Delineating the effects of morphological changes on retinal hemodynamics in diabetic human retinas: An invitro investigation

Diabetes-related vascular abnormalities are commonly encountered in the retinal vasculature, the most common being the increased tortuosity and reduced lumen diameter. These morphological changes significantly affect the underlying hemodynamics and remain unexplored. The current study examines the changes produced by the altered morphology on the blood flow velocity and wall shear stress (WSS) using particle streak velocimetry (PSV) experiments and numerical simulations and compares it with the healthy scenario. The diabetic and healthy retinal arteries are extracted from patient-specific fundus images and transparently printed using stereolithography (SLA) in three dimensions. Flow visualization experiments are performed using the blood-mimicking fluid (BMF) with three different flow rates, whose values are evaluated using the similarity analysis. Experimental and simulation results illustrate a significant reduction in the average axial velocity and WSS due to tortuosity with maximum percentage reductions of 10% and 11%, respectively, compared to healthy. Additionally, a strong correlation is observed between a particular artery's local tortuosity and the WSS, with a higher tortuosity index leading to the development of low-shear regions inside the diabetic artery. A 14% diameter reduction in the diabetic arteries leads to approximately 65% and 63% increase in the velocity and WSS, respectively, compared to healthy. Moreover, the experiments also capture the effect of decreased blood viscosity on the WSS in the case of diabetic arteries, illustrating a significant decrease in WSS values. The experiments performed in the current study may help ophthalmologists estimate the induced damage that the arterial morphological changes may create and facilitate an accurate prognosis of retinal vascular diseases.