder (IGD) leading to serious impairments in cognitive, psychological and social functions has gradually been increasing. However, very few studies conducted to date have addressed issues related to the event-related potential (ERP) patterns in IGD. Identifying the neurobiological characteristics of IGD is important to elucidate the pathophysiology of this condition. P300 is a useful ERP component for investigating electrophysiological features of the brain. The aims of the present study were to investigate differences between patients with IGD and healthy controls (HCs), with regard to the P300 component of the ERP during an auditory oddball task, and to examine the relationship of this component to the severity of IGD symptoms in identifying the relevant neurophysiological features of IGD. Twenty-six patients diagnosed with IGD and 23 age-, sex-, education- and intelligence quotient-matched HCs participated in this study. During an auditory oddball task, participants had to respond to the rare, deviant tones presented in a sequence of frequent, standard tones. The IGD group exhibited a significant reduction in response to deviant tones compared with the HC group in the P300 amplitudes at the midline centro-parietal electrode regions. We also found a negative correlation between the severity of IGD and P300 amplitudes. The reduced amplitude of the P300 component in an auditory oddball task may reflect dysfunction in auditory information processing and cognitive capabilities in IGD. These findings suggest that reduced P300 amplitudes may be candidate neurobiological marker for IGD.

Tremendous result of bevacizumab in malignant hypertensive retinopathy

Signs of hypertensive retinopathy are common and are correlated with elevated blood pressure. Patients who have swelling of both optic discs and very high blood pressure (i.e., malignant retinopathy) need urgent antihypertensive treatment. A patient was reported with malignant hypertensive retinopathy who recovered promptly following single intravitreal bevacizumab injection. Intravitreal bevacizumab (1.25 mg/0.05 mL) was injected in two eyes of a patient having malignant hypertensive retinopathy with optic disc edema, macular edema, and retinal exudates. A complete ophthalmic examination, including the best-corrected visual acuity (BCVA), central macular thickness on optical coherence tomography (OCT), and fluorescein angiography (FAG), was performed before and after the treatments. Two eyes in a patient received a single intravitreal injection of bevacizumab had improvement of macular edema on OCT at 1 month and decreased fluorescein leakage on FAG 3 months after the treatment, which led to improvements in the BCVA both eyes. The results suggest that intravitreal bevacizumab injections might be a useful and safe adjunctive treatment of malignant hypertensive retinopathy, in addition to proper medical management of malignant hypertension.

Differences in functional connectivity between alcohol dependence and internet gaming disorder

INTRODUCTION

Internet gaming disorder (IGD) and alcohol dependence (AD) have been reported to share clinical characteristics including craving and over-engagement despite negative consequences. However, there are also clinical factors that differ between individuals with IGD and those with AD in terms of chemical intoxication, prevalence age, and visual and auditory stimulation.

METHODS

We assessed brain functional connectivity within the prefrontal, striatum, and temporal lobe in 15 patients with IGD and in 16 patients with AD. Symptoms of depression, anxiety, and the attention deficit hyperactivity disorder were assessed in patients with IGD and in patients with AD.

RESULTS

Both AD and IGD subjects have positive functional connectivity between the dorsolateral prefrontal cortex (DLPFC), cingulate, and cerebellum. In addition, both groups have negative functional connectivity between the DLPFC and the orbitofrontal cortex. However, the AD subjects have positive functional connectivity between the DLPFC, temporal lobe and striatal areas while IGD subjects have negative functional connectivity between the DLPFC, temporal lobe and striatal areas.

CONCLUSIONS

AD and IGD subjects may share deficits in executive function, including problems with self-control and adaptive responding. However, the negative connectivity between the DLPFC and the striatal areas in IGD subjects, different from the connectivity observed in AD subjects, may be due to the earlier prevalence age, different comorbid diseases as well as visual and auditory stimulation.

Hypertensive choroidopathy in pre-eclampsia: two consecutive cases

Hypertensive retinopathy is well known, but choroidopathy is uncommon and associated with acute increases in blood pressure. Nonperfused areas of the choriocapillaris lead to changes of overlying retinal pigment epithelium (RPE), resulting in neurosensory or RPE detachments. The authors describe two patients with serous retinal detachments associated with acute arterial hypertension in pre-eclampsia and HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome. Subretinal fluid was demonstrated on ultra-widefield fundus imaging and optical coherence tomography. Fluorescein angiography and indocyanine green angiography enabled imaging of the choroidal hypoperfusion. All signs and symptoms resolved after 1 and 3 months, respectively, with persistent macular pigmentary changes in both patients.

Semi-automated retinal vessel analysis in nonmydriatic fundus photography

PURPOSE

Funduscopic assessment of the retinal vessels may be used to assess the health status of microcirculation and as a component in the evaluation of cardiovascular risk factors. Typically, the evaluation is restricted to morphological appreciation without strict quantification. Our purpose was to develop and validate a software tool for semi-automated quantitative analysis of retinal vasculature in nonmydriatic fundus photography.

METHODS

matlab software was used to develop a semi-automated image recognition and analysis tool for the determination of the arterial-venous (A/V) ratio in the central vessel equivalent on 45° digital fundus photographs. Validity and reproducibility of the results were ascertained using nonmydriatic photographs of 50 eyes from 25 subjects recorded from a 3DOCT device (Topcon Corp.). Two hundred and thirty-three eyes of 121 healthy subjects were evaluated to define normative values.

RESULTS

A software tool was developed using image thresholds for vessel recognition and vessel width calculation in a semi-automated three-step procedure: vessel recognition on the photograph and artery/vein designation, width measurement and calculation of central retinal vessel equivalents. Mean vessel recognition rate was 78%, vessel class designation rate 75% and reproducibility between 0.78 and 0.91. Mean A/V ratio was 0.84. Application on a healthy norm cohort showed high congruence with prior published manual methods. Processing time per image was one minute.

CONCLUSIONS

Quantitative geometrical assessment of the retinal vasculature may be performed in a semi-automated manner using dedicated software tools. Yielding reproducible numerical data within a short time leap, this may contribute additional value to mere morphological estimates in the clinical evaluation of fundus photographs.

The association between endothelial dysfunction and hypertensive retinopathy in essential hypertension

BACKGROUND

Endothelial dysfunction, which is characterized by an imbalance between relaxing and contracting factors, procoagulant and anticoagulant substances, and between pro-inflammatory mediators, may play a particularly significant role in the pathogenesis of atherosclerosis. Numerous experimental and clinical reports suggest that a high von Willebrand factor (vWF) level reflects endothelial damage or dysfunction. Hypertensive retinopathy (HR) is a condition characterized by a spectrum of retinal vascular signs in people with elevated blood pressure. The pathophysiological mechanism of HR is not completely understood. Elevated blood pressure alone does not fully account for the extent of retinopathy. Endothelial dysfunction and mechanisms known to be involved in vascular lesions may be involved in the pathophysiological mechanism of HR. Therefore, this study was designed to answer the following questions: (i) Do vWf levels change in HR? and (ii) Is there any relation between degree of HR and vWf levels?

MATERIAL AND METHODS

This study included 80 hypertensive patients with HR. Group 1 comprised 40 patients with grade I HR, and group 2 comprised 40 patients with grade II HR. We selected 40 healthy subjects for the control group.

RESULTS

Level of vWf in group 2 was significantly higher than in group 1 (p=0.017) and the control group (p<0.001), and it was also higher in group 1 than in the control group (p<0.005). Also, vWf showed positive correlation with degree of HR in the hypertensive group (r=0.284, p=0.009).

CONCLUSIONS

Our study suggests that endothelial dysfunction, which is a mechanism known to be involved in vascular lesions, may promote the development of HR.

The role of SIRT1 in ocular aging

The sirtuins are a highly conserved family of nicotinamide adenine dinucleotide (NAD+)-dependent histone deacetylases that helps regulate the lifespan of diverse organisms. The human genome encodes seven different sirtuins (SIRT1-7), which share a common catalytic core domain but possess distinct N- and C-terminal extensions. Dysfunction of some sirtuins have been associated with age-related diseases, such as cancer, type II diabetes, obesity-associated metabolic diseases, neurodegeneration, and cardiac aging, as well as the response to environmental stress. SIRT1 is one of the targets of resveratrol, a polyphenolic SIRT1 activator that has been shown to increase the lifespan and to protect various organs against aging. A number of animal studies have been conducted to examine the role of sirtuins in ocular aging. Here we review current knowledge about SIRT1 and ocular aging. The available data indicate that SIRT1 is localized in the nucleus and cytoplasm of cells forming all normal ocular structures, including the cornea, lens, iris, ciliary body, and retina. Upregulation of SIRT1 has been shown to have an important protective effect against various ocular diseases, such as cataract, retinal degeneration, optic neuritis, and uveitis, in animal models. These results suggest that SIRT1 may provide protection against diseases related to oxidative stress-induced ocular damage, including cataract, age-related macular degeneration, and optic nerve degeneration in glaucoma patients.

Hypertensive retinopathy in severely hypertensive children: demographic, clinical, and ophthalmoscopic findings from a 30-year British cohort

PURPOSE

There is scarce data regarding the incidence and clinical features of hypertensive retinopathy in children. The authors studied a large British cohort of severely hypertensive children to ascertain who developed hypertensive retinopathy, the severity, and the visual prognosis.

METHODS

A retrospective review was performed of children undergoing renal angiography for investigation of severe hypertension at a tertiary institution from 1980 to 2010. All relevant cardiovascular, radiologic, and ophthalmic information was collected from case notes of the children identified in the study period. The outcome measures were presenting blood pressure, presence/severity of hypertensive retinopathy, and visual outcome.

RESULTS

Fifty-three severely hypertensive children were identified; 30 with renovascular disease (RVD+) and 23 without (RVD-). The majority had 'stage 2 hypertension.' There were no significant differences in age, gender, or blood pressure between RVD+ and RVD- children. Seven (18%) of the 39 children receiving ophthalmic assessment had hypertensive retinopathy, of whom 6 had severe disease (retinal hemorrhages, exudates, and optic disc edema). There was a trend toward a higher prevalence of hypertensive retinopathy in the RVD+ group (n = 5) but this was not statistically significant. Children with hypertensive retinopathy had higher blood pressure than those without (median: 216/158 vs 150/98 mm Hg, P < .001).

CONCLUSIONS

This is the first study examining the incidence and characteristics of hypertensive retinopathy in British children with severe hypertension. The authors found an 18% incidence of hypertensive retinopathy, in some cases with permanent visual reduction.

An ocular view of the IGF-IGFBP system

IGFs and their binding proteins have been shown to exhibit both protective and deleterious effects in ocular disease. Recent studies have characterized the expression patterns of different IGFBPs in retinal layers and within the vitreous. IGFBP-3 has roles in vascular protection stimulating proliferation, migration, and differentiation of vascular progenitor cells to sites of injury. IGFBP-3 increases pericyte ensheathment and shows anti-inflammatory effects by reducing microglia activation in diabetes. IGFBP-5 has recently been linked to mediating fibrosis in proliferative vitreoretinopathy but also reduces neovascularization. Thus, the regulatory balance between IGF and IGFBPs can have profound impact on target tissues. This review discusses recent findings of IGF and IGFBP expression in the eye with relevance to different retinopathies.

Alterations in regional homogeneity of resting-state brain activity in internet gaming addicts

Backgrounds

Internet gaming addiction (IGA), as a subtype of internet addiction disorder, is rapidly becoming a prevalent mental health concern around the world. The neurobiological underpinnings of IGA should be studied to unravel the potential heterogeneity of IGA. This study investigated the brain functions in IGA patients with resting-state fMRI.

Methods

Fifteen IGA subjects and fourteen healthy controls participated in this study. Regional homogeneity (ReHo) measures were used to detect the abnormal functional integrations.

Results

Comparing to the healthy controls, IGA subjects show enhanced ReHo in brainstem, inferior parietal lobule, left posterior cerebellum, and left middle frontal gyrus. All of these regions are thought related with sensory-motor coordination. In addition, IGA subjects show decreased ReHo in temporal, occipital and parietal brain regions. These regions are thought responsible for visual and auditory functions.

Conclusions

Our results suggest that long-time online game playing enhanced the brain synchronization in sensory-motor coordination related brain regions and decreased the excitability in visual and auditory related brain regions.

The association of oxidative stress with hypertensive retinopathy

This study was designed to answer the following questions: (i) Do levels of serum gamma-glutamyl transferase (GGT), a marker of oxidative stress, change in hypertensive retinopathy (HR)? (ii) Is there any relation between degree of HR and GGT levels? This study included 80 hypertensive patients with HR. Group 1 comprised 40 patients with grade I HR, and group 2 comprised 40 patients with grade II HR. We selected 40 healthy subjects for the control group. Level of GGT in group 2 was significantly higher than in group 1 (P = 0.005) and control group (P = 0.001); it was also higher in group 1 than in control group (P = 0.025). Our study suggests that oxidative stress, mechanisms known to be involved in vascular lesions, may promote the development of HR.

Emergency management of hypertension in children

Systemic arterial hypertension in children has traditionally been thought to be secondary in origin. Increased incidence of risk factors like obesity, sedentary life-styles, and faulty dietary habits has led to increased prevalence of the primary arterial hypertension (PAH), particularly in adolescent age children. PAH has become a global epidemic worldwide imposing huge economic constraint on health care. Sudden acute increase in systolic and diastolic blood pressure can lead to hypertensive crisis. While it generally pertains to secondary hypertension, occurrence of hypertensive crisis in PAH is however rare in children. Hypertensive crisis has been further subclassified depending on presence or absence of end-organ damage into hypertensive emergency or urgency. Both hypertensive emergencies and urgencies are known to cause significant morbidity and mortality. Increasing awareness among the physicians, targeted at investigation of the pathophysiology of hypertension and its complications, better screening methods, generation, and implementation of novel treatment modalities will impact overall outcomes. In this paper, we discuss the etiology, pathogenesis, and management of hypertensive crisis in children. An extensive database search using keywords was done to obtain the information.

Sex differences in primary hypertension

Men have higher blood pressure than women through much of life regardless of race and ethnicity. This is a robust and highly conserved sex difference that it is also observed across species including dogs, rats, mice and chickens and it is found in induced, genetic and transgenic animal models of hypertension. Not only do the differences between the ovarian and testicular hormonal milieu contribute to this sexual dimorphism in blood pressure, the sex chromosomes also play a role in and of themselves. This review primarily focuses on epidemiological studies of blood pressure in men and women and experimental models of hypertension in both sexes. Gaps in current knowledge regarding what underlie male-female differences in blood pressure control are discussed. Elucidating the mechanisms underlying sex differences in hypertension may lead to the development of anti-hypertensives tailored to one's sex and ultimately to improved therapeutic strategies for treating this disease and preventing its devastating consequences.

How does hypertension affect your eyes?

Hypertension has profound effects on various parts of the eye. Classically, elevated blood pressure results in a series of retinal microvascular changes called hypertensive retinopathy, comprising of generalized and focal retinal arteriolar narrowing, arteriovenous nicking, retinal hemorrhages, microaneurysms and, in severe cases, optic disc and macular edema. Studies have shown that mild hypertensive retinopathy signs are common and seen in nearly 10% of the general adult non-diabetic population. Hypertensive retinopathy signs are associated with other indicators of end-organ damage (for example, left ventricular hypertrophy, renal impairment) and may be a risk marker of future clinical events, such as stroke, congestive heart failure and cardiovascular mortality. Furthermore, hypertension is one of the major risk factors for development and progression of diabetic retinopathy, and control of blood pressure has been shown in large clinical trials to prevent visual loss from diabetic retinopathy. In addition, several retinal diseases such as retinal vascular occlusion (artery and vein occlusion), retinal arteriolar emboli, macroaneurysm, ischemic optic neuropathy and age-related macular degeneration may also be related to hypertension; however, there is as yet no evidence that treatment of hypertension prevents vision loss from these conditions. In management of patients with hypertension, physicians should be aware of the full spectrum of the relationship of blood pressure and the eye.

Ocular lesions associated with systemic hypertension in dogs: 65 cases (2005-2007)

OBJECTIVE

To characterize ocular findings in hypertensive dogs, determine prevalence of hypertension in dogs with ocular disease suggestive of hypertension, and examine possible relationships between degree of hypertension and ocular disease.

DESIGN

Retrospective case series.

ANIMALS

65 dogs initially referred for blood pressure measurement (n = 22), ophthalmic examination (25), or both (18).

PROCEDURES

Medical records were reviewed to identify dogs examined at the teaching hospital that underwent a complete ophthalmic examination and blood pressure measurement within a 24-hour period between January 1, 2005, and December 31, 2007. Signalment, history, blood pressure measurements, ophthalmic examination findings, and any vasoactive drug treatments were recorded. Ocular lesions considered likely to be associated with systemic hypertension included retinal hemorrhage, retinal detachment, hyphema, tortuous vessels, and subretinal edema.

RESULTS

Of the 65 dogs, 42 were hypertensive (systolic blood pressure ≥ 160 mm Hg) and 23 were normotensive. Sixty-two percent (26/42) of hypertensive dogs had ≥ 1 type of ocular lesion identified. Retinal hemorrhage was the most common ocular lesion in hypertensive dogs (17/42 [40%]). The presence of ≥ 1 type of ocular lesion had moderate sensitivity and specificity of 62% and 61 %, respectively, for identification of hypertension. Fifteen of the 25 (60%) dogs referred for blood pressure measurement after initial ophthalmic examination were found to be hypertensive.

CONCLUSIONS AND CLINICAL RELEVANCE

Ocular lesions are common in dogs with systemic hypertension. Dogs with hypertension or diseases associated with hypertension should be monitored carefully for evidence of ocular target organ damage, and hypertension should be systematically ruled out in dogs with characteristic ocular lesions.

The optometrist's role in the management of hypertensive crises

BACKGROUND

In hypertensive crises, ocular findings are pivotal to making correct management decisions. Joint National Committee on Prevention, Detection, and Treatment of High Blood Pressure (JNC-7) guidelines define hypertensive crises as blood pressure greater than 180/120 mmHg associated with signs or symptoms of target organ damage. Urgent cases are those without optic disc edema but that necessitate control within 24 to 72 hours. Emergent cases are those with optic disc edema, also known as malignant hypertension, demanding control within 1 to 6 hours.

CASE REPORTS

Two cases are illustrated, as might be seen in optometric offices, of severe stage II hypertension. In case 1, the acute elevation of blood pressure (220/110 mmHg), was assessed as an urgent case and was correctly managed with the primary care provider through outpatient care. The second case of acute elevation of blood pressure (250/150 mmHg) and ocular findings of severe hypertensive retinopathy was sent as an emergent case to the emergency room.

CONCLUSION

These cases exemplify optometric in-office decisions to effectively manage urgent and emergent cases of hypertensive crises. Utilizing an urgent versus emergent classification of retinopathy can lead to the appropriate management decision for these patients.

Diabetic eNOS-knockout mice develop accelerated retinopathy

PURPOSE

Dysfunction of endothelial nitric oxide synthase (eNOS) has been implicated in the pathogenesis of diabetic vascular complications. This study was undertaken to determine the role of eNOS in the development of diabetic retinopathy (DR), by investigating the functional consequences of its deficiency in the diabetic state.

METHODS

Diabetes was induced in eNOS-knockout (eNOS(-/-)) and C57B/6 mice by streptozotocin (STZ) injection. Retinal vasculature was evaluated by albumin extravasation, to quantitatively measure vascular permeability, and by trypsin-digested retinal vascular preparations, to quantify acellular capillaries. Gliosis was evaluated by immunofluorescent techniques. Retinal capillary basement membrane thickness was assessed by transmission electron microscopy. Total retinal nitric oxide level was assessed by measuring nitrate/nitrite using a fluorometric-based assay, iNOS expression was examined by real-time PCR.

RESULTS

Diabetic eNOS(-/-) mice exhibit more severe retinal vascular permeability than age-matched diabetic C57BL/6 mice, detectable as early as 3 weeks after diabetes induction. Diabetic eNOS(-/-) mice also show earlier onset and an increased number of acellular capillaries, sustained gliosis, and increased capillary basement membrane thickness. Total nitric oxide (NO) level was also increased, concomitant with elevated iNOS expression in diabetic eNOS(-/-) retina.

CONCLUSIONS

Diabetic eNOS(-/-) mice exhibit A significantly wider range of advanced retinal vascular complications than the age-matched diabetic C57BL/6 mice, supporting the notion that eNOS-derived NO plays an essential role in retinal vascular function. This mouse model also faithfully replicates many of the hallmarks of vascular changes associated with human retinopathy, thus providing a unique model to aid in understanding the pathologic mechanisms of and to develop effective therapeutic strategies for diabetic retinopathy.

The role of advanced glycation end products in retinal ageing and disease

The retina is exposed to a lifetime of potentially damaging environmental and physiological factors that make the component cells exquisitely sensitive to age-related processes. Retinal ageing is complex and a raft of abnormalities can accumulate in all layers of the retina. Some of this pathology serves as a sinister preamble to serious conditions such as age-related macular degeneration (AMD) which remains the leading cause of irreversible blindness in the Western world. The formation of advanced glycation end products (AGEs) is a natural function of ageing but accumulation of these adducts also represents a key pathophysiological event in a range of important human diseases. AGEs act as mediators of neurodegeneration, induce irreversible changes in the extracellular matrix, vascular dysfunction and pro-inflammatory signalling. Since many cells and tissues of the eye are profoundly influenced by such processes, it is fitting that advanced glycation is now receiving considerable attention as a possible pathogenic factor in visual disorders. This review presents the current evidence for a pathogenic role for AGEs and activation of the receptor for AGEs (RAGE) in initiation and progression of retinal disease. It draws upon the clinical and experimental literature and highlights the opportunities for further research that would definitively establish these adducts as important instigators of retinal disease. The therapeutic potential for novel agents that can ameliorate AGE formation of attenuate RAGE signalling in the retina is also discussed.