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Retinal and Cerebral Microvascular Signs and Diabetes: The Age, Gene/Environment Susceptibility-Reykjavik Study

¹Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, National Institutes of Health (NIH), Bethesda, Maryland
²Division of Epidemiology and Clinical Research, National Eye Institute, NIH, Bethesda, Maryland
³Icelandic Heart Association, Kopavogur, Iceland
⁴Department of Ophthalmology, University of Wisconsin School of Medicine and Public Health-Madison, Wisconsin
⁵Faculty of Medicine, University of Iceland, Reykjavik, Iceland
⁶Department of Ophthalmology, Landspitali-University Hospital, Reykjavik, Iceland
⁷Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

Objective: Diabetes increases the risk for microvascular disease. The retina and the brain both have intricate microvascular systems that are developmentally similar. Here, we seek to examine whether microvascular lesions in the retina and in the brain are associated, and whether this association differs among people with and without diabetes.

Research Design And Methods: The analysis included 4218 participants of the Icelandic population-based Age, Gene/Environment Susceptibility-Reykjavik Study, who were born in 1907–1935 and previously followed as a part of the Reykjavik Study. Retinal focal arteriolar narrowing, arteriovenous nicking, and microaneurysms/hemorrhages were evaluated on digital retinal images of both eyes. Cerebral microbleeds were evaluated from magnetic resonance images. Data were analyzed with logistic and multinomial logistic regression models controlling for demographics, major cardiovascular risk factors, cerebral infarcts, and white matter lesions.

Results: Evidence of brain microbleeds was found in 485 (11.5%) persons, including 192 with multiple (2) microbleeds. Subjects with signs of retinal microvascular lesions were at a significantly increased likelihood for having multiple cerebral microbleeds. Persons with diabetes, in combination with the presence of either retinal arteriovenous nicking (odds ratio, 2.47; 95% CI, 1.42–4.31) or retinal microaneurysms/hemorrhages (odds ratio, 2.28; 95% CI, 1.24–4.18), were significantly more likely to have multiple cerebral microbleeds.

Conclusions: Retinal microvascular abnormalities and brain microbleeds may occur together in older adults. People with both diabetes and signs of retinal microvascular lesions (arteriovenous nicking and microaneurysms/hemorrhages) are more likely to have multiple microbleeds in the brain. Microvascular disease in diabetes extends to the brain.

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