Changes in Retinal Vasculature Phenotype and Choroidal Blood Flow at High Altitude in Healthy Lowlanders.

Purpose: The aim of this study was to characterize changes in retinal vessel diameters and choroidal blood flow in healthy lowlanders during a high-altitude expedition.

Methods: Ocular examination, fundus images acquired using a handheld camera, and laser Doppler flowmetry (LDF) measurements within the subfoveal choroid (blood flow = ChBF, blood velocity = ChVel, and blood volume = ChVol) were carried out at 200 m and after 9 days at 5100 m in 11 healthy participants. Fundus images were analyzed with the semi-automatic software Vessel Assessment and Measurement Platform for Images of the Retina (VAMPIRE) version 3.2 to quantify retinal vessel parameters: the central retinal artery equivalent (CRAE), the central retinal vein equivalent (CRVE), and arterial and venular tortuosity. Hematocrit and hemoglobin concentrations were also measured at both altitudes.

Results: Corneal thickness increased slightly at altitude (median = 536 µm, interquartile range = 25-75%: [521-571] at 200 m vs. 561 µm [540-574] at 5100 m, P = 0.004). No participant was affected by high-altitude retinopathy. From 200 m to 5100 m, ChVol and ChBF decreased significantly (-31% [43-22], P = 0.003 and -13% [22-8], P = 0.01, respectively), ChVel increased (+17% [10-44], P = 0.003), and CRVE (+10% [3-14], P = 0.04) and venular tortuosity (+142% [71-168], P = 0.04) increased significantly. The altitude-induced increase in hematocrit correlated negatively with the decrease in ChBF (r = -0.88, P < 0.001) and positively with the increase in CRVE (r = 0.88, P = 0.01).

Conclusions: Acute high-altitude exposure leads to a decrease of ChBF (partly related to a decrease in blood volume) and an increase in retinal vein diameter and tortuosity. The physiological consequences of these changes on retinal blood flow and retinal function remain to be explored.