Vascular response of the bulbar conjunctiva to diabetes and elevated blood pressure

Objective: Retinovascular changes associated with diabetes have been clearly documented; changes in vessels of the conjunctiva are less well described. We examined changes in conjunctival vessel morphologic features in participants with and without diabetes. Design: Case-control study. Participants and Controls: Fifty-three patients with diabetes (17 with type 1 diabetes, 36 with type 2 diabetes) and 60 controls (all aged 20-94 years). Methods: Digital red-free conjunctival images were captured and an automated computer algorithm was used to derive indices that describe the morphologic features of vessels of the conjunctiva. Percentage differences in vessel indices were adjusted for age, gender, blood pressure, and smoking status. Main Outcome Measures: Mean vessel diameter (micrometers) and vessel density (square millimeters of vessel per square centimeter of bulbar conjunctiva). Results: A strong positive association between the duration of diabetes and overall mean vessel width was observed (P < 0.001), resulting from changes in larger vessels (> 80 mu m in width). Conversely, the duration of diabetes showed a strong inverse association with vessel area (P < 0.001) that appeared to be driven by the trend observed in smaller vessels (< 40 mu m in width). A 25% reduction (95% confidence interval [CI], -35% to -13%; P < 0.001) in vessel density in those with type 1 diabetes and a 14% reduction (95% CI, -24% to -3%; P = 0.016) in those with type 2 diabetes, compared with controls, was observed. Mean vessel widths were 11% (95% CI, 4%-17%; P = 0.001) wider in type 1 and 5% (95% CI, 0%-10%; P = 0.073) wider in those with type 2 diabetes compared with controls. The difference in magnitude of effect for type 1 and type 2 diabetes compared with controls was explained by duration of diabetes. Grade of diabetic retinopathy and elevated blood pressure showed similar but less strong associations with vessel indices. Conclusions: Loss of capillaries and macrovessel dilation in the conjunctiva associated with diabetes compares with well-known vessel changes in the retina. Associations between morphologic changes in the conjunctiva and elevated blood pressure were similar but less strong; this may show that diabetic angiopathy predominates in those with both diabetes and elevated blood pressure. (c) 2005 by the American Academy of Ophthalmology.