The retinal microvasculature as an early indicator of chronic disease risk in older populations

  • Rachael O'Neill

Student thesis: Doctoral ThesisDoctor of Philosophy


It has previously been suggested that the measurement of retinal blood vessel parameters could provide an increased understanding of chronic systemic diseases with a vascular component. This easy, non-invasive imaging modality provides an indication of microvascular health that may reflect ongoing changes elsewhere in the body. The current published literature provides conflicting evidence on the associations between chronic disease and retinal microvascular parameters and this thesis provides additional support for the potential of these measures in the assessment of chronic disease outcomes. The primary aims of this thesis were to perform cross-sectional analyses of the baseline data from the Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA), to investigate associations between variation in retinal microvascular parameters and several chronic disease outcomes including chronic kidney disease, mild cognitive impairment, depression and diabetes. In addition, the potential systemic effects of vascular endothelial growth factor inhibition therapy, a primary intervention for the treatment of diabetic macular oedema and neovascular age-related macular degeneration, on long-term renal outcomes was evaluated in a cohort with diabetic macular oedema.

There was no evidence detected to suggest that regular long-term intravitreal vascular endothelial growth factor inhibition significantly effects renal function following treatment for diabetic macular oedema. Evidence of associations between chronic kidney disease and increased retinal venular tortuosity, and between depression and reduced arteriolar tortuosity were identified, showing the potential clinical utility for identification of those at increased disease risk and possible intervention targets. No evidence of association between retinal microvascular parameters and mild cognitive impairment or diabetes were detected.

Overall, this thesis highlights the potential benefits that retinal imaging may offer in improving the understanding of chronic disease with a vascular component. The non-invasive, ease of use, low cost and opportunistic basis for retinal image capture may offer future clinical utility for the assessment and stratification of chronic disease risk.
Date of AwardJul 2021
Original languageEnglish
Awarding Institution
  • Queen's University Belfast
SponsorsNorthern Ireland Department for the Economy
SupervisorGareth McKay (Supervisor) & Peter Maxwell (Supervisor)


  • Retinal measures
  • chronic disease
  • older people

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