Measurement of retinal vascular caliber: issues and alternatives to using the arteriole to venule ratio.
OBJECTIVE
The arteriole to venule ratio (AVR) is widely used in studies of the associations of retinal microvascular disease with systemic and ocular outcomes. This is a discussion of the limitations of AVR; a comparison of its predictive information with that of its components, arteriolar and venular caliber; and a description of a suggested alternative method of modeling arteriolar and venular calibers directly.


METHODS
Data from the population-based Blue Mountains Eye Study were used to compare the predictive information in models using AVR with models using arteriolar and venular calibers directly. Determination was made of how the apparent relationship between vessel caliber and two systemic outcomes (blood pressure [BP] and white blood cell count [WBC]) was influenced by the choice of regression model. These findings were interpreted with reference to the known biological relationship among vessel calibers, BP, and WBC.


RESULTS
Models using arteriolar and venular calibers directly had more predictive information than models using AVR. The apparent relationship of vessel caliber to BP and WBC differed substantially, depending on the model chosen. For example, after adjustment for age, sex, and other covariates, decreasing venular caliber was associated with higher systolic BP when modeled separately, but was associated with lower systolic BP when modeled simultaneously with arteriolar caliber.


CONCLUSIONS
The findings suggest AVR provides less information with regards to predicting systemic outcomes than its two components. Modeling arteriolar and venular calibers separately could be biased by confounding, while modeling both simultaneously appears to provide unbiased, biologically plausible results. The use of this approach is recommended in future research relating retinal vascular caliber to systemic or ocular outcomes.
Liew
Gerald
G
Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Instiute, University of Sydney, Sydney, Australia.
Sharrett
A Richey
AR
Kronmal
Richard
R
Klein
Ronald
R
Wong
Tien Yin
TY
Mitchell
Paul
P
Kifley
Annette
A
Wang
Jie Jin
JJ
D000368:Aged; D001160:Arterioles; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D008297:Male; D012161:Retinal Artery / Q000502:physiology*; D012171:Retinal Vessels / Q000502:physiology*; D014699:Venules