Skip to main content

Advertisement

SpringerLink
Log in

Telemedical assessment of optic nerve head and retina in patients after recent minor stroke or TIA

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

The aim of the study is to telemedically assess the prevalence of simple optic nerve atrophy and retinal arteriolar anomalies in subjects who have had a minor stroke or TIA within 14 days, and to compare these results with an age-matched control group. By using a mobile examination unit, retinal photographs were taken with a 45° non-mydriatic colour fundus camera (KOWA NM-45, non-mydriatic-alpha) in patients who had suffered from a minor stroke or TIA within 14 days of the time of the examination. Retinal photographs were focused on the optic nerve head region. Pupils were not dilated. The documented medical history and the retinal images were stored on a server using browser independent web-based software running on PCs, tablets and smartphones. After completing the upload of the medical interview and the retinal images into the electronic patient chart, all retinal images were evaluated via telemedicine by an experienced senior consultant ophthalmologist. Age-matched normotensive, non-diabetic subjects (aged 40–89 years) who reported no systemic or ocular diseases were used as the control group. Both study groups were divided into five decades of life (40–49; 50–59; 60–69; 70–79; 80–89 years). We calculated the prevalences and the ratios of prevalences of optic nerve atrophy and retinal arteriolar anomalies between the stroke and the control group per decades of life. 139 minor stroke or TIA subjects (aged 40–89 years) and 1611 age-matched control subjects were examined. In the stroke group, we found significantly increased prevalences of optic nerve atrophy and retinal arteriolar anomalies throughout the 5th–8th decade of life when compared to age-matched controls. The prevalence of optic nerve atrophy in stroke subjects outranged the prevalence in the controls depending on age-class by a factor of 3–21. Simple optic nerve atrophy is frequent in patients who have suffered from an ischemic stroke or TIA, and it seems to indicate vascular damage, indicating the necessity for telemedically assisted assessment of the optic nerve.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Wong TY, Klein R, Islam FM et al (2006) Diabetic retinopathy in a multi-ethnic cohort in the United States. Am J Ophthalmol 141:446–455

    Article  PubMed  PubMed Central  Google Scholar 

  2. Wong TY, Mitchell P (2004) Hypertensive retinopathy. N Engl J Med 351:2310–2317

    Article  CAS  PubMed  Google Scholar 

  3. Wong TY, Klein R, Couper DJ et al (2001) Retinal microvascular abnormalities and incident stroke: the atherosclerosis risk in communities study. Lancet 358:1134–1140

    Article  CAS  PubMed  Google Scholar 

  4. Wong TY, Mitchell P (2007) The eye in hypertension. Lancet 369:425–435

    Article  PubMed  Google Scholar 

  5. Wong TY, Hubbard LD, Klein R et al (2002) Retinal microvascular abnormalities and blood pressure in older people: the cardiovascular health study. Br J Ophthalmol 86:1007–1013

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Wong TY, Klein R, Klein BE et al (2001) Retinal microvascular abnormalities and their relationship with hypertension, cardiovascular disease, and mortality. Surv Ophthalmol 46:59–80

    Article  CAS  PubMed  Google Scholar 

  7. Klein R (1992) Retinopathy in a population based study. Trans Am Ophthalmol Soc 90:561–594

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Klein R, Klein BE, Moss SE (1997) The relation of systemic hypertension to changes in the retinal vasculature: the beaver dam eye study. Trans Am Ophthalmol Soc 95:329–350

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Wong TY, Klein R, Sharrett AR et al (2003) The prevalence and risk factors of retinal microvascular abnormalities in older persons: the cardiovascular health study. Ophthalmology 110:658–666

    Article  PubMed  Google Scholar 

  10. Mitchell P, Wang JJ, Wong TY et al (2005) Retinal microvascular signs and risk of stroke and stroke mortality. Neurology 65:1005–1009

    Article  CAS  PubMed  Google Scholar 

  11. Henderson AD, Bruce BB, Newman NJ et al (2011) Hypertension-related eye abnormalities and the risk of stroke. Rev Neurol Dis 8:1–9

    PubMed  PubMed Central  Google Scholar 

  12. Doubal FN, Hokke PE, Wardlaw JM et al (2009) Retinal microvascular abnormalities and stroke: a systematic review. J Neurol Neurosurg Psychiatry 80:158–165

    Article  CAS  PubMed  Google Scholar 

  13. Baker ML, Hand PJ, Wang JJ et al (2008) Retinal signs and stroke: revisiting the link between the eye and brain. Stroke 39:1371–1379

    Article  PubMed  Google Scholar 

  14. De Silva DA, Manzano JJ, Liu EY et al (2011) Retinal microvascular changes and subsequent vascular events after ischemic stroke. Neurology 77:896–903

    Article  PubMed  Google Scholar 

  15. Hayreh SS, Jonas JB (2000) Appearance of the optic disk and retinal nerve fibre layer in atherosclerosis and arterial hypertension: an experimental study in rhesus monkeys. Am J Ophthalmol 130:91–96

    Article  CAS  PubMed  Google Scholar 

  16. Achmed E (2001) A textbook of ophthalmology. Prentice-Hall of India Private Limited, New Delhi, pp 359–361

    Google Scholar 

  17. Hayreh SS, Zimmerman MB (2007) Fundus changes in central retinal artery occlusion. Retina 27:276–289

    Article  PubMed  Google Scholar 

  18. Leistner S, Michelson G, Laumeier I et al (2013) Intensified secondary prevention intending a reduction of recurrent events in TIA and minor stroke patients (INSPiRE-TMS): a protocol for a randomised controlled trial. BMC Neurol 13:11

    Article  PubMed  PubMed Central  Google Scholar 

  19. Michelson G, Groh M, Groh MJ et al (2005) Telemedical-supported screening of retinal vessels (“talking eyes”). Klin Monbl Augenheilkd 222:319–325

    Article  CAS  PubMed  Google Scholar 

  20. Michelson G, Laser M, Müller S et al (2011) Validation of telemedical fundus images from patients with retinopathy. Klin Monbl Augenheilkd 228:234–238

    Article  CAS  PubMed  Google Scholar 

  21. Paulus J, Meier J, Bock R et al (2010) Retinal microvascular changes and target. Int J Comput Assist Radiol Surg 5:557–564

    Article  PubMed  Google Scholar 

  22. Jonas JB, Nguyen NX, Naumann GO (1989) Optic disc morphometry in simple optic nerve atrophy. Acta Ophthalmol (Copenh) 67:199–203

    Article  CAS  Google Scholar 

  23. Lehmann MV, Schmieder RE (2011) Remodelling of retinal small arteries in hypertension. Am J Hypertens 24:1267–1273

    Article  PubMed  Google Scholar 

  24. Ritt M, Harazny JM, Ott C et al (2012) Influence of blood flow on arteriolar wall-to-lumen ratio in the human retinal circulation in vivo. Microvasc Res 83:111–117

    Article  PubMed  Google Scholar 

  25. Boltz A, Schmidl D, Werkmeister RM et al (2013) Regulation of optic nerve head blood flow during combined changes in intraocular pressure and arterial blood pressure. J Cereb Blood Flow Metab 33:1850–1856

    Article  PubMed  PubMed Central  Google Scholar 

  26. Schmidl D, Boltz A, Kaya S et al (2013) Role of nitric oxide in optic nerve head blood flow regulation during an experimental increase in intraocular pressure in healthy humans. Exp Eye Res 116:247–253

    Article  CAS  PubMed  Google Scholar 

  27. Ritt M, Harazny JM, Ott C et al (2011) Basal nitric oxide activity is an independent determinant of arteriolar structure in the human retinal circulation. J Hypertens 29:123–129

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank Gabriele Nieweler, Katrin Haug and Sabine Wunderlich for conducting the digital photographs of the ocular fundus in minor stroke and TIA patients. The present work was performed in fulfilment of the requirements for obtaining the degree “Dr. Med.” from the Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU).

Funding

The authors declare that there has been no funding: this research received no specific Grant from any funding agency in the public, commercial or not-for-profit sectors.

Contributorship statements

Johannes Wolz is the corresponding author. He is responsible for the statistical processing and analysis of the data gained by the Talkingeyes® network. He selected the subjects of the two study groups, conducted the statistical calculations and interpreted the results in the context of existing study results. He drafted all chapters. Professor Dr. Heinrich Audebert is the principal investigator of the INSPiRE-TMS study. He is responsible for the study design of the trial including the integration of fundoscopy, for the collection of the medical data and for the creation of the digital photographs of the ocular fundus of 139 minor stroke and TIA patients. Professor Dr. Georg Michelson is the head of the IZPI. He is responsible for the collection of the medical data and the creation of the digital fundus photographs of 9426 patients in the context of the Talkingeyes® network. He was responsible for the medical evaluation of all images. Dr. Inga Laumeier, Dr. Michael Ahmadi, Dr. Maureen Steinicke and Dr. Caroline Ferse are responsible for the recruitment of 139 minor stroke and TIA patients, the documentation of the medical data and the sending of the digital images of the ocular fundus to the IZPI Erlangen.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany

    Johannes Wolz & Georg Michelson

  2. Department of Neurology, Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany

    Heinrich Audebert, Inga Laumeier, Michael Ahmadi, Maureen Steinicke & Caroline Ferse

  3. Interdisciplinary Centre of Ophthalmic Preventive Medicine and Imaging, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany

    Georg Michelson

Authors
  1. Johannes Wolz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heinrich Audebert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Inga Laumeier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Ahmadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maureen Steinicke
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Caroline Ferse
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Georg Michelson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Johannes Wolz.

Ethics declarations

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria, educational grants, participation in speakers’ bureaus, membership, employment, consultancies, stock ownership, or other equity interest, and expert testimony or patent-licencing arrangements) or non-financial interest (such as personal or professional relationships, affiliation, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethics approval

This analysis is based on data gained by a study group of the Department of Ophthalmology at the University Hospital Erlangen and the Centre for Stroke Research of the Neurological Clinic at the Charité University Berlin, Campus Benjamin Franklin [17]. Ethics approval was obtained by the Ethics Committee of the Charité University Berlin (EA2/084/11). The study was registered with the registry of clinical trials (clinicaltrials.gov: 01586702) and was performed in accordance with the Declaration of Helsinki. All persons gave their informed consent prior to their inclusion in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wolz, J., Audebert, H., Laumeier, I. et al. Telemedical assessment of optic nerve head and retina in patients after recent minor stroke or TIA. Int Ophthalmol 37, 39–46 (2017). https://doi.org/10.1007/s10792-016-0222-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-016-0222-7

Keywords

Search

Navigation