Retinal Arteriolar Tortuosity Is Associated With Retinopathy and Early Kidney Dysfunction in Type 1 Diabetes

Am J Ophthalmol. 2012 Jan;153(1):176-83.e1. doi: 10.1016/j.ajo.2011.06.005. Epub 2011 Sep 9.


Purpose: To examine the association of retinal vessel tortuosity with diabetic retinopathy and early nephropathy in type 1 diabetes.

Design: Cross-sectional.

Methods: A total of 1159 participants with type 1 diabetes aged 12 to 20 years, attending diabetes clinics in Children's Hospital at Westmead, Sydney, Australia between 1990 and 2002, were included. Retinal photography and clinical examinations were performed during the baseline visit to assess diabetic retinopathy and albumin excretion rate (AER). Retinal vessel tortuosity was measured from digitized retinal photographs using a semi-automated computer program by a single grader masked to participants' characteristics. Diabetic retinopathy was defined as ETDRS level ≥21 (mild nonproliferative retinopathy) and early kidney dysfunction was defined as AER ≥7.5 μg/min.

Results: Of 944 patients (81.4%), 85 (9.0%) had signs of retinopathy only, 250 (26.5%) had early kidney dysfunction only, and 85 (9.0%) had both retinopathy and early kidney dysfunction. In multivariate analysis, higher arteriolar tortuosity was associated with retinopathy (odds ratio [OR] 2.01, 95% confidence interval [CI] 1.23-3.29, the highest quartile vs the remaining 3 quartiles), early kidney dysfunction (OR 1.56, 95% CI 1.06-2.28, per standard deviation [SD] increase), or coexistence of both complications (OR 1.96, 95% CI 1.21-3.24, the highest quartile vs the remaining 3 quartiles).

Conclusions: Greater retinal arteriolar tortuosity was independently associated with retinopathy and early stage of nephropathy in type 1 diabetes. These findings may offer the potential of quantitative measurement of retinal vessel tortuosity for diabetic complication risk assessment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Arterioles / pathology
  • Blood Pressure
  • Child
  • Cholesterol / blood
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 1 / diagnosis*
  • Diabetic Nephropathies / blood
  • Diabetic Nephropathies / diagnosis*
  • Diabetic Retinopathy / blood
  • Diabetic Retinopathy / diagnosis*
  • Female
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Male
  • Retinal Artery / pathology*
  • Young Adult


  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human
  • Cholesterol