|
1
|
Chen X, Si H, Fu Y, Yang W, Luo Y, Xiao W. Association of retinal microvascular abnormalities with all-cause and specific-cause mortality among U.S. adults. BMC Public Health 2024; 24:3572. [PMID: 39716194 DOI: 10.1186/s12889-024-21117-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 12/17/2024] [Indexed: 12/25/2024] Open
Abstract
BACKGROUND Retinal microvascular abnormalities (RMA) reflect cumulative microvascular damage from systemic diseases and aging. However, little is known about the association between RMA and long-term survival outcomes. This study aimed to examine the relationships between RMA and the risk of all-cause and specific-cause mortality among U.S. adults. METHODS Individuals aged ≥ 40 years were included from the U.S. National Health and Nutrition Examination Survey, 2005-2008. RMA and its subtypes, including retinopathy, arteriovenous nicking (AVN), focal arteriolar narrowing (FAN) and Hollenhorst plaque (HP), were manually graded from retinal photographs. Associations between RMA and the risk of all-cause and cause-specific mortality were examined with Cox regression analysis. RESULTS This cohort study of 5775 adults included 2881 women (weighted proportion, 52.6%) and 2894 men (weighted, 47.4%), with a weighted mean (SE) age of 56.6 (0.4) years. RMA were present in 1251 participants (weighted, 17.9%), of whom 710 (weighted, 9.8%) had retinopathy, 635 (weighted, 9.3%) had AVN, 64 (weighted, 1.0%) had FAN, and 21 (weighted, 0.3%) had HP. During a median of 12.2 years (range, 0.1-15.0 years) of follow-up, 1488 deaths occurred, including 452 associated with cardiovascular disease (CVD), 341 associated with cancer, and 695 associated with other causes. After adjusting confounding factors, the presence of any RMA and retinopathy at baseline was associated with higher risk of all-cause mortality (HR, 1.26; 95%CI, 1.07-1.47; HR, 1.36; 95%CI, 1.09-1.71, respectively), CVD mortality (HR, 1.36; 95%CI, 1.06-1.73; HR, 1.53; 95%CI, 1.04-2.26, respectively) and other-cause mortality (HR, 1.33; 95%CI, 1.06-1.67; HR, 1.55; 95%CI, 1.20-2.01, respectively). Additionally, FAN was significantly associated with an increased risk of other-cause mortality (HR, 2.06; 95%CI, 1.16-3.65). Although AVN was not associated with mortality in the whole population, it was significantly related to higher risks of all-cause and CVD death in those with obesity (HR, 1.68; 95%CI, 1.12-2.52; HR, 1.96; 95%CI, 1.23-3.13, respectively). CONCLUSIONS This study revealed that the presence of RMA is independently associated with greater risks of all-cause, CVD and other-cause mortality in adults aged 40 years or older.
Collapse
Affiliation(s)
- Xiaoyun Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Hongyu Si
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Yihang Fu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Weimin Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Yan Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-Sen University, Guangzhou, 510060, China.
| | - Wei Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-Sen University, Guangzhou, 510060, China.
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, People's Republic of China.
| |
Collapse
|
|
2
|
Wang C, Li Y, Feng J, Liu H, Wang Y, Wan Y, Zheng M, Li X, Chen T, Xiao X. Plasmalogens and Octanoylcarnitine Serve as Early Warnings for Central Retinal Artery Occlusion. Mol Neurobiol 2024; 61:8026-8037. [PMID: 38459364 DOI: 10.1007/s12035-024-04093-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/03/2024] [Indexed: 03/10/2024]
Abstract
Central retinal artery occlusion (CRAO) is a kind of ophthalmic emergency which may cause loss of functional visual acuity. However, the limited treatment options emphasize the significance of early disease prevention. Metabolomics has the potential to be a powerful tool for early identification of individuals at risk of CRAO. The aim of the study was to identify potential biomarkers for CRAO through a comprehensive analysis. We employed metabolomics analysis to compare venous blood samples from CRAO patients with cataract patients for the venous difference, as well as arterial and venous blood from CRAO patients for the arteriovenous difference. The analysis of metabolites showed that PC(P-18:0/22:6(4Z,7Z,10Z,13Z,16Z,19Z)), PC(P-18:0/20:4(5Z,8Z,11Z,14Z)) and octanoylcarnitine were strongly correlated with CRAO. We also used univariate logistic regression, random forest (RF), and support vector machine (SVM) to screen clinical parameters of patients and found that HDL-C and ApoA1 showed significant predictive efficacy in CRAO patients. We compared the predictive performance of the clinical parameter model with combined model. The prediction efficiency of the combined model was significantly better with area under the receiver operating characteristic curve (AUROC) of 0.815. Decision curve analysis (DCA) also exhibited a notably higher net benefit rate. These results underscored the potency of these three substances as robust predictors of CRAO occurrence.
Collapse
Affiliation(s)
- Chuansen Wang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jie Fang Road, Wuhan, 430060, Hubei, China
| | - Ying Li
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jie Fang Road, Wuhan, 430060, Hubei, China
| | - Jiaqing Feng
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jie Fang Road, Wuhan, 430060, Hubei, China
| | - Hang Liu
- Department of Clinical Laboratory, Institute of Translational Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuedan Wang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jie Fang Road, Wuhan, 430060, Hubei, China
| | - Yuwei Wan
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jie Fang Road, Wuhan, 430060, Hubei, China
| | - Mengxue Zheng
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jie Fang Road, Wuhan, 430060, Hubei, China
| | - Xuejie Li
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jie Fang Road, Wuhan, 430060, Hubei, China
| | - Ting Chen
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jie Fang Road, Wuhan, 430060, Hubei, China.
| | - Xuan Xiao
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jie Fang Road, Wuhan, 430060, Hubei, China.
- Department of Clinical Laboratory, Institute of Translational Medicine, Renmin Hospital of Wuhan University, Wuhan, China.
| |
Collapse
|
|
3
|
Girach Z, Sarian A, Maldonado-García C, Ravikumar N, Sergouniotis PI, Rothwell PM, Frangi AF, Julian TH. Retinal imaging for the assessment of stroke risk: a systematic review. J Neurol 2024; 271:2285-2297. [PMID: 38430271 PMCID: PMC11055692 DOI: 10.1007/s00415-023-12171-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 03/03/2024]
Abstract
BACKGROUND Stroke is a leading cause of morbidity and mortality. Retinal imaging allows non-invasive assessment of the microvasculature. Consequently, retinal imaging is a technology which is garnering increasing attention as a means of assessing cardiovascular health and stroke risk. METHODS A biomedical literature search was performed to identify prospective studies that assess the role of retinal imaging derived biomarkers as indicators of stroke risk. RESULTS Twenty-four studies were included in this systematic review. The available evidence suggests that wider retinal venules, lower fractal dimension, increased arteriolar tortuosity, presence of retinopathy, and presence of retinal emboli are associated with increased likelihood of stroke. There is weaker evidence to suggest that narrower arterioles and the presence of individual retinopathy traits such as microaneurysms and arteriovenous nicking indicate increased stroke risk. Our review identified three models utilizing artificial intelligence algorithms for the analysis of retinal images to predict stroke. Two of these focused on fundus photographs, whilst one also utilized optical coherence tomography (OCT) technology images. The constructed models performed similarly to conventional risk scores but did not significantly exceed their performance. Only two studies identified in this review used OCT imaging, despite the higher dimensionality of this data. CONCLUSION Whilst there is strong evidence that retinal imaging features can be used to indicate stroke risk, there is currently no predictive model which significantly outperforms conventional risk scores. To develop clinically useful tools, future research should focus on utilization of deep learning algorithms, validation in external cohorts, and analysis of OCT images.
Collapse
Affiliation(s)
- Zain Girach
- Sheffield Medical School, University of Sheffield, Beech Hill Rd, Broomhall, Sheffield, UK
| | - Arni Sarian
- Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, UK
| | - Cynthia Maldonado-García
- Centre for Computational Imaging and Simulation Technologies in Biomedicine, School of Computing, University of Leeds, Leeds, UK
| | - Nishant Ravikumar
- Centre for Computational Imaging and Simulation Technologies in Biomedicine, School of Computing, University of Leeds, Leeds, UK
| | - Panagiotis I Sergouniotis
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, UK
- Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, UK
| | - Peter M Rothwell
- Wolfson Centre for the Prevention of Stroke and Dementia, University of Oxford, Oxford, UK
| | - Alejandro F Frangi
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- School of Computer Science, Faculty of Science and Engineering, University of Manchester, Kilburn Building, Manchester, UK
- Christabel Pankhurst Institute, The University of Manchester, Manchester, UK
| | - Thomas H Julian
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, UK.
- Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, UK.
| |
Collapse
|
|
4
|
Chowdhury TA, Anderson JV. An unusual finding on routine diabetes retinal screening. Diabet Med 2024; 41:e15302. [PMID: 38303403 DOI: 10.1111/dme.15302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Affiliation(s)
- Tahseen A Chowdhury
- Department of Diabetes and Metabolism, The Royal London Hospital, London, UK
| | - John V Anderson
- Department of Diabetes and Endocrinology, Homerton University Hospital, London, UK
| |
Collapse
|
|
5
|
Teebagy S, Jastrzembski BG, Oke I. Factors Associated With Incidental Retinal Emboli in the U.S. Adult Population. Am J Ophthalmol 2024; 257:34-37. [PMID: 37582466 DOI: 10.1016/j.ajo.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/01/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE We sought to estimate the prevalence of incidental retinal emboli and identify associated factors using a nationally representative sample of the U.S. POPULATION DESIGN Cross-sectional study. METHODS We included adult (age ≥40 years) participants of the 2005-2008 National Health and Nutrition Examination Survey (NHANES). Incidental retinal emboli were identified through retinal fundus photography. Multivariable logistic regression was used to determine the association between the presence of retinal emboli and sociodemographic, lifestyle, and clinical factors (age, sex, race/ethnicity, education, income, smoking, alcohol use, body mass index [BMI], hypertension, diabetes, hypercholesterolemia, and history of cardiovascular disease). RESULTS This study included 5,764 adults (53% female). Incidental retinal emboli were identified in 0.7% (39/5764) of individuals. The survey-weighted prevalence of retinal emboli increased with age, from 0.1% in participants 40-49 years of age to 1.4% in participants≥70 years of age. The prevalence did not differ by sex or race/ethnicity. Factors associated with retinal emboli after adjusting for age and sex included underweight BMI (odds ratio [OR] 7.24 [95% confidence interval {CI} 1.06-49.3]), current smoking (OR 6.16 [95% CI 1.49-25.5]), low household income (OR 4.41 [95% CI 1.3-15.0]), and hypertension (OR 2.67 [95% CI 1.31-5.44]). CONCLUSIONS In a cohort representative of the U.S. adult population, the prevalence of incidental retinal emboli increased with age but did not differ by sex, race, or ethnicity. Further investigation into the potential association of socioeconomic and nutritional status with retinal emboli may enable opportunities to identify individuals with underlying cardiovascular risk.
Collapse
Affiliation(s)
- Sean Teebagy
- From the Department of Ophthalmology and Visual Sciences (S.T.), University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Benjamin G Jastrzembski
- Department of Ophthalmology and Vision Science (B.G.J.), University of California Davis Eye Center, Sacramento, California, USA
| | - Isdin Oke
- Department of Ophthalmology (I.O.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
|
6
|
Srivastava SR, Sarkar P, Ganguly P, Mukherjee D, Ray BK, Dubey S, Pandit A, Sengupta A, Bandopadhyay M, Ghosh AK, Poddar KG, Guha S, Ayub A. Central Retinal Artery Occlusion in COVID-Associated Mucormycosis. J Glob Infect Dis 2023; 15:66-71. [PMID: 37469471 PMCID: PMC10353642 DOI: 10.4103/jgid.jgid_185_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/24/2022] [Accepted: 02/02/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction Significant surge of mucormycosis was reported in the Indian Subcontinent during the second wave of the COVID-19 pandemic. COVID-associated mucormycosis (CAM) was defined as the development of features of mucormycosis with prior or current history of COVID-19 infection. Rapid angioinvasion is an important characteristic of mucormycosis. Authors intended to find out the prevalence of retinal arterial occlusion and its association with vascular embolic occlusion elsewhere in the body among CAM patients in this study. Methods This was an observational study. All consecutive-confirmed cases of mucormycosis (n = 89) and age-/gender-/risk factor-matched controls (n = 324) admitted in the designated COVID center were included in the study. All cases and controls underwent comprehensive ophthalmological, otorhinological, and neurological examinations. All necessary investigations to support the clinical diagnosis were done. Qualitative data were analyzed using the Chi-square test. Quantitative data for comparison of means between the cases and controls were done using unpaired t-test. Results Twenty-one (23.59%) patients manifested the defined outcome of central retinal artery occlusion (CRAO). Among age-matched control, with similar diabetic status, none had developed the final outcome as defined (P < 0.05). About 90.47% of subjects with CRAO presented with no perception of light vision. Thirteen subjects (61.9%) with the final outcome developed clinical manifestations of stroke during the course of their illness with radiological evidence of watershed infarction (P = 0.001). Orbital debridement was performed in 9 (42.85%) subjects while orbital exenteration was done in 8 (38.09%) subjects. Conclusions CRAO in CAM patients was found to have aggressive nature turning the eye blind in a very short period of time. CRAO can serve as a harbinger for subsequent development of more debilitating and life-threatening conditions such as stroke among CAM patients.
Collapse
Affiliation(s)
| | - Peyalee Sarkar
- Department of Neurology, Bangur Institute of Neurosciences, IPGME and R and SSKMH, Kolkata, West Bengal, India
| | - Purban Ganguly
- Division of Orbit and Oculoplasty, Regional Institute of Ophthalmology, Kolkata, West Bengal, India
| | - Debaleena Mukherjee
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGME and R and SSKMH, Kolkata, West Bengal, India
| | - Biman Kanti Ray
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGME and R and SSKMH, Kolkata, West Bengal, India
| | - Souvik Dubey
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGME and R and SSKMH, Kolkata, West Bengal, India
| | - Alak Pandit
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGME and R and SSKMH, Kolkata, West Bengal, India
| | - Amitabh Sengupta
- Department of Pulmonary Medicine, IPGME and R and SSKMH, Kolkata, West Bengal, India
| | | | - Asim Kumar Ghosh
- Regional Institute of Ophthalmology, Kolkata, West Bengal, India
| | | | - Soumyajit Guha
- Department of Ophthalmology, IPGME and R and SSKMH, Kolkata, West Bengal, India
| | - Asif Ayub
- Regional Institute of Ophthalmology, Kolkata, West Bengal, India
| |
Collapse
|
|
7
|
Bakhoum CY, Madala S, Long CK, Adabifirouzjaei F, Freeman WR, Goldbaum MH, DeMaria AN, Bakhoum MF. Retinal vein occlusion is associated with stroke independent of underlying cardiovascular disease. Eye (Lond) 2023; 37:764-767. [PMID: 35411111 PMCID: PMC9998396 DOI: 10.1038/s41433-022-02038-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/03/2022] [Accepted: 03/15/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of mortality and morbidity. Thus, identifying associated risk factors may lead to earlier interventions aimed at reducing the risk of stroke development. Since cardiovascular disease simultaneously increases the risk of stroke and retinal vein occlusion (RVO), we sought to determine whether RVO is associated with the risk of stroke independent of underlying cardiovascular co-morbidities. METHODS In this cross-sectional study, we reviewed the records of 80,754 individuals who were evaluated by an ophthalmologist over a 6-year period. We identified individuals with RVO, stroke and cardiovascular diseases including hypertension, diabetes mellitus, carotid disease, coronary artery disease and atrial fibrillation. Multivariable logistic regression models were used to analyze odds ratios for RVO and stroke. RESULTS After adjusting for age, sex, cardiovascular disease and other risk factors, we found that the presence of RVO was associated with an odds ratio for stroke of 1.73 (CI, 1.40-2.12, p < 0.001). The association between RVO and stroke, after adjusting for sex and cardiovascular co-morbidities, was significantly stronger in individuals younger than 50 years of age, with an odds ratio of having a stroke of 3.06 (1.34-6.25, p < 0.001), while the presence of RVO in individuals older than 85 years was not significantly associated with stroke 1.19 (0.77-1.79, p = 0.41). CONCLUSIONS Our findings demonstrate that RVO is significantly associated with stroke, even after adjusting for underlying cardiovascular co-morbidities. This association was highly significant in younger subjects, while not significant in older individuals.
Collapse
Affiliation(s)
- Christine Y Bakhoum
- Department of Pediatrics, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA
| | - Samantha Madala
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Christopher K Long
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA
| | - Fatemeh Adabifirouzjaei
- Department of Medicine, Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, CA, USA
| | - William R Freeman
- Department of Ophthalmology, Shiley Eye Center, University of California San Diego, La Jolla, CA, USA
| | - Michael H Goldbaum
- Department of Ophthalmology, Shiley Eye Center, University of California San Diego, La Jolla, CA, USA
| | - Anthony N DeMaria
- Department of Medicine, Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, CA, USA
| | - Mathieu F Bakhoum
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA.
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.
- Yale Cancer Center, Yale University, New Haven, CT, USA.
| |
Collapse
|
|
8
|
Retinal Artery Occlusion as an Early Indicator of Macrovascular Complications in Diabetes. Am J Med 2023; 136:179-185. [PMID: 36170938 DOI: 10.1016/j.amjmed.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND A characteristic of the retinal circulation is that arterial occlusion is embolic or secondary to vasculitis but rarely or never due to in situ atherosclerosis. Therefore, retinal artery occlusion suggests the presence of cardiac or large-vessel disease outside the eye. This cohort study examined the general risk of macrovascular disease in individuals with diabetes, with or without retinal artery occlusion. METHODS We retrieved data on 992 subjects with incident retinal artery occlusion and preexisting diabetes, registered in Denmark between January 1, 2000, and December 31, 2018. Each retinal artery occlusion subject was matched for age, sex, and diabetes duration, with 5 control subjects with diabetes but without retinal artery occlusion. We performed survival analyses to compare the risk of extraocular macrovascular disease between the 2 groups in a 5-year follow-up. RESULTS After 1 year, the incidence of macrovascular disease in subjects with retinal artery occlusion was approximately 21 per 100 person-years (95% confidence interval [CI]: 18.11-24.29), compared to 6.25 per 100 patient-years (95% CI: 5.57-7.00) in those without retinal artery occlusion. After 5 years, the cumulative incidences of macrovascular disease were 51.2% (95% CI: 47.9-54.7%) and 29.4% (95% CI: 28.0-30.8%) in patients with diabetes with or without retinal artery occlusion, respectively. Hazard rate ratios were 3.36 (95% CI: 2.79-4.05) after 1 year and 2.27 (95% CI: 2.04-2.53) after 5 years. CONCLUSION Among individuals with diabetes, those diagnosed with retinal artery occlusion had a higher general risk of macrovascular complications for at least 5 years after the occlusion event compared with those without retinal artery occlusion.
Collapse
|
|
9
|
Qu Y, Zhuo Y, Lee J, Huang X, Yang Z, Yu H, Zhang J, Yuan W, Wu J, Owens D, Zee B. Ischemic and haemorrhagic stroke risk estimation using a machine-learning-based retinal image analysis. Front Neurol 2022; 13:916966. [PMID: 36071896 PMCID: PMC9441897 DOI: 10.3389/fneur.2022.916966] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Stroke is the second leading cause of death worldwide, causing a considerable disease burden. Ischemic stroke is more frequent, but haemorrhagic stroke is responsible for more deaths. The clinical management and treatment are different, and it is advantageous to classify their risk as early as possible for disease prevention. Furthermore, retinal characteristics have been associated with stroke and can be used for stroke risk estimation. This study investigated machine learning approaches to retinal images for risk estimation and classification of ischemic and haemorrhagic stroke. Study design A case-control study was conducted in the Shenzhen Traditional Chinese Medicine Hospital. According to the computerized tomography scan (CT) or magnetic resonance imaging (MRI) results, stroke patients were classified as either ischemic or hemorrhage stroke. In addition, a control group was formed using non-stroke patients from the hospital and healthy individuals from the community. Baseline demographic and medical information was collected from participants' hospital medical records. Retinal images of both eyes of each participant were taken within 2 weeks of admission. Classification models using a machine-learning approach were developed. A 10-fold cross-validation method was used to validate the results. Results 711 patients were included, with 145 ischemic stroke patients, 86 haemorrhagic stroke patients, and 480 controls. Based on 10-fold cross-validation, the ischemic stroke risk estimation has a sensitivity and a specificity of 91.0% and 94.8%, respectively. The area under the ROC curve for ischemic stroke is 0.929 (95% CI 0.900 to 0.958). The haemorrhagic stroke risk estimation has a sensitivity and a specificity of 93.0% and 97.1%, respectively. The area under the ROC curve is 0.951 (95% CI 0.918 to 0.983). Conclusion A fast and fully automatic method can be used for stroke subtype risk assessment and classification based on fundus photographs alone.
Collapse
Affiliation(s)
- Yimin Qu
- Centre for Clinical Research and Biostatistics, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- Centre for Clinical Trials and Biostatistics Lab, CUHK Shenzhen Research Institute, Shenzhen, China
- School of Population Medicine and Public Health, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Yuanyuan Zhuo
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Jack Lee
- Centre for Clinical Research and Biostatistics, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- Centre for Clinical Trials and Biostatistics Lab, CUHK Shenzhen Research Institute, Shenzhen, China
| | - Xingxian Huang
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Zhuoxin Yang
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Haibo Yu
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Jinwen Zhang
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Weiqu Yuan
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Jiaman Wu
- Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | | | - Benny Zee
- Centre for Clinical Research and Biostatistics, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- Centre for Clinical Trials and Biostatistics Lab, CUHK Shenzhen Research Institute, Shenzhen, China
| |
Collapse
|
|
10
|
Ørskov M, Vorum H, Larsen TB, Lip GYH, Bek T, Skjøth F. Clinical risk factors for retinal artery occlusions: a nationwide case-control study. Int Ophthalmol 2022; 42:2483-2491. [PMID: 35305540 DOI: 10.1007/s10792-022-02247-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/11/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE This study seeks to examine potential risk factors for the development of retinal artery occlusions (RAO). METHODS We used data obtained from Danish nationwide registries to evaluate potential risk factors for RAO present up to 5 years prior to the RAO diagnosis. The study included 5312 patients diagnosed with RAO registered in the Danish National Patient Register and 26,560 controls assessed from the general population matched on sex and age at index date. Adjusted conditional logistic regression was used to estimate the odds ratio of included risk factors for RAO diagnosis. We conducted supplementary analyses stratified on sex and age, and on RAO subtype. In addition, interaction analyses were performed between strata in the stratified analyses. RESULTS Risk factors associated with the development of RAO included diabetes, arterial hypertension, ischemic heart disease, peripheral artery disease, stroke, renal disease, cataract, and glaucoma, with ORs ranging from 1.33 to 4.94. Atrial fibrillation and sleep apnea yielded effect measures close to equivalence. The presence of a risk factor was generally associated with higher odds of RAO among the population ≤ 55 of age. Arterial hypertension was stronger associated with RAO in male patients than in female patients. The association with arterial hypertension was stronger for CRAO than for BRAO subtype. CONCLUSION The investigated risk factors suggest that atherosclerosis and conditions changing the intraocular pressure are involved in the pathophysiology of RAO.
Collapse
Affiliation(s)
- Marie Ørskov
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.
| | - Henrik Vorum
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - Torben Bjerregaard Larsen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus N, Denmark
| | - Flemming Skjøth
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
- Unit for Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
|
11
|
McDermott JJ, Lee TC, Chan AX, Ye GY, Shahrvini B, Saseendrakumar BR, Ferreyra H, Nudleman E, Baxter SL. Novel Association between Opioid Use and Increased Risk of Retinal Vein Occlusion Using the National Institutes of Health All of Us Research Program. OPHTHALMOLOGY SCIENCE 2022; 2:100099. [PMID: 35721456 PMCID: PMC9205363 DOI: 10.1016/j.xops.2021.100099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/19/2022]
Abstract
Purpose To assess for risk factors for retinal vein occlusion (RVO) among participants in the National Institutes of Health All of Us database, particularly social risk factors that have not been well studied, including substance use. Design Retrospective, case-control study. Participants Data were extracted for 380 adult participants with branch retinal vein occlusion (BRVO), 311 adult participants with central retinal vein occlusion (CRVO), and 1520 controls sampled among 311 640 adult participants in the All of Us database. Methods Data were extracted regarding demographics, comorbidities, income, housing, insurance, and substance use. Opioid use was defined by relevant diagnosis and prescription codes, with prescription use > 30 days. Controls were sampled at a 4:1 control to case ratio from a pool of individuals aged > 18 years without a diagnosis of RVO and proportionally matched to the demographic distribution of the 2019 U.S. census. Multivariable logistic regression identified medical and social determinants significantly associated with BRVO or CRVO. Statistical significance was defined as P < 0.05. Main Outcome Measure Development of BRVO or CRVO based on diagnosis codes. Results Among patients with BRVO, the mean (standard deviation) age was 70.1 (10.5) years. The majority (53.7%) were female. Cases were diverse; 23.7% identified as Black, and 18.4% identified as Hispanic or Latino. Medical risk factors including glaucoma (odds ratio [OR], 3.29; 95% confidence interval [CI], 2.22-4.90; P < 0.001), hypertension (OR, 2.15; 95% CI, 1.49-3.11; P < 0.001), and diabetes mellitus (OR, 1.68; 95% CI, 1.18-2.38; P = 0.004) were re-demonstrated to be associated with BRVO. Black race (OR, 2.64; 95% CI, 1.22-6.05; P = 0.017) was found to be associated with increased risk of BRVO. Past marijuana use (OR, 0.68; 95% CI, 0.50-0.92; P = 0.013) was associated with decreased risk of BRVO; however, opioid use (OR, 1.98; 95% CI, 1.41-2.78; P < 0.001) was associated with a significantly increased risk of BRVO. Similar associations were found for CRVO. Conclusions Understanding RVO risk factors is important for primary prevention and improvement in visual outcomes. This study capitalizes on the diversity and scale of a novel nationwide database to elucidate a previously uncharacterized association between RVO and opioid use.
Collapse
Affiliation(s)
- John J. McDermott
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Terrence C. Lee
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Alison X. Chan
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Gordon Y. Ye
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Bita Shahrvini
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Bharanidharan Radha Saseendrakumar
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Henry Ferreyra
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Eric Nudleman
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Sally L. Baxter
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| |
Collapse
|
|
12
|
SUDDEN VISION LOSS FROM CENTRAL RETINAL ARTERY OCCLUSION AS A PRESENTING SYMPTOM OF MITRAL VALVE PAPILLARY FIBROELASTOMA. Retin Cases Brief Rep 2022; 16:95-98. [PMID: 31574007 DOI: 10.1097/icb.0000000000000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We describe a central retinal artery occlusion with cilioretinal sparing in a young male patient who was found to have mitral valve papillary fibroelastoma. METHODS At the initial examination, a 33-year-old Hispanic man had visual acuity of 20/200 in his left eye, and 2 weeks later, visual acuity improved to 20/20. Diagnosis required transesophageal echocardiography to localize the lesion. RESULTS Mitral valve papillary fibroelastoma involving the mitral valve was successfully treated with tumor resection. CONCLUSION Routine echocardiography should be performed in all patients presenting with central retinal artery occlusion as it may diagnose treatable cardiogenic etiologies and present further potentially life-threatening embolic events.
Collapse
|
|
13
|
Ramachandran N, Schmiedel O, Vaghefi E, Hill S, Wilson G, Squirrell D. Evaluation of the prevalence of non-diabetic eye disease detected at first screen from a single region diabetic retinopathy screening program: a cross-sectional cohort study in Auckland, New Zealand. BMJ Open 2021; 11:e054225. [PMID: 34907067 PMCID: PMC8672006 DOI: 10.1136/bmjopen-2021-054225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To evaluate the prevalence of incidental non-diabetic ocular comorbidities detected at first screen in a large diabetic retinopathy (DR) screening programme. DESIGN Cross-sectional cohort study. SETTING Single large metropolitan diabetic eye screening programme in Auckland, New Zealand. PARTICIPANTS Twenty-two thousand seven hundred and seventy-one participants who attended screening from September 2008 to August 2018. RESULTS Hypertensive retinopathy (HTR) was observed in 14.2% (3236/22 771) participants. Drusen were present in 14.0% participants under the age of 55 years, increasing to 20.5% in those 55 years and older. The prevalence of neovascular age-related macular degeneration (AMD) was 0.5% in participants aged<55 years, 2.4% in participants aged 55-75 years and 16% in participants aged>75 years. Retinal vein occlusion and retinal arterial embolus were prevalent in 0.7% and 0.02%, respectively, in participants aged<55 years, increasing to 2.2% and 0.4%, respectively, in those >75 years. Cataracts were common being present in 37.1% of participants over the age of 75 years. Only 386 individuals (1.7%) were labelled as glaucoma suspects. Geographic atrophy, epiretinal membrane, choroidal nevi and posterior capsular opacification had an increased prevalence in older individuals. CONCLUSIONS Our data suggest that AMD, HTR and cataracts are routinely detected during DR screening. The incorporation of the detection of these ocular comorbidities during DR screening provide opportunities for patients to modify risk factors (smoking cessation and diet for AMD, blood pressure for HTR) and allow access to cataract surgery.
Collapse
Affiliation(s)
- Nishanthan Ramachandran
- Department of Ophthalmology, Auckland District Health Board Ophthalmology, Auckland, New Zealand
| | - Ole Schmiedel
- Department of Ophthalmology, Auckland District Health Board Ophthalmology, Auckland, New Zealand
| | - Ehsan Vaghefi
- Optometry and Vision Sciences, The University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Sophie Hill
- Department of Ophthalmology, Auckland District Health Board Ophthalmology, Auckland, New Zealand
| | - Graham Wilson
- Ophthalmology, Gisborne Hospital, Gisborne, New Zealand
| | - David Squirrell
- Department of Ophthalmology, Auckland District Health Board Ophthalmology, Auckland, New Zealand
| |
Collapse
|
|
14
|
István L, Czakó C, Élő Á, Mihály Z, Sótonyi P, Varga A, Ungvári Z, Csiszár A, Yabluchanskiy A, Conley S, Csipő T, Lipecz Á, Kovács I, Nagy ZZ. Imaging retinal microvascular manifestations of carotid artery disease in older adults: from diagnosis of ocular complications to understanding microvascular contributions to cognitive impairment. GeroScience 2021; 43:1703-1723. [PMID: 34100219 PMCID: PMC8492863 DOI: 10.1007/s11357-021-00392-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
Carotid artery stenosis (CAS) is a consequence of systemic atherosclerotic disease affecting the aging populations of the Western world. CAS is frequently associated with cognitive impairment. However, the mechanisms contributing to the development of vascular cognitive impairment (VCI) associated with CAS are multifaceted and not fully understood. In addition to embolization and decreased blood flow due to the atherosclerotic lesion in the carotid artery, microcirculatory dysfunction in the cerebral circulation also plays a critical role in CAS-related VCI. To better understand the microvascular contributions to cognitive decline associated with CAS and evaluate microvascular protective effects of therapeutic interventions, it is essential to examine the structural and functional changes of the microvessels in the central nervous system (CNS). However, there are some limitations of in vivo brain vascular imaging modalities. The retinal microvasculature provides a unique opportunity to study pathogenesis of cerebral small vessel disease and VCI, because the cerebral circulation and the retinal circulation share similar anatomy, physiology and embryology. Similar microvascular pathologies may manifest in the brain and the retina, thus ocular examination can be used as a noninvasive screening tool to investigate pathological changes in the CNS associated with CAS. In this review, ocular signs of CAS and the retinal manifestations of CAS-associated microvascular dysfunction are discussed. The advantages and limitation of methods that are capable of imaging the ocular circulation (including funduscopy, fluorescein angiography, Doppler sonography, optical coherence tomography [OCT] and optical coherence tomography angiography [OCTA]) are discussed. The potential use of dynamic retinal vessel analysis (DVA), which allows for direct visualization of neurovascular coupling responses in the CNS, for understanding microvascular contributions to cognitive decline in CAS patients is also considered.
Collapse
Affiliation(s)
- Lilla István
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Cecilia Czakó
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Ágnes Élő
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| | - Zsuzsanna Mihály
- Department of Vascular & Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Péter Sótonyi
- Department of Vascular & Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Andrea Varga
- Department of Vascular & Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Zoltán Ungvári
- Department of Biochemistry and Molecular Biology, Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Theoretical Medicine Doctoral School/Departments of Medical Physics and Informatics & Cell Biology and Molecular Medicine, University of Szeged, Szeged, Hungary
| | - Anna Csiszár
- Department of Biochemistry and Molecular Biology, Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Theoretical Medicine Doctoral School/Departments of Medical Physics and Informatics & Cell Biology and Molecular Medicine, University of Szeged, Szeged, Hungary
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Andriy Yabluchanskiy
- Department of Biochemistry and Molecular Biology, Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shannon Conley
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Tamás Csipő
- Department of Biochemistry and Molecular Biology, Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Ágnes Lipecz
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
- Department of Biochemistry and Molecular Biology, Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Ophthalmology, Josa Andras Hospital, Nyiregyhaza, Hungary
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary.
- Department of Ophthalmology, Weill Cornell Medical College, New York City, NY, USA.
- Department of Clinical Ophtalmology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, 39 Mária Street, 1085, Budapest, Hungary
| |
Collapse
|
|
15
|
Zhao L, Wang H, Yang X, Jiang B, Li H, Wang Y. Multimodal Retinal Imaging for Detection of Ischemic Stroke. Front Aging Neurosci 2021; 13:615813. [PMID: 33603658 PMCID: PMC7884475 DOI: 10.3389/fnagi.2021.615813] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study aims to evaluate ocular changes in patients with ischemic stroke using multimodal imaging and explore the predictive value of ocular abnormalities for ischemic stroke. Methods: A total of 203 patients (ischemic stroke group, 62; control group, 141) were enrolled in this study. Basic data from patients, including age; gender; height; weight; history of hypertension, hyperlipidemia, diabetes, alcohol use, and coronary heart disease; and smoking status, were collected. Consequently, Doppler color ultrasound, color fundus photography, and optical coherence tomography (OCT) examinations were conducted. Differences in traditional risk factors and ocular parameters between the two groups were compared, and binary logistic regression was used for multivariate analysis. Results: The central retinal artery equivalent (CRAE) in the ischemic stroke group was 150.72 ± 20.15 μm and that in the control group was 159.68 ± 20.05 μm. The difference was statistically significant (P = 0.004). Moreover, the subfoveal choroidal thickness (SFChT) in the ischemic stroke group was 199.90 ± 69.27 μm and that in the control group was 227.40 ± 62.20 μm. The difference was statistically significant (P = 0.006). Logistic regression results showed that smoking [odds ratio (OR) = 2.823; 95% confidence interval (95% CI) = 1.477-5.395], CRAE (OR = 0.980; 95% CI = 0.965-0.996), and SFChT (OR = 0.994; 95% CI = 0.989-0.999) are associated with increased risk of ischemic stroke when ocular parameters were combined with traditional risk factors. The area under the receiver operating characteristic (ROC) curve was 0.726, which shows good diagnostic accuracy. Conclusion: SFChT may be a diagnostic marker for early detection and monitoring of ischemic stroke. Combined with traditional risks, retinal artery diameter, and choroidal thickness, the prediction model can improve ischemic stroke prediction.
Collapse
Affiliation(s)
- Lu Zhao
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Wang
- Department of Ophthalmology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiufen Yang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Bin Jiang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongyang Li
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Multidisciplinary Team Center for Ocular Vascular Diseases, College of Ophthalmology, Capital Medical University, Beijing, China
| | - Yanling Wang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
|
16
|
Kim YD, Kim JY, Park YJ, Park SJ, Baik SH, Kang J, Jung C, Woo SJ. Cerebral magnetic resonance imaging of coincidental infarction and small vessel disease in retinal artery occlusion. Sci Rep 2021; 11:864. [PMID: 33441709 PMCID: PMC7806736 DOI: 10.1038/s41598-020-80014-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/14/2020] [Indexed: 12/14/2022] Open
Abstract
There are several reports in the literature on the association between non-arteritic retinal artery occlusion (NA-RAO) and acute ischemic stroke. We investigated the burden of small vessel disease (SVD) and cerebral coincident infarction observed on cerebral magnetic resonance imaging (MRI) in patients with newly diagnosed NA-RAO. In this retrospective, observational, case-series study, consecutive patients with NA-RAO who underwent cerebral MRI within one month of diagnosis between September 2003 and October 2018 were included. The classification of NA-RAO was based on ophthalmologic and systemic examinations. We also investigated the co-incident infarction and burden of underlying SVD, which were categorized as white matter hyperintensity lesion (WMH), cerebral microbleeds (CMB), and silent lacunar infarction (SLI). Among the 272 patients enrolled in the study, 18% presented co-incident infarction and 73% had SVD, which included WMH (70%), CMB (14%), and SLI (30%). Co-incident infarction, WMH, and SLI significantly increased with age: co-incident infarction was observed in 8% of young (< 50 years) patients and 30% of old (≥ 70 years) patients. The embolic etiology of RAO (large artery atherosclerosis, cardioembolism, and undetermined etiology) was significantly associated with the prevalence of SVD (82%: 70%: 64%, P = 0.002) and co-incident infarction (30%: 19%: 8%; P = 0.009). Therefore, high co-incidence of acute cerebral infarction and underlying SVD burden warrant careful neurologic examination and appropriate brain imaging, followed by management of NA-RAO. Urgent brain imaging is particularly pertinent in elderly patients with NA-RAO.
Collapse
Affiliation(s)
- Yong Dae Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.,Department of Ophthalmology, Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Jun Yup Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young Joo Park
- Department of Ophthalmology, Kangwon National University Hospital, Chuncheon, South Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Sung Hyun Baik
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Jihoon Kang
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
| |
Collapse
|
|
17
|
Brown bissonnette GA, Pollard KC. Association of retinal emboli with atheroembolic renal disease and stroke. Clin Exp Optom 2020; 103:921-922. [DOI: 10.1111/cxo.13021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Grace A Brown bissonnette
- Department of Ophthalmology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA,
| | - Kendra C Pollard
- Department of Ophthalmology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA,
| |
Collapse
|
|
18
|
Chen SN, Hwang JF, Huang J, Wu SL. Retinal arterial occlusion with multiple retinal emboli and carotid artery occlusion disease. Haemodynamic changes and pathways of embolism. BMJ Open Ophthalmol 2020; 5:e000467. [PMID: 32789185 PMCID: PMC7390230 DOI: 10.1136/bmjophth-2020-000467] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/22/2020] [Accepted: 07/10/2020] [Indexed: 11/25/2022] Open
Abstract
Objective To introduce a special subgroup, retinal artery occlusion (RAO) with multiple emboli, which is highly associated with ipsilateral carotid artery occlusion disease (CAOD). Methods and analysis This is a cohort study. Cases of RAO with multiple retinal emboli were consecutively enrolled. All patients underwent at least one of the carotid/cerebral evaluations: carotid arteriography, orbital/carotid colour Doppler ultrasonography and CT angiography to demonstrate haemodynamic changes and to discuss possible mechanisms and pathways of the emboli. Results Among 208 RAO eyes, 12 eyes (5.7%) in 11 patients had multiple emboli were recruited in this study. Eleven eyes (91.6%) had ipsilateral carotid plaques and atherosclerosis with high-grade stenosis; among them, five were total carotid occlusion. Haemodynamic changes were found in nine patients with RAO (81.8%) with carotid stenosis 60% or greater. Most compensatory intracranial circulations were re-established via the circle of Willi with antegrade ophthalmic flows, but the direction of ophthalmic flow reversed in three eyes indicating the recruitment of external collaterals. Two cases underwent carotid stent successfully. Conclusion RAOs with multiple emboli are rare but highly associated with severe CAOD with haemodynamic flow changes, warning critical condition in carotid/cerebral circulations. Either direct embolism from the carotid or cardiac lesions or indirect embolism via the collateral pathways is the mechanism of pathogenesis. Immediate action should start to manage these patients to prevent further deterioration.
Collapse
Affiliation(s)
- San-Ni Chen
- Department of Ophthalmology, Changhua Christian Medical Foundation Changhua Christian Hospital, Changhua, Taiwan.,School of Medicine, Chung Shan Medical University, Changhua, Taiwan.,Department of Optometry, College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
| | - Jiunn-Feng Hwang
- Department of Ophthalmology, Changhua Christian Medical Foundation Changhua Christian Hospital, Changhua, Taiwan
| | - Jeff Huang
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Shey-Lin Wu
- Department of Neurology, Changhua Christian Medical Foundation Changhua Christian Hospital, Changhua City, Taiwan
| |
Collapse
|
|
19
|
Egan RA, Lutsep HL. Prevalence of Retinal Emboli and Acute Retinal Artery Occlusion in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2019; 29:104446. [PMID: 31837921 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/19/2019] [Accepted: 09/22/2019] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE In population-based studies asymptomatic retinal emboli occur in .32%-2.9% of people. Retinal artery occlusion (RAO) may occur concurrently with cerebral stroke but the frequency is unknown. No study has examined how commonly retinal emboli occur in the acute stroke population. We aimed to assess the prevalence of retinal emboli and RAO at the time of carotid territory ischemic stroke. METHODS Patients were enrolled prospectively after onset of symptoms consistent with the diagnosis of carotid territory ischemic stroke. Every participant underwent pharmacologic dilation of both pupils and bedside funduscopic examination. Emboli were classified as cholesterol, calcific, platelet/fibrin, or other and categorized by the side of occurrence. Stroke was classified as atheroembolic, cardioembolic, embolic stroke of undetermined source, lacunar, or other. Acute RAO was diagnosed by direct visualization of ischemic retinal whitening. RESULTS Sixty-five patients were enrolled with a mean age of 59.2 years; 23 were female (35.4%). Eleven of 65 subjects (16.9%) had retinal emboli visible on funduscopy; all were cholesterol emboli except a single platelet/fibrin embolus in a patient with atheroembolic source. Six patients (9%) had acute RAO and no RAO was seen in the lacunar or undetermined source subgroups. CONCLUSIONS Retinal emboli occurred more than 10 times more frequently in the acute stroke patient than in large population-based studies. RAOs also occurred concurrently with ischemic stroke. Although emboli were seen in patients with atheroembolic and cardioembolic sources, all patients with carotid disease had emboli in the ipsilateral eye. Future studies are required to determine if the presence of retinal emboli or RAO may help elucidate an etiology in patients suffering from embolic stroke of undetermined source.
Collapse
Affiliation(s)
- Robert A Egan
- MultiCare Rockwood Clinic, Department of Neurology and Ophthalmology, Spokane, Washington.
| | - Helmi L Lutsep
- Oregon Stroke Center, Department of Neurology, Oregon Health and Science University, Portland, Oregon
| |
Collapse
|
|
20
|
Laczynski DJ, Gallop J, Lyden SP, Bena J, Yuan A, Smolock CJ, Caputo FJ. Retinal artery occlusion does not portend an increased risk of stroke. J Vasc Surg 2019; 72:198-203. [PMID: 31843299 DOI: 10.1016/j.jvs.2019.08.279] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/29/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to determine the subsequent risk of stroke after a diagnosis of retinal artery occlusion (RAO). We hypothesized that the risk would be low and comparable to that of the general population. RAO is relatively rare and often incorrectly diagnosed. We believe our institution is in a unique position to investigate this relationship with both a high-volume eye center and vascular laboratory. METHODS This was a retrospective, single-institution review of 221 patients diagnosed with RAO from 2004 to 2018, confirmed with fluorescein angiography. Demographics, comorbidities, imaging of the carotid arteries, and prospective events, such as stroke, myocardial infarction (MI), and death, were recorded. Time to first stroke, first MI, and death was estimated using Kaplan-Meier estimation separately and as a composite end point. RESULTS There were 221 patients identified with a confirmed diagnosis of RAO. The mean age in the cohort was 66.1 years; 53% of patients were male, and 29% were diabetic. Median length of follow-up was 2.2 years. Five patients (2.3%) had a documented stroke; four of the five strokes occurred at the time of RAO, with one that was contralateral occurring at 1.2 years. There were eight MIs (3.6%) in the cohort, two of which resulted in death. Twenty-two patients (10%) experienced a stroke, MI, or death. There were 141 (63.8%) patients who had carotid imaging performed, of whom 20 (14.2%) were found to have >50% stenosis. CONCLUSIONS The rate of stroke in patients with confirmed RAO was 2.3%; however, excluding concurrent ischemic events, the risk was <1%. The incidence of carotid artery stenosis >50% was 14.2%. The authors conclude that the risk of stroke after confirmed RAO is lower than previously reported and comparable to prior population-based studies of all at-risk adults.
Collapse
Affiliation(s)
- David J Laczynski
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Joshua Gallop
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Sean P Lyden
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jim Bena
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alex Yuan
- Department of Ophthalmology, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Francis J Caputo
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
| |
Collapse
|
|
21
|
Kim YD, Kim YK, Yoon YE, Yoon CH, Park KH, Woo SJ. Association of Retinal Artery Occlusion with Subclinical Coronary Artery Disease. J Korean Med Sci 2019; 34:e286. [PMID: 31726494 PMCID: PMC6856299 DOI: 10.3346/jkms.2019.34.e286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/19/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND To evaluate the association between retinal artery occlusion (RAO) and subclinical coronary artery disease (CAD). METHODS We studied 41 patients with non-arteritic RAO without any history or symptoms of CAD, who had undergone coronary computed tomographic angiography (CCTA) for systemic atherosclerotic evaluation between 2007 and 2012. The age- and gender-matched control group comprised 4-fold subjects who were randomly selected from asymptomatic subjects who underwent CCTA during general health evaluation. Medical records and CCTA findings were compared between RAO patients and control groups. Multiple logistic regression analysis was carried out to assess the risk factors associated with CAD. RESULTS Cardiovascular risk factors were not significantly different between RAO patients and control groups. RAO patients showed higher coronary artery calcium score than did control subjects (267.9 ± 674.9 vs. 120.2 ± 289.5). On CCTA, the prevalence of obstructive CAD (diameter stenosis ≥ 50%) in RAO patients was significantly higher than that in controls (29% vs. 15%; odds ratio [OR], 3.0). RAO patients demonstrated a significantly higher segment-involvement score (SIS) (2.6 ± 3.0 vs. 1.6 ± 2.4) and segment-stenosis score (SSS) (3.6 ± 4.8 vs. 2.0 ± 3.3) than did controls. After adjustment of associated factors, RAO showed significant association (OR, 3.0) with obstructive CAD and extensive CAD (SIS > 4: OR, 2.8; SSS > 8: OR, 3.4). CONCLUSION Patients with RAO had a higher prevalence of subclinical obstructive CAD with a more extensive and heavier burden of coronary artery plaques than did age- and gender-matched controls. Physicians should understand the potential risk of CAD in RAO patients.
Collapse
Affiliation(s)
- Yong Dae Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yong Kyu Kim
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yeonyee E Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Hwan Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
| |
Collapse
|
|
22
|
Dattilo M, Biousse V, Landau K, Newman NJ. Treatment of Central Retinal Artery Occlusion. Neuroophthalmology 2019. [DOI: 10.1007/978-3-319-98455-1_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
|
23
|
Dumitrascu OM, Demaerschalk BM, Valencia Sanchez C, Almader-Douglas D, O'Carroll CB, Aguilar MI, Lyden PD, Kumar G. Retinal Microvascular Abnormalities as Surrogate Markers of Cerebrovascular Ischemic Disease: A Meta-Analysis. J Stroke Cerebrovasc Dis 2018; 27:1960-1968. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.02.041] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/17/2018] [Accepted: 02/19/2018] [Indexed: 01/11/2023] Open
|
|
24
|
Abstract
Acute retinal arterial ischemia, which includes transient monocular vision loss (TMVL), branch retinal artery occlusion (BRAO), central retinal artery occlusion (CRAO) and ophthalmic artery occlusion (OAO), is most commonly the consequence of an embolic phenomenon from the ipsilateral carotid artery, heart or aortic arch, leading to partial or complete occlusion of the central retinal artery (CRA) or its branches. Acute retinal arterial ischemia is the ocular equivalent of acute cerebral ischemia and is an ophthalmic and medical emergency. Patients with acute retinal arterial ischemia are at a high risk of having further vascular events, such as subsequent strokes and myocardial infarctions (MIs). Therefore, prompt diagnosis and urgent referral to appropriate specialists and centers is necessary for further work-up (such as brain magnetic resonance imaging with diffusion weighted imaging, vascular imaging, and cardiac monitoring and imaging) and potential treatment of an urgent etiology (e.g., carotid dissection or critical carotid artery stenosis). Since there are no proven, effective treatments to improve visual outcome following permanent retinal arterial ischemia (central or branch retinal artery occlusion), treatment must focus on secondary prevention measures to decrease the likelihood of subsequent ischemic events.
Collapse
Affiliation(s)
- Michael Dattilo
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Neurologic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
|
25
|
Christiansen CB, Torp-Pedersen C, Olesen JB, Gislason G, Lamberts M, Carlson N, Buron M, Juul N, Lip GYH. Risk of incident atrial fibrillation in patients presenting with retinal artery or vein occlusion: a nationwide cohort study. BMC Cardiovasc Disord 2018; 18:91. [PMID: 29743025 PMCID: PMC5944106 DOI: 10.1186/s12872-018-0825-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 04/30/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The inter-relationships of atrial fibrillation (AF) to retinal vascular occlusions (whether retinal artery occlusion (RAO) or retinal venous occlusion (RVO)) remain unclear. It is unknown if a presentation of retinal artery or venous occlusions may indicate a new onset cardiac arrhythmia. To shed light on this association, we investigated the risk of new onset AF in patients with known RAO and RVO. METHODS Patients with retinal occlusions from 1997 to 2011 were identified through Danish nationwide registries and matched 1:5 according to sex and age. Cumulative incidence and unadjusted rates of AF according to retinal vascular occlusions (i.e. RAO or RVO) were determined. Hazard ratios (HR) of AF according to retinal vascular occlusion were adjusted for hypertension, diabetes, vascular disease and prior stroke/systemic thromboembolism/transient ischemic attack. RESULTS One thousand three hundred sixty-eight cases with retinal vascular occlusions were identified (median age 71.4 (inter quartile range (IQR); 61.2-79.8), 47.3% male). RAO constituted 706 cases (51.6%) and RVO 529 (38.7%). The rate of incident AF amongst all cases with retinal vascular occlusion was 1.74 per 100 person-years (95% confidence interval (CI), 1.47-2.06) compared to 1.22 (95% CI, 1.12-1.33) in the matched control group. The rate of AF in RAO was 2.01 (95% CI, 1.6-2.52) and 1.52 (1.15-2.01) in RVO. HRs of incident AF adjusted for cardiovascular comorbidities were 1.26 (95% CI; 1.04-1.53, p = 0.019) for any retinal vascular occlusion, 1.45 (95% CI; 1.10-1.89, p = 0.015) for RAO, and 1.02 (95% CI; 0.74-1.39, p = 0.920) for RVO. CONCLUSIONS A new diagnosis of retinal vascular occlusion in patients without prior AF was associated with increased risk of incident AF, particularly amongst patients with RAO. Awareness of AF in patients with retinal vascular occlusions is advised.
Collapse
Affiliation(s)
| | - Christian Torp-Pedersen
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D, 9220 Aalborg, Denmark
| | - Jonas Bjerring Olesen
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900 Hellerup, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900 Hellerup, Denmark
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Danish Heart Foundation, Vognmagergade 7, 3. sal, 1120 Copenhagen, Denmark
| | - Morten Lamberts
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900 Hellerup, Denmark
| | - Nicholas Carlson
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900 Hellerup, Denmark
- The Danish Heart Foundation, Vognmagergade 7, 3. sal, 1120 Copenhagen, Denmark
| | - Mathias Buron
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900 Hellerup, Denmark
| | - Nikolai Juul
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900 Hellerup, Denmark
| | - Gregory Y. H. Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Edgbaston, Birmingham, Birmingham, B15 2TT UK
| |
Collapse
|
|
26
|
Fusi-Rubiano WJ, Yang YC, Smallwood AF, Chavan RC, Khogali S, Narendran N, Cotton JM. Retinal embolic events: frequency and impact following transcatheter aortic valve implantation (TAVI) for aortic stenosis. BMJ Open Ophthalmol 2018; 1:e000033. [PMID: 29354700 PMCID: PMC5721649 DOI: 10.1136/bmjophth-2016-000033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 05/06/2017] [Accepted: 05/24/2017] [Indexed: 11/24/2022] Open
Abstract
Objectives Transcatheter aortic valve implantation (TAVI) is an established treatment for patients with severe symptomatic aortic stenosis. It has a cerebrovascular accident rate of about 5% but the effect on retinal embolic events has not been previously reported. This study investigated the occurrence of retinal emboli following TAVI. Methods and analysis In this prospective observational study, 20 patients underwent full ophthalmic examination to assess retinal embolic events prior to TAVI and at 48 hours and 1 month post-TAVI. Results At 48 hours post-TAVI, one patient had a new cotton wool spot in the right eye. At 1 month, another two patients had new retinal emboli events in at least one eye and a fourth patient developed retinal splinter haemorrhages in the right eye. Conclusion Retinal embolic events and new retinal abnormalities following TAVI occurred in 15% and 20% of our cohort, respectively, without any associated retinal damage or significant visual problems. Retinal evaluation may be a useful surrogate test for cerebral embolisation in future studies assessing the utility of new valve prostheses and embolic protection devices
Collapse
Affiliation(s)
| | - Yit C Yang
- Department of Ophthalmology, New Cross Hospital, WV10 0QP, Wolverhampton, UK.,School of Life and Health Sciences, Aston University, B4 7ET, Birmingham, UK
| | - Andrew F Smallwood
- Department of Research and Development, New Cross Hospital, WV10 0QP, Wolverhampton, UK
| | - Randhir C Chavan
- Birmingham Midland Eye Centre, City Hospital, B18 7QH, Birmingham, UK
| | - Saib Khogali
- Department of Cardiology, Heart and Lung Centre, New Cross Hospital, WV10 0QP, Wolverhampton, UK
| | - Nirodhini Narendran
- Department of Ophthalmology, New Cross Hospital, WV10 0QP, Wolverhampton, UK
| | - James M Cotton
- Department of Cardiology, Heart and Lung Centre, New Cross Hospital, WV10 0QP, Wolverhampton, UK
| |
Collapse
|
|
27
|
Newman A, Andrew N, Casson R. Review of the association between retinal microvascular characteristics and eye disease. Clin Exp Ophthalmol 2017; 46:531-552. [PMID: 29193621 DOI: 10.1111/ceo.13119] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 10/29/2017] [Accepted: 11/22/2017] [Indexed: 12/20/2022]
Abstract
Computerized retinal imaging technologies enable the static and dynamic measurement of a range of retinal microvascular parameters. Large population-based studies have reported associations between these microvascular indices and various ophthalmic diseases including diabetes, age-related macular degeneration, retinal artery embolism, retinal vein occlusion, glaucoma and non-glaucomatous optic neuropathies. Increasingly, sophisticated imaging and analysis techniques have the potential to provide relevant clinical information regarding disease risk and progression; however, further studies are required to verify associations and strengthen the predictive power of these techniques. We summarize the current state of knowledge regarding retinal microvascular characteristics and eye disease.
Collapse
Affiliation(s)
- Alexander Newman
- Department of Ophthalmology, Gold Coast University Hospital, Queensland, Australia.,Griffith University School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Nicholas Andrew
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia
| | - Robert Casson
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
|
28
|
Abstract
Stroke is the fifth leading cause of death and disability in the United States. According to World Heart Federation, every year, 15 million people suffer from stroke worldwide out of which nearly 6 million people die and another 5 million people are disabled. Out of many organs affected after stroke, one of them is eye. Majority of the stroke victims suffer vision loss due to stroke-induced retinal damage. However, stroke-induced retinal damage and microvascular changes have not been given paramount importance in understanding stroke pathophysiology and predicting its occurrence. Retinal imaging can be a very powerful tool to understand and predict stroke. This review will highlight the importance of retinal changes in predicting occurrence of stroke, major retinal changes, the relationship between retinal diseases and stroke and moreover, molecular mechanisms delineating the stroke induced-retinal changes and therapeutics associated with it.
Collapse
Affiliation(s)
- Varun Kumar
- Department of Ophthalmology, School of Medicine, Stanford University, Stanford, CA, USA
| |
Collapse
|
|
29
|
Cheung N, Teo K, Zhao W, Wang JJ, Neelam K, Tan NYQ, Mitchell P, Cheng CY, Wong TY. Prevalence and Associations of Retinal Emboli With Ethnicity, Stroke, and Renal Disease in a Multiethnic Asian Population: The Singapore Epidemiology of Eye Disease Study. JAMA Ophthalmol 2017; 135:1023-1028. [PMID: 28837736 DOI: 10.1001/jamaophthalmol.2017.2972] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance To our knowledge, population-based data on retinal emboli are limited in Asia. Besides its associations with traditional cardiovascular risk factors and stroke, associations between retinal emboli and renal disease and function remain unclear. Objective To examine the prevalence of and risk factors for retinal emboli in a large, contemporary, multiethnic Asian population. Design, Setting, and Participants This population-based cross-sectional study was conducted from 2004 to 2011 and included a total of 10 033 Chinese, Malay, and Indian persons aged 40 to 80 years residing in the general communities of Singapore. Analyses were performed from November 2016 to February 2017. Interventions or Exposures Retinal emboli were ascertained from retinal photographs obtained from both eyes of all participants according to a standardized protocol. Age-standardized prevalence of retinal emboli was calculated using the 2010 Singapore adult population. Risk factors were assessed from comprehensive systemic and ophthalmic examinations, interviews, and laboratory investigations. Main Outcomes and Measures Retinal emboli. Results Of the 10 033 participants, 9978 (99.5%) had gradable retinal photographs. Of these, 5057 (50.7%) were female, and 3375 (33.8%) were Indian. We identified 88 individuals (0.9%) with retinal emboli; the overall person-specific, age-standardized prevalence of retinal emboli was 0.75% (95% CI, 0.60-0.95), with the highest prevalence seen in the Indian cohort (0.98%), followed by the Chinese (0.73%) and Malay (0.44%) cohorts (P = .03). In multivariable-adjusted analysis, factors associated with prevalent retinal emboli included older age (per 5-year increase; odds ratio [OR], 1.22; 95% CI, 1.05-1.41), Indian ethnicity (compared with Malay ethnicity; OR, 3.58; 95% CI, 1.95-6.60), hypertension (OR, 1.95; 95% CI, 1.03-3.70), chronic kidney disease (OR, 2.05; 95% CI, 1.15-3.64), creatinine level (per SD increase; OR, 1.13; 95% CI, 1.05-1.21), glomerular filtration rate (per SD increase; OR, 0.67; 95% CI, 0.51-0.86), and history of stroke (OR, 3.45; 95% CI, 1.70-6.99). Conclusions and Relevance Based on 88 individuals among 9978 participants of 3 major Asian ethnic populations, retinal emboli were most commonly seen in Indian persons and associated with conventional cardiovascular risk factors, stroke, and chronic kidney disease. Therefore, its presence may signal vascular embolic event and damage not only in the brain but also in the kidneys. If these data are confirmed in longitudinal studies, they would suggest that persons with retinal emboli may require both general cardiovascular and renal assessment.
Collapse
Affiliation(s)
- Ning Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, National University of Singapore, Singapore
| | - Kelvin Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Wanting Zhao
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Jie Jin Wang
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, National University of Singapore, Singapore
| | - Kumari Neelam
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore
| | - Nicholas Y Q Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia.,Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, National University of Singapore, Singapore
| |
Collapse
|
|
30
|
Pula JH, Yuen CA. Eyes and stroke: the visual aspects of cerebrovascular disease. Stroke Vasc Neurol 2017; 2:210-220. [PMID: 29507782 PMCID: PMC5829892 DOI: 10.1136/svn-2017-000079] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/30/2017] [Accepted: 06/02/2017] [Indexed: 01/05/2023] Open
Abstract
A large portion of the central nervous system is dedicated to vision and therefore strokes have a high likelihood of involving vision in some way. Vision loss can be the most disabling residual effect after a cerebral infarction. Transient vision problems can likewise be a harbinger of stroke and prompt evaluation after recognition of visual symptoms can prevent future vascular injury. In this review, we discuss the visual aspects of stroke. First, anatomy and the vascular supply of the visual system are considered. Then, the different stroke syndromes which involve vision are discussed. Finally, topics involving the assessment, prognosis, treatment and therapeutic intervention of vision-specific stroke topics are reviewed.
Collapse
Affiliation(s)
- John H Pula
- Department of Neurology, NorthShore University HealthSystem, Chicago, Illinois, USA
| | - Carlen A Yuen
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
|
31
|
Abstract
Central retinal artery occlusion (CRAO) is caused by partial or complete occlusion of the central retinal artery, most commonly by an embolus from the ipsilateral carotid artery, aortic arch, or heart, and is the ocular equivalent of an acute cerebral ischemic event. The risk factors for a CRAO and acute cerebral ischemia are very similar, if not identical. Because no current therapeutic intervention has been shown to improve visual outcomes compared with the natural history of CRAO, management of CRAO should be focused on secondary prevention of vascular events, such as cerebral ischemia, myocardial infarction, and cardiovascular death.
Collapse
Affiliation(s)
- Michael Dattilo
- Department of Ophthalmology, Emory University School of Medicine, 1365-B Clifton Road, Northeast, Atlanta, GA 30322, USA; Neuro-Ophthalmology, Emory Eye Center, 1365-B Clifton Road, Northeast, Atlanta, GA 30322, USA
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, 1365-B Clifton Road, Northeast, Atlanta, GA 30322, USA; Neuro-Ophthalmology, Emory Eye Center, 1365-B Clifton Road, Northeast, Atlanta, GA 30322, USA; Department of Neurology, Emory University School of Medicine, 12 Executive Park Drive, Northeast, Atlanta, GA 30329, USA.
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, 1365-B Clifton Road, Northeast, Atlanta, GA 30322, USA; Neuro-Ophthalmology, Emory Eye Center, 1365-B Clifton Road, Northeast, Atlanta, GA 30322, USA; Department of Neurology, Emory University School of Medicine, 12 Executive Park Drive, Northeast, Atlanta, GA 30329, USA; Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
| |
Collapse
|
|
32
|
Hong JH, Sohn SI, Kwak J, Yoo J, Ahn SJ, Woo SJ, Jung C, Yum KS, Bae HJ, Chang JY, Jung JH, Lee JS, Han MK. Retinal artery occlusion and associated recurrent vascular risk with underlying etiologies. PLoS One 2017; 12:e0177663. [PMID: 28570629 PMCID: PMC5453434 DOI: 10.1371/journal.pone.0177663] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/01/2017] [Indexed: 11/25/2022] Open
Abstract
Background and purpose RAO is caused by various etiologies and subsequent vascular events may be associated with underlying etiologies. Our aim is to investigate the etiologies of RAO, the occurrence of subsequent vascular events and their association in patients with RAO. Methods We analyzed data from 151 consecutive patients presenting with acute non-arteritic RAO between 2003 and 2013 in a single tertiary-care hospital. The primary outcome was the occurrence of a vascular event defined as stroke, myocardial infarction, and vascular death within 365 days of the RAO onset. The Kaplan-Meier survival analysis and Cox proportional hazard model were used to estimate the hazard ratio of the vascular events. Results Large artery atherosclerosis (LAA) was the etiology more frequently associated with of RAO (41.1%, 62/151). During the one year follow-up, ischemic stroke and vascular events occurred in 8.6% and 9.9% of patients, respectively. Ten vascular events occurred in RAO patients attributed to LAA and 4 occurred in undetermined etiology. RAO patients with LAA had a nearly four times higher risk of vascular events compared to those without LAA (hazard ratio 3.94, 95% confidence interval 1.21–12.81). More than a half of all events occurred within one month and over three fourths of ischemic strokes occurred ipsilateral to the RAO. Conclusion After occurrence of RAO, there is a high risk of a subsequent vascular event, particularly ipsilateral stroke, within one month. LAA is an independent factor for the occurrence of a subsequent vascular event. Management for the prevention of secondary vascular events is necessary in patients with RAO especially with LAA. Large clinical trials are needed to confirm these findings.
Collapse
Affiliation(s)
- Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jaehyuk Kwak
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Joonsang Yoo
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Seong Joon Ahn
- Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyu Sun Yum
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jun Young Chang
- Department of Neurology, Gyengsang national university Changwon Hospital, Changwon, Korea
| | - Jin-Heon Jung
- Department of Critical care medicine & Neurology, Dong-A University Hospital, Busan, Korea
| | - Ji Sung Lee
- Clinical Trial Center, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
| |
Collapse
|
|
33
|
Frost S, Brown M, Stirling V, Vignarajan J, Prentice D, Kanagasingam Y. Utility of Ward-Based Retinal Photography in Stroke Patients. J Stroke Cerebrovasc Dis 2016; 26:600-607. [PMID: 28010951 DOI: 10.1016/j.jstrokecerebrovasdis.2016.11.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/19/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Improvements in acute care of stroke patients have decreased mortality, but survivors are still at increased risk of future vascular events and mitigation of this risk requires thorough assessment of the underlying factors leading to the stroke. The brain and eye share a common embryological origin and numerous similarities exist between the small vessels of the retina and brain. Recent population-based studies have demonstrated a close link between retinal vascular changes and stroke, suggesting that retinal photography could have utility in assessing underlying stroke risk factors and prognosis after stroke. Modern imaging equipment can facilitate precise measurement and monitoring of vascular features. However, use of this equipment is a challenge in the stroke ward setting as patients are frequently unable to maintain the required seated position, and pupil dilatation is often not feasible as it could potentially obscure important neurological signs of stroke progression. MATERIALS AND METHODS This small study investigated the utility of a novel handheld, nonmydriatic retinal camera in the stroke ward and explored associations between retinal vascular features and stroke risk factors. This camera circumvented the practical limitations of conducting retinal photography in the stroke ward setting. RESULTS A positive correlation was found between carotid disease and both mean width of arterioles (r = .40, P = .00571) and venules (r = .30, P = .0381). CONCLUSIONS The results provide further evidence that retinal vascular features are clinically informative about underlying stroke risk factors and demonstrate the utility of handheld retinal photography in the stroke ward.
Collapse
Affiliation(s)
- Shaun Frost
- CSIRO Australian e-Health Research Center/Health and Biosecurity, Perth, Western Australia, Australia.
| | - Michael Brown
- Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Verity Stirling
- Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Janardhan Vignarajan
- CSIRO Australian e-Health Research Center/Health and Biosecurity, Perth, Western Australia, Australia
| | - David Prentice
- Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Yogesan Kanagasingam
- CSIRO Australian e-Health Research Center/Health and Biosecurity, Perth, Western Australia, Australia
| |
Collapse
|
|
34
|
Ahmmed AA, Carey PE, Steel DHW, Sandinha T. Assessing Patients with Asymptomatic Retinal Emboli Detected at Retinal Screening. Ophthalmol Ther 2016; 5:175-182. [PMID: 27339266 PMCID: PMC5125117 DOI: 10.1007/s40123-016-0055-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Indexed: 11/27/2022] Open
Abstract
Introduction Asymptomatic retinal emboli have been associated with diabetes, the presence of significant carotid artery stenosis (≥70%) and an increased risk of stroke. However, there is no clear guidance on how best to investigate and manage patients found to have asymptomatic retinal emboli. Therefore, this study aimed to assess the incidence of significant carotid artery stenosis in patients found to have asymptomatic retinal emboli at diabetic retinopathy screening, and to examine disease management approaches among these patients. Methods Patients with new retinal emboli visible at diabetic retinopathy screening were referred to a medical retinopathy clinic and underwent examinations according to a standardized protocol, including carotid Doppler ultrasound and echocardiography. Case notes of patients referred between January 2013 and April 2014 were reviewed. Results of investigations, medication changes and the number of patients who underwent relevant surgical interventions were noted. Results Retinal emboli were present in 44 of 13,643 people screened (0.32%). Full data were available for 39 patients. Twenty-two patients (56%) had relevant medication changes. Nine (23%) patients had significant carotid artery stenosis. One underwent carotid endarterectomy, and eight received maximal medical therapy. Conclusion Significant carotid artery stenosis was not uncommon in patients with incident retinal emboli at retinal screening. The referral and investigation protocols identified individuals at risk of cerebrovascular events and led to optimized management. Pathways utilizing Doppler ultrasound and physician referral should be more widely implemented.
Collapse
Affiliation(s)
- Afsara A Ahmmed
- The Medical School, Newcastle University, Newcastle upon Tyne, UK.
| | - Peter E Carey
- Department of Metabolic Medicine, Sunderland Royal Hospital, Sunderland, UK
| | - David H W Steel
- Sunderland Eye Infirmary, Sunderland, UK.,Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | | |
Collapse
|
|
35
|
Abstract
The retinal circulation is a potential marker of cerebral vascular disease because it shares origin and drainage with the intracranial circulation and because it can be directly visualized using ophthalmoscopy. Cross-sectional and cohort studies have demonstrated associations between chronic retinal and cerebral vascular disease, acute retinal and cerebral vascular disease, and chronic retinal vascular disease and acute cerebral vascular disease. In particular, certain qualitative features of retinopathy, retinal artery occlusion, and increased retinal vein caliber are associated with concurrent and future cerebrovascular events. These associations persist after accounting for confounding variables known to be disease-causing in both circulations, which supports the potential use of retinal vasculature findings to stratify individuals with regards to cerebral vascular disease risk.
Collapse
|
|
36
|
Friedlander AH, Giaconi JA, Tsui I, Aghazadehsanai N, Chang TI, Garrett NR. Meaningful correlation between asymptomatic retinal arteriole emboli and calcified carotid plaque found on panoramic dental imaging of males with diabetes. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:434-40. [PMID: 26972542 DOI: 10.1016/j.oooo.2015.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/01/2015] [Accepted: 12/14/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is ongoing controversy with regard to the stability of calcified carotid artery plaques (CCAPs) seen in the bifurcation area on panoramic images (PIs). Therefore, we sought to evaluate the possibility of these plaques shedding emboli by observing their relationship with ipsilateral retinal emboli. STUDY DESIGN The study group included 50 neurologically and visually asymptomatic males with diabetes, with PIs that incidentally demonstrated CCAPs (CCAP+) and contemporaneous digital retinal images that had been obtained for evaluation of diabetic retinopathy. The control group consisted of 50 males with diabetes who were matched for age and body mass index and had undergone both imaging studies and whose PIs were devoid of carotid plaques (CCAP-). The presence of retinal emboli was determined by two ophthalmologists blinded to the patients' medical histories, and the prevalence rates for the two groups were calculated. RESULTS The presence of asymptomatic retinal arteriolar emboli was found in the eye ipsilateral to the radiographically observed carotid atheroma in 10 of 50 (20%) of the patients in the CCAP+ group, compared with 2 of 50 (4%) in the CCAP- group, and this difference was statistically significant (Fisher's exact P < .03). CONCLUSIONS Some male patients with diabetes mellitus type II having calcified carotid artery atheromas in the bifurcation area, as visualized on PIs, may have significant sequelae as evidenced by retinal artery emboli.
Collapse
Affiliation(s)
- Arthur H Friedlander
- Associate Chief of Staff and Director of Graduate Medical Education, Veterans Affairs Greater Los Angeles Healthcare System; Director of Quality Assurance, Hospital Dental Service, Ronald Reagan UCLA Medical Center; Professor-in-Residence of Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, CA, USA.
| | - JoAnn A Giaconi
- Chief of Ophthalmology, Veterans Affairs Greater Los Angeles Healthcare System; Associate Clinical Professor at the UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | - Irena Tsui
- Staff Ophthalmologist, Veterans Affairs Greater Los Angeles Healthcare System and Assistant Professor at the UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | - Nona Aghazadehsanai
- Oral and Maxillofacial Surgery Research Fellow, Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Tina I Chang
- Director of the Research Fellowship and Inpatient Oral and Maxillofacial Surgery, Veterans Affairs Greater Los Angeles Healthcare System; Instructor of Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, CA, USA
| | - Neal R Garrett
- Professor Emeritus, School of Dentistry, University of California, Los Angeles, CA, USA
| |
Collapse
|
|
37
|
Rim TH, Han J, Choi YS, Hwang SS, Lee CS, Lee SC, Kim SS. Retinal Artery Occlusion and the Risk of Stroke Development: Twelve-Year Nationwide Cohort Study. Stroke 2016; 47:376-82. [PMID: 26742801 DOI: 10.1161/strokeaha.115.010828] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 12/08/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to evaluate the risk of subsequent stroke development after retinal artery occlusion (RAO). METHODS National registry data were collected from the Korean National Health Insurance Service, comprised 1 025 340 random subjects. Patients diagnosed with RAO in 2002 and 2003 were excluded. The RAO group was composed of patients with an initial diagnosis of either central or other RAO between January 2004 and December 2013 (n=401). The comparison group was composed of randomly selected patients (5 per RAO patient; n=2003) who were matched to the RAO group according to sociodemographic factors and year of RAO diagnosis. Each sampled patient was tracked until 2013. Cox proportional hazard regression was used. RESULTS Stroke occurred in 15.0% of the RAO group and in 8.0% of the comparison group (P < 0.001). RAO was associated with an increased risk of stroke occurrence (hazard ratio, 1.78; 95% confidence interval, 1.32-2.41). The magnitude of the RAO effect for stroke was larger among younger adults aged <65 years (hazard ratio, 3.11) than older adults aged ≥65 years (hazard ratio, 1.26). However, the risk of subsequent stroke was significantly increased in older adults aged ≥65 years at the 4-year follow-up (hazard ratio, 1.58; 95% confidence interval, 1.01-2.48). CONCLUSIONS RAO was significantly associated with subsequent stroke after adjusting for comorbidities and sociodemographic factors. These findings are limited by uncontrolled confounding factors and need to be replicated by other observational studies.
Collapse
Affiliation(s)
- Tyler Hyungtaek Rim
- From the Department of Ophthalmology, Severance Hospital, Institute of Vision Research (T.H.R., J.H., C.S.L., S.C.L., S.S.K.), Department of Radiology, Severance Hospital (Y.S.C.), and Yonsei Healthcare Big Data Based Knowledge Integration System Research Center and Institute of Convergence Science (S.S.K.), Yonsei University College of Medicine, Seoul, Korea; and Department of Social and Preventive Medicine, Inha University School of Medicine, Epidemiology, Incheon, South Korea (S.-s.H.)
| | - Jinu Han
- From the Department of Ophthalmology, Severance Hospital, Institute of Vision Research (T.H.R., J.H., C.S.L., S.C.L., S.S.K.), Department of Radiology, Severance Hospital (Y.S.C.), and Yonsei Healthcare Big Data Based Knowledge Integration System Research Center and Institute of Convergence Science (S.S.K.), Yonsei University College of Medicine, Seoul, Korea; and Department of Social and Preventive Medicine, Inha University School of Medicine, Epidemiology, Incheon, South Korea (S.-s.H.)
| | - Yoon Seong Choi
- From the Department of Ophthalmology, Severance Hospital, Institute of Vision Research (T.H.R., J.H., C.S.L., S.C.L., S.S.K.), Department of Radiology, Severance Hospital (Y.S.C.), and Yonsei Healthcare Big Data Based Knowledge Integration System Research Center and Institute of Convergence Science (S.S.K.), Yonsei University College of Medicine, Seoul, Korea; and Department of Social and Preventive Medicine, Inha University School of Medicine, Epidemiology, Incheon, South Korea (S.-s.H.)
| | - Seung-sik Hwang
- From the Department of Ophthalmology, Severance Hospital, Institute of Vision Research (T.H.R., J.H., C.S.L., S.C.L., S.S.K.), Department of Radiology, Severance Hospital (Y.S.C.), and Yonsei Healthcare Big Data Based Knowledge Integration System Research Center and Institute of Convergence Science (S.S.K.), Yonsei University College of Medicine, Seoul, Korea; and Department of Social and Preventive Medicine, Inha University School of Medicine, Epidemiology, Incheon, South Korea (S.-s.H.)
| | - Christopher Seungkyu Lee
- From the Department of Ophthalmology, Severance Hospital, Institute of Vision Research (T.H.R., J.H., C.S.L., S.C.L., S.S.K.), Department of Radiology, Severance Hospital (Y.S.C.), and Yonsei Healthcare Big Data Based Knowledge Integration System Research Center and Institute of Convergence Science (S.S.K.), Yonsei University College of Medicine, Seoul, Korea; and Department of Social and Preventive Medicine, Inha University School of Medicine, Epidemiology, Incheon, South Korea (S.-s.H.)
| | - Sung Chul Lee
- From the Department of Ophthalmology, Severance Hospital, Institute of Vision Research (T.H.R., J.H., C.S.L., S.C.L., S.S.K.), Department of Radiology, Severance Hospital (Y.S.C.), and Yonsei Healthcare Big Data Based Knowledge Integration System Research Center and Institute of Convergence Science (S.S.K.), Yonsei University College of Medicine, Seoul, Korea; and Department of Social and Preventive Medicine, Inha University School of Medicine, Epidemiology, Incheon, South Korea (S.-s.H.)
| | - Sung Soo Kim
- From the Department of Ophthalmology, Severance Hospital, Institute of Vision Research (T.H.R., J.H., C.S.L., S.C.L., S.S.K.), Department of Radiology, Severance Hospital (Y.S.C.), and Yonsei Healthcare Big Data Based Knowledge Integration System Research Center and Institute of Convergence Science (S.S.K.), Yonsei University College of Medicine, Seoul, Korea; and Department of Social and Preventive Medicine, Inha University School of Medicine, Epidemiology, Incheon, South Korea (S.-s.H.).
| |
Collapse
|
|
38
|
Risk and Risk Periods for Stroke and Acute Myocardial Infarction in Patients with Central Retinal Artery Occlusion. Ophthalmology 2015; 122:2336-2343.e2. [PMID: 26298716 DOI: 10.1016/j.ophtha.2015.07.018] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/19/2015] [Accepted: 07/15/2015] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To investigate the risk of stroke and acute myocardial infarction (AMI) in patients with incident central retinal artery occlusion (CRAO). DESIGN A self-controlled case series (SCCS) study. PARTICIPANTS Patients with incident CRAO from the entire Korean population of 48 million individuals. METHODS We used the Korean national claim database (2007-2011) for analyses. After identifying patients with incident CRAO, the relative incidence rate ratios (IRRs) for stroke and AMI in risk periods were measured in these patients using a SCCS method. MAIN OUTCOME MEASURES The IRRs of stroke and AMI by risk periods. RESULTS Of 1655 patients with incident CRAO in 2009-2010, 165 had stroke/AMI (ischemic stroke in 139, hemorrhagic stroke in 13, and AMI in 15) in the observation period spanning 365 days before and after the occurrence of CRAO. The IRR of stroke/AMI 1 to 30 days after CRAO occurrence significantly increased (14.0; 95% confidence interval [CI], 8.90-22.00); the IRR peaked during the 1 to 7 days after CRAO occurrence (44.51; 95% CI, 27.07-73.20), and the increased risk was present for the first 30 days. The IRR of stroke/AMI also significantly increased 1 to 30 days (6.82; 95% CI, 4.01-11.60) and 31 to 90 days (2.86; 95% CI, 1.66-4.93) before CRAO occurrence. Subanalysis for only ischemic stroke showed similar, magnified IRRs in the risk periods compared with all events. The IRRs were not significantly different between sexes or age groups (<65 vs. ≥65 years). CONCLUSIONS Patients with incident CRAO are at increased risk of ischemic stroke just after CRAO occurrence, and the risk is particularly increased during the first week immediately after the CRAO occurrence. The results suggest that patients with incident CRAO require immediate neurologic evaluation and preventive treatment to reduce mortality and morbidity.
Collapse
|
|
39
|
Abstract
Retinal emboli are opacities identified in retinal arterioles and are often incidental findings on ophthalmic examination. They are generally composed of cholesterol, platelet-fibrin, or calcium and are thought to arise from carotid arteries, coronary arteries, or cardiac valves. In the general population, the estimated prevalence is 0.2% to 1.3%, and the estimated incidence is 0.9% to 2.9%. The transient nature of retinal emboli likely explains the variations between and within these reported figures. The strongest risk factor for retinal emboli is smoking, which has been reported consistently across many studies. Other likely risk factors include older age, hypertension, male sex, total cholesterol, coronary artery disease, and history of coronary artery bypass grafting. The presence of multiple risk factors, as is common in many patients, confers a higher risk for retinal emboli. Several studies suggest that retinal emboli predict an increase in stroke-related, all-cause, and possibly cardiovascular mortality. Due to these sequelae, patients often undergo further workup, most commonly carotid ultrasonography. However, given the low prevalence of significant carotid disease in patients with retinal emboli, further workup, such as carotid ultrasound, should be reserved for those with risk factors for carotid disease. All patients would benefit from medical optimization and coordinated care with the primary care physician.
Collapse
|
|
40
|
Park SJ, Choi NK, Seo KH, Park KH, Woo SJ. Nationwide incidence of clinically diagnosed central retinal artery occlusion in Korea, 2008 to 2011. Ophthalmology 2014; 121:1933-8. [PMID: 24913283 DOI: 10.1016/j.ophtha.2014.04.029] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 12/31/2013] [Accepted: 04/21/2014] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To define the incidence and demographics of clinically diagnosed central retinal artery occlusion (CRAO) in Korea. DESIGN Nationwide population-based retrospective study using data entered into the Korean national health claims database from 2007 to 2011. PARTICIPANTS Data of the entire Korean population (N = 47,990,761, based on the 2010 census) were analyzed. METHODS We used the national health claims database to identify patients diagnosed with CRAO. Incident cases were those with no claims related to CRAO in 2007 and were included once on the earliest claims related to CRAO in the years 2008 to 2011. Incident cases had a disease-free period before diagnosis of at least 1 to 4 years. The average incidence rate of CRAO was estimated according to the entire Korean population. MAIN OUTCOME MEASURES The person-time incidence rates of clinically diagnosed CRAO in Korea, including the age- and sex-specific incidence rates, were estimated. RESULTS A total of 3464 CRAO cases (59.1% men) were identified. The incidence rate of clinically diagnosed CRAO during the study period was 1.80 per 100,000 person-years (95% confidence interval [CI], 1.74-1.86). The incidence rate among men and women was 2.15 (95% CI, 2.05-2.24) and 1.47 (95% CI, 1.39-1.54) per 100,000 person-years (male-to-female ratio, 1.47), respectively. The age-specific male-to-female ratios were constant between the ages of 30 and 89 years (range, 1.51-2.10 years). The highest incidence of 10.08 (95% CI, 8.80-11.35) per 100,000 person-years was observed in those aged 80 to 84 years (14.65 [95% CI, 11.90-17.40] and 8.00 [95% CI, 6.63-9.37] per 100,000 person-years for men and women aged 80-84 years, respectively). The incidence rate of CRAO increased exponentially with age until the 9th decade of life. CONCLUSIONS To our knowledge, this is the first nationwide epidemiologic study of CRAO in individuals of all ages. The incidence rate of CRAO in Korea increased exponentially with increasing age and was highest among those aged 80 to 84 years. Moreover, the incidence rate in men was 1.47 times higher than that in women.
Collapse
Affiliation(s)
- Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Nam-Kyong Choi
- Medical Research Collaborating Center, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Kyung Ha Seo
- Medical Research Collaborating Center, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
| |
Collapse
|
|
41
|
Plunkett O, Lip PL, Lip GYH. Atrial fibrillation and retinal vein or artery occlusion: looking beyond the eye. Br J Ophthalmol 2014; 98:1141-3. [PMID: 24642665 DOI: 10.1136/bjophthalmol-2013-304646] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Oliver Plunkett
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Peck Lin Lip
- The Birmingham and Midland Eye Centre, City Hospital, Birmingham, UK
| | - Gregory Y H Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| |
Collapse
|
|
42
|
Christiansen CB, Lip GYH, Lamberts M, Gislason G, Torp-Pedersen C, Olesen JB. Retinal vein and artery occlusions: a risk factor for stroke in atrial fibrillation. J Thromb Haemost 2013; 11:1485-92. [PMID: 23663383 DOI: 10.1111/jth.12297] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Retinal vascular occlusions may constitute an independent risk factor for stroke in patients with atrial fibrillation. METHODS We performed a retrospective study on a nationwide cohort with atrial fibrillation from 1997 to 2008. The rate of stroke/systemic thromboembolism (TE)/transitory ischemic attack (TIA) was determined for atrial fibrillation patients with and without a history of retinal vascular occlusion. A Cox regression analysis, adjusted for risk factors and medications, was performed to determine the independent predictive value of retinal arterial or venous occlusion for the risk of ischemic stroke, TE or TIA in atrial fibrillation patients. RESULTS We included 87 202 patients with non-valvular atrial fibrillation. At baseline, a history of retinal arterial occlusion was diagnosed in 224 patients (0.26%) and a history of retinal venous occlusion in 361 (0.41%). Patients without retinal occlusion had a rate of stroke/TE/TIA of 4.52 (95% confidence interval [CI] 4.44-4.60). For patients with retinal arterial occlusion, the rate of stroke/TE/TIA was 8.16 (95% CI 6.35-10.49) per 100 person-years, and for patients with retinal venous occlusion it was 7.28 (95% CI 5.93-8.94) per 100 person-years. In multivariate analysis, both retinal arterial occlusions (hazard ratio [HR] 1.39, 95% CI 1.08-1.79) and retinal venous occlusions (HR 1.26, 95% CI 1.02-1.54) were associated with an increased risk of future stroke/TE/TIA. CONCLUSIONS A history of retinal arterial or retinal venous occlusion is associated with an increased risk of stroke/TE/TIA in patients with atrial fibrillation. Thus, prior retinal vascular occlusion may be considered as a previous thromboembolic event when evaluating stroke risk in patients with atrial fibrillation.
Collapse
Affiliation(s)
- C B Christiansen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
| | | | | | | | | | | |
Collapse
|
|
43
|
Patel PS, Sadda SR. Retinal Artery Obstructions. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00051-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
|
44
|
Katsi V, Marketou M, Vlachopoulos C, Tousoulis D, Souretis G, Papageorgiou N, Stefanadis C, Vardas P, Kallikazaros I. Impact of arterial hypertension on the eye. Curr Hypertens Rep 2012; 14:581-590. [PMID: 22673879 DOI: 10.1007/s11906-012-0283-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Systemic hypertension has been linked to a wide range of major eye diseases. High arterial blood pressure (BP) decreases choroidal circulatory flow, increases intraocular pressure, and is associated with retinal microvascular abnormalities and prevalence of retinal vein occlusion (RVO) and retinopathy. This review offers a comprehensive overview of ocular diseases associated with hypertension and emphasizes their importance as predictors to future cardiovascular events. It also gives evidence-based clinical data for the therapeutic approach of eye disease in hypertensive patients.
Collapse
Affiliation(s)
- Vasiliki Katsi
- Cardiology Department, Hippokration Hospital, Athens, Greece.
| | | | | | | | | | | | | | | | | |
Collapse
|
|
45
|
Chang YS, Jan RL, Weng SF, Wang JJ, Chio CC, Wei FT, Chu CC. Retinal artery occlusion and the 3-year risk of stroke in Taiwan: a nationwide population-based study. Am J Ophthalmol 2012; 154:645-652.e1. [PMID: 22809785 DOI: 10.1016/j.ajo.2012.03.046] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 03/29/2012] [Accepted: 03/30/2012] [Indexed: 11/15/2022]
Abstract
PURPOSE To verify the association between retinal artery occlusion (RAO) and stroke with a large-scale nationwide study. DESIGN Retrospective nationwide population-based administrative database study. METHODS Data were collected from the Longitudinal Health Insurance Database 2000 (LHID2000), which contains claim data from 1 million randomly selected beneficiaries among Taiwan's 23 million residents. The study cohort consisted of all patients with a diagnosis of RAO from January 1999 through December 2006 (n = 464). The control group consisted of randomly selected patients (n = 2748) matched with the study group by age, sex, date of index medical care, and comorbid hypertension. Patients were tracked from their index date for 3 years. The Kaplan-Meier method was used to compute the stroke-free survival rate. Cox proportional hazard regressions were used to compute the adjusted stroke-free survival rate after adjusting for possible confounding factors. RESULTS Ninety-one RAO patients (19.61%) and 280 controls (10.05%) had a stroke (P < .0001) during the 3-year follow-up period. Compared with the controls, the incidence rate ratios of stroke in RAO patients were 9.46 at 0-1 month, 5.57 at 1-6 months, and 2.16 at 0-3 years after RAO (P < .0001). After adjusting for age, sex, and selected comorbid disorders, the hazard ratio of having a stroke for RAO patients was still 2.07 times higher than that of controls and 3.34 times higher in the ≤60-year-old subgroup. CONCLUSIONS RAO increases the risk for subsequent stroke. Early neurologic evaluation and secondary prevention for stroke are recommended for RAO patients.
Collapse
Affiliation(s)
- Yuh-Shin Chang
- Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan
| | | | | | | | | | | | | |
Collapse
|
|
46
|
Shrestha GS, Upadhyaya S, Sharma AK, Gajurel BP. Ocular–visual defect and visual neglect in stroke patients – A report from Kathmandu, Nepal. JOURNAL OF OPTOMETRY 2012; 5:43-49. [PMCID: PMC3860999 DOI: 10.1016/j.optom.2011.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 11/22/2011] [Indexed: 09/27/2023]
Abstract
Purpose To find out the type of visual defects, ocular defects or visual neglect occurring in patients with stroke. Methods In this cross-sectional study including 40 subjects diagnosed as stroke, assessment included visual acuity with the Sheridan-Gardner chart, objective and subjective refraction, duction and version eye movement, cover test at distance and near, anterior segment examination with the slit lamp, posterior segment examination after pupil dilatation, color vision test with the Farnsworth D-15 test, diplopia charting, the Hess charting, and visual field examination on Goldmann perimetry. 33 subjects (82.5%) having stroke underwent star cancellation test for visual neglect evaluation. Chi-square test with Yate's correction was performed to evaluate associations between visual neglect and neurological findings. Results The mean age of the subjects was 52.1 ± 15.7 years with male/female ratio of 0.7. Neurological findings included hemiplegia/hemiparesis in 84.8%, ischemic stroke in 80%, left hemisphere involvement in 60%, and cortical area involvement in 65%. Ocular finding included extraocular muscle palsy in 17.5%, exotropia in 12.5%, and ptosis in 7.5%. Co-morbid ocular findings such as cataract, retinopathy, and age-related macular degeneration were also reported. Visual neglect was present in 54.5% subjects predominantly affecting the left side. Conclusion This study reports the relationship between ocular–visual disorders and stroke. There should be a formal screening for visual problems in stroke patients in hospital and rehabilitation settings.
Collapse
Affiliation(s)
- Gauri Shankar Shrestha
- B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Suraj Upadhyaya
- B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Ananda Kumar Sharma
- B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | | |
Collapse
|
|
47
|
Effect of regular smoking on flicker induced retinal vasodilatation in healthy subjects. Microvasc Res 2011; 82:351-5. [DOI: 10.1016/j.mvr.2011.07.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 07/01/2011] [Accepted: 07/02/2011] [Indexed: 11/19/2022]
|
|
48
|
Kojuri J, Mehdizadeh M, Rostami H, Shahidian D. Clinical significance of retinal emboli during diagnostic and therapeutic cardiac catheterization in patients with coronary artery disease. BMC Cardiovasc Disord 2011; 11:5. [PMID: 21255443 PMCID: PMC3032753 DOI: 10.1186/1471-2261-11-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 01/21/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac catheterization may cause retinal embolization, a risk factor for cerebrovascular emboli and stroke. We describe the incidence of clinically silent and apparent retinal emboli following diagnostic and interventional coronary catheterization and associated risk factors. METHODS Three hundred selected patients attending a tertiary referral center for diagnostic and therapeutic cardiac catheterization were studied. Retinal examination and examination of the visual field and acuity were done before and after catheterization by a retinal specialist. RESULTS There were 5 case of retinal embolus before catheterization, and 19 patients (incidence 6.3%) developed new retinal arteriolar emboli after catheterization. Only 1 patient developed clinically apparent changes in vision. Two conventional risk factors (age and hypertension) were significantly associated with new retinal emboli. The risk of retinal emboli was also significantly associated with operator expertise. CONCLUSIONS Retinal embolism was found after coronary catheterization in 6.3% of our patients. This finding indicates that the retinal, and possibly the cerebral circulation, may be compromised more frequently than is clinically apparent as a complication of coronary catheterization. Age and hypertension are independent predictors of retinal embolism.
Collapse
Affiliation(s)
- Javad Kojuri
- Department of Cardiology, Shiraz University of Medical Sciences,Shiraz, Iran
| | - Morteza Mehdizadeh
- Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Rostami
- Department of Cardiology, Shiraz University of Medical Sciences,Shiraz, Iran
| | - Danial Shahidian
- Department of Cardiology, Shiraz University of Medical Sciences,Shiraz, Iran
| |
Collapse
|
|
49
|
Cohen R, Padilla J, Light D, Diller R. Carotid artery occlusive disease and ocular manifestations: Importance of identifying patients at risk. ACTA ACUST UNITED AC 2010; 81:359-63. [PMID: 20630374 DOI: 10.1016/j.optm.2009.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2009] [Revised: 09/12/2009] [Accepted: 10/23/2009] [Indexed: 12/20/2022]
Abstract
Ocular manifestations of carotid artery occlusive disease, when present, warrant further systemic workup including carotid artery Doppler ultrasound scan. Vascular ocular pathology that may indicate underlying carotid artery disease includes amaurosis fugax, retinal emboli, ocular ischemic syndrome, retinal vascular occlusions, and glaucoma. Early atherosclerotic changes, however, may remain undetected with carotid artery Doppler ultrasound scan. Risk factors for atherosclerosis should be assessed, and additional imaging to detect underlying pathophysiology of carotid artery occlusive disease may also be indicated for preventative management. A review of the literature is conducted to determine the association of ocular sequelae with hemodynamically significant carotid artery stenosis. The role of brachial artery flow-mediated dilation as an independent predictor for cardiovascular disease is also discussed.
Collapse
Affiliation(s)
- Raneat Cohen
- Dayton Veterans Affairs Medical Center, Dayton, OH, USA.
| | | | | | | |
Collapse
|
|
50
|
Wilde C, Rathore D, Chen HC. A retrospective review of the management of asymptomatic retinal emboli identified during diabetic retinopathy screening: a case of inappropriate referral? ACTA ACUST UNITED AC 2010. [DOI: 10.1177/1474651409354758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Diabetic retinopathy screening generates many referrals of diabetic patients to ophthalmic clinics for incidental non-retinopathy pathology such as asymptomatic retinal emboli. Evidence exists that these patients have a 10 fold increased relative risk of stroke. With this in mind we evaluated our current management for this group. Methods A retrospective review was conducted for patients referred by the screening programme to the Eye Clinic, Derbyshire Royal Infirmary in 2008. Data were collected on modifiable cardiovascular risk factors, investigations conducted and treatment decisions. Results Nineteen patients were identified with asymptomatic retinal emboli: nine (47%) had known vascular disease; 13 patients (68%) were taking anti-platelet agents and 11 (58%) a statin. The mean blood pressure (BP) was 152/81 mmHg, but 10 patients (53%) had a BP > 140 mmHg and 47% were on antihypertensive medication. Carotid Doppler scans were performed on eight patients (42%), of whom two (25%) had stenosis over 70%. No new medications such as aspirin were started, nor any alteration made to anti-hypertensive medication. Conclusion As the eye clinic visit resulted in no change to the patients’ management, we feel that it may be more appropriate to refer these patients to a medical clinic to optimise their stroke risk reduction management. Br J Diabetes Vasc Dis 2010; 10:126—129
Collapse
Affiliation(s)
- Craig Wilde
- Department of Ophthalmology, Derbyshire Royal Infirmary, Derbyshire, UK,
| | - Deepa Rathore
- Department of Ophthalmology, Derbyshire Royal Infirmary, Derbyshire, UK
| | - Hean-Choon Chen
- Department of Ophthalmology, Derbyshire Royal Infirmary, Derbyshire, UK
| |
Collapse
|