Digital eye profiled by retinal vascular features reveals heterogeneous patterns and links to vascular outcomes in type 2 diabetes

Research output: Contribution to conferenceAbstractpeer-review


Purpose: Retinal vascular morphological features (RVMFs) derived from retinal fundus images serve as sensitive biomarkers for systemic vascular diseases. Existing literatures focused on only a few pre-selected RVMFs but overlooked the inter-correlation among all available RVMFs, which leads to inconsistent findings. Analyzing all RVMFs simultaneously can generate a comprehensive digital profile for overall retinal vascular pattern (RVP) and provide reliable insights into the association with systemic vascular diseases.

Methods: The study cohort consists of all participants from GoDARTS (Genetics of Diabetes Audit and Research in Tayside, Scotland) who had their retinal images analyzed by VAMPIRE (Vascular Assessment and Measurement Platform for Images of the Retina). RVMF data were linked to electronic health records. Confirmatory factor analysis generated 22 latent factors from 149 RVMFs, providing a comprehensive profile of overall RVP. K-means clustering was used to identify distinct RVP clusters. Cox proportional hazards regression was used to compare ten-year incidences of vascular outcomes across RVP clusters, including a composite cardiovascular (CV) endpoint (fatal and non-fatal), hospitalization for heart failure (HHF), de novo chronic kidney disease (CKD), and all-cause death.

Results: 4103 participants with type 2 diabetes (age: 67 ± 11 years, 55% male) were included. K-means clustering identified three distinct RVP clusters (Figure 1). Individuals in cluster 2 characterized with greater venous tortuosity, while those in cluster 3 had wider vessels but greater arterial tortuosity. Comparing to cluster 1, individuals in cluster 2 had higher 10-year incidences of composite CV endpoint (adjusted hazard ratio [aHR] = 1.27; 95% CI: 1.09 – 1.47; p = 0.002), de novo CKD (1.32 [1.07 – 1.63]; p = 0.011), and all-cause death (1.17 [1.03 – 1.34]; p = 0.020). Higher incidence of HHF was observed in cluster 3 (1.27 [1.03 – 1.57]; p = 0.028), but not in cluster 2.

Conclusions: The findings revealed heterogeneous RVPs in people with type 2 diabetes, and their associations to different vascular outcomes. This paves the way for further personalized risk assessment and targeted interventions. Further validation is needed to consolidate the findings.
Original languageEnglish
Publication statusPublished - 9 May 2024
EventARVO 2024 Annual Meeting: Vision for the Future - The Seattle Convention Center, Arch Building, Seattle, United States
Duration: 5 May 20249 May 2024


ConferenceARVO 2024 Annual Meeting
Country/TerritoryUnited States
Internet address


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