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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.
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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.
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Medawar NG, Dorweiler TF, Abela GS, Busik JV, Grant MB. The role of cholesterol crystals and ocular crystal emboli in retinal pathology. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 47:100475. [PMID: 39493444 PMCID: PMC11530860 DOI: 10.1016/j.ahjo.2024.100475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Accepted: 10/06/2024] [Indexed: 11/05/2024]
Abstract
Cholesterol crystals (CC) can be responsible for a range of clinical syndromes in the retina from asymptomatic plaques to retinal artery occlusion with clinical trials providing evidence for the efficacy in lipid lowering therapies in preventing ocular pathology. Much of the literature has focused on CC in retinal circulation as a marker of poor systemic health and have attempted to use them to categorize risk of mortality and stroke. More recently cholesterol accumulation and CC formation have been linked to development of diabetic retinopathy with CC formation in the retina due to aberrant retinal cholesterol homeostasis and not simply systemic dyslipidemia.
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Affiliation(s)
- Nicholas G. Medawar
- University of Alabama at Birmingham, Department of Visual Sciences and Ophthalmology, Birmingham, AL, United States of America
| | - Tim F. Dorweiler
- Boston Children's Hospital, Department of Surgery, Cambridge, MA, United States of America
| | - George S. Abela
- Michigan State University, Department of Medicine, College of Human Medicine, East Lansing, MI, United States of America
| | - Julia V. Busik
- University of Oklahoma, Department of Biochemistry and Physiology, Oklahoma City, OK, United States of America
| | - Maria B. Grant
- University of Alabama at Birmingham, Department of Visual Sciences and Ophthalmology, Birmingham, AL, United States of America
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Ørskov M, Vorum H, Larsen TB, Lip GYH, Bek T, Skjøth F. Similarities and differences in systemic risk factors for retinal artery occlusion and stroke: A nationwide case-control study. J Stroke Cerebrovasc Dis 2022; 31:106610. [PMID: 35777081 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106610] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Retinal artery occlusion (RAO) has been considered a stroke equivalent. This study compares risk factor profiles for thromboembolism among patients with RAO and stroke, respectively. METHODS This case-control study is based on 5683 RAO patients entered in the Danish National Patient Register between 1st of January 2000 and 31st of December 2018. Cases were matched on sex, year of birth, and age at event with 28,415 stroke patients. The Danish nationwide registries were used to collect information about age, sex, previous diagnoses, and drug prescriptions. Adjusted conditional logistic regression models were used to investigate the association between hypothesised risk factors and the patient outcome. RESULTS For atrial fibrillation, a substantially stronger association to stroke was found, with an odds ratio (OR) of 0.52 (95% CI: 0.47-0.58) when comparing RAO patients with stroke patients. RAO was stronger associated with arterial hypertension, peripheral artery disease, retinal vein occlusion, cataract, and glaucoma with OR's ranging from 1.21-11.70. The identified effect measures reached equivalence or was close to equivalence for diabetes, heart failure, ischemic heart disease, and renal disease. CONCLUSION The differences in risk factor profiles between RAO and stroke suggests differences in the pathophysiology of the two diseases. These variations in pathophysiologies between the two diseases may indicate that different interventions are needed to ensure the optimal long-term prognosis for the patients.
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Affiliation(s)
- Marie Ørskov
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Hobrovej 18-22, Aalborg DK-9000, Denmark; Department of Clinical Medicine, Aalborg Thrombosis Research Unit, 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, Aalborg, Denmark; Hobrovej 18-22, Aalborg DK-9000, Denmark; Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Faculty of Health, Aalborg University, Aalborg, Denmark; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Flemming Skjøth
- Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Faculty of Health, Aalborg University, Aalborg, Denmark; Unit for Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
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Early menopause is associated with increased risk of retinal vascular occlusions: a nationwide cohort study. Sci Rep 2022; 12:6068. [PMID: 35414644 PMCID: PMC9005535 DOI: 10.1038/s41598-022-10088-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/28/2022] [Indexed: 12/24/2022] Open
Abstract
This nationwide population-based cohort study evaluated the association between female reproductive factors and the incidence of retinal vein occlusion (RVO) and retinal artery occlusion (RAO) using data provided by the Korea National Health Insurance Service. A total of 2,289,347 postmenopausal women over 50 years of age who participated in both national health screening and cancer screening in 2013 or 2014 were included. Data on female reproductive factors, including age at menarche, age at menopause, parity, history of hormone replacement therapy, and oral contraceptive pill usage, were collected. Patients were followed up until December 2018, and incident cases of RVO and RAO were identified using registered diagnostic codes from claim data. During an average follow-up period of 4.90 years, 7461 and 1603 patients were newly diagnosed with RVO and RAO, respectively. In the multivariable-adjusted Cox proportional hazard model, patients who experienced menopause after 55 years of age had a lower risk of RVO and RAO development compared to those who had menopause before 45 years of age, with a hazard ratio (95% confidence interval) of 0.83 (0.76–0.95) for RVO and 0.80 (0.66‒0.98) for RAO. In conclusion, early menopause was an independent risk factor for future development of RVO and RAO.
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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.
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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
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Hwang S, Kang SW, Choi KJ, Son KY, Lim DH, Shin DW, Kim K, Kim SJ. High-density Lipoprotein Cholesterol and the Risk of Future Retinal Artery Occlusion Development: A Nationwide Cohort Study. Am J Ophthalmol 2022; 235:188-196. [PMID: 34624247 DOI: 10.1016/j.ajo.2021.09.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the association between high-density lipoprotein (HDL) cholesterol levels and the future risk of retinal artery occlusion (RAO). DESIGN Population-based cohort study. METHODS This study used data provided by the Korean National Health Insurance Service. A total of 9,316,212 individuals aged > 40 years who participated in the Korean National Health Screening Program in 2013 or 2014 were included. Data on risk factors - including age, sex, income level, systemic comorbidities, behavioral factors, and baseline lipid profiles - were collected from health screening results and claims data. Patients were followed up until December 2018 and incident cases of RAO were identified using registered diagnostic codes from claims data. A prospective association between HDL cholesterol level and incident RAO was investigated using the multivariable-adjusted Cox proportional hazard model. RESULTS During an average follow-up period of 4.93 years, 9878 patients were newly diagnosed with RAO. Compared with those with low HDL cholesterol levels (< 40 mg/dL), patients with high HDL cholesterol levels (≥ 60 mg/dL) had a lower risk of future RAO development, with a hazard ratio (95% CI) of 0.78 (0.73-0.83) in the age-adjusted and sex-adjusted model and 0.88 (0.83-0.95) in the full-adjusted model. The younger subgroup (< 60 years) had an HR of 0.81 in the high HDL cholesterol group compared with the low HDL cholesterol group, while the older subgroup (≥ 60 years) had an HR of 0.93 (P for interaction = .012). CONCLUSION A low HDL cholesterol level is an independent risk factor for the development of RAO.
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Affiliation(s)
- Sungsoon Hwang
- From Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H, S.W.K, K.J.C, K.Y.S, D.H.L, S.J.K); Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University (S.H, D.H.L, D.W.S)
| | - Se Woong Kang
- From Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H, S.W.K, K.J.C, K.Y.S, D.H.L, S.J.K)
| | - Kyung Jun Choi
- From Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H, S.W.K, K.J.C, K.Y.S, D.H.L, S.J.K)
| | - Ki Young Son
- From Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H, S.W.K, K.J.C, K.Y.S, D.H.L, S.J.K)
| | - Dong Hui Lim
- From Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H, S.W.K, K.J.C, K.Y.S, D.H.L, S.J.K); Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University (S.H, D.H.L, D.W.S)
| | - Dong Wook Shin
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University (S.H, D.H.L, D.W.S); Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine (D.W.S); Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University (D.W.S, K.K)
| | - Kyunga Kim
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University (D.W.S, K.K); Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea, (K.K)
| | - Sang Jin Kim
- From Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H, S.W.K, K.J.C, K.Y.S, D.H.L, S.J.K).
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Kalloniatis M, Wang H, Katalinic P, Ly A, Apel W, Nivison-Smith L, Kalloniatis KF. Ocular ischaemia: signs, symptoms, and clinical considerations for primary eye care practitioners. Clin Exp Optom 2022; 105:117-134. [PMID: 34982952 DOI: 10.1080/08164622.2021.1999771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Ischaemic stroke is a major disease burden as well as a leading cause of death. Early signs of ischaemic stroke can manifest in the eye, placing primary eyecare practitioners in an important position to identify patients at risk of ischaemic stroke and initiate suitable referral pathways. The vascular supply to the brain is reviewed with reference to vision including the various retinal signs and ocular symptoms associated with transient ischaemic attacks and ischaemic stroke. Using a range of clinical cases, the diverse clinical presentations of retinal embolic events, as well as other forms of vascular occlusion, are highlighted and the underlying pathophysiology is discussed. A succinct scheme for the assessment and management of ischaemic events for primary eye care practitioners is provided.
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Affiliation(s)
- Michael Kalloniatis
- Centre for Eye Health, the University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Henrietta Wang
- Centre for Eye Health, the University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Paula Katalinic
- Centre for Eye Health, the University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Angelica Ly
- Centre for Eye Health, the University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Warren Apel
- Centre for Eye Health, the University of New South Wales, Sydney, Australia.,The Eye Health Centre, Aspley, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, the University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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Gunzinger JM, Ibrahimi B, Baur J, Wiest MRJ, Piccirelli M, Pangalu A, Straumann D, Nietlispach F, Moarof I, Zweifel SA. Assessment of Retinal Capillary Dropout after Transcatheter Aortic Valve Implantation by Optical Coherence Tomography Angiography. Diagnostics (Basel) 2021; 11:diagnostics11122399. [PMID: 34943635 PMCID: PMC8700652 DOI: 10.3390/diagnostics11122399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is an alternative to open heart surgery in the treatment of symptomatic aortic valve stenosis, which is often the treatment of choice in elderly and frail patients. It carries a risk of embolic complications in the whole cerebral vascular bed, which includes the retinal vasculature. The main objective was the evaluation of retinal emboli visible on optical coherence tomography angiography (OCTA) following TAVI. This is a prospective, single center, observational study enrolling consecutive patients over two years. Patients were assessed pre- and post-TAVI. Twenty-eight patients were included in the final analysis, 82.1% were male, median age was 79.5 (range 52–88), median BCVA was 82.5 letters (range 75–93). Eight patients (28.6%) presented new capillary dropout lesions in their post-TAVI OCTA scans. There was no statistically significant change in BCVA. Quantitative analysis of macular or peripapillary OCTA parameters did not show any statistically significant difference in pre- and post-intervention. In conclusion, capillary dropout lesions could frequently be found in patients after TAVI. Quantitative measurements of macular and peripapillary flow remained stable, possibly indicating effective ocular blood flow regulation within the range of left ventricular ejection fraction in our cohort.
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Affiliation(s)
- Jeanne Martine Gunzinger
- Department of Ophthalmology, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland; (J.B.); (M.R.J.W.); (S.A.Z.)
- Correspondence:
| | - Burbuqe Ibrahimi
- Department of Cardiology, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland; (B.I.); (F.N.)
| | - Joel Baur
- Department of Ophthalmology, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland; (J.B.); (M.R.J.W.); (S.A.Z.)
| | - Maximilian Robert Justus Wiest
- Department of Ophthalmology, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland; (J.B.); (M.R.J.W.); (S.A.Z.)
| | - Marco Piccirelli
- Department of Information Technology and Electrical Engineering, ETH Zurich, 8092 Zurich, Switzerland;
| | - Athina Pangalu
- Department of Neuroradiology, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland;
| | - Dominik Straumann
- Department of Neurology, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland;
| | - Fabian Nietlispach
- Department of Cardiology, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland; (B.I.); (F.N.)
- Heartcenter im Park, Hirslanden Clinic Im Park, 8027 Zurich, Switzerland
| | - Igal Moarof
- Department of Cardiology, Kantonsspital Baden, 5404 Baden, Switzerland;
| | - Sandrine Anne Zweifel
- Department of Ophthalmology, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland; (J.B.); (M.R.J.W.); (S.A.Z.)
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Mac Grory B, Schrag M, Biousse V, Furie KL, Gerhard-Herman M, Lavin PJ, Sobrin L, Tjoumakaris SI, Weyand CM, Yaghi S. Management of Central Retinal Artery Occlusion: A Scientific Statement From the American Heart Association. Stroke 2021; 52:e282-e294. [PMID: 33677974 DOI: 10.1161/str.0000000000000366] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE Central retinal artery occlusion (CRAO) is a form of acute ischemic stroke that causes severe visual loss and is a harbinger of further cerebrovascular and cardiovascular events. There is a paucity of scientific information on the appropriate management of CRAO, with most strategies based on observational literature and expert opinion. In this scientific statement, we critically appraise the literature on CRAO and provide a framework within which to consider acute treatment and secondary prevention. METHODS We performed a literature review of randomized controlled clinical trials, prospective and retrospective cohort studies, case-control studies, case reports, clinical guidelines, review articles, basic science articles, and editorials concerning the management of CRAO. We assembled a panel comprising experts in the fields of vascular neurology, neuro-ophthalmology, vitreo-retinal surgery, immunology, endovascular neurosurgery, and cardiology, and document sections were divided among the writing group members. Each member received an assignment to perform a literature review, synthesize the data, and offer considerations for practice. Multiple drafts were circulated among the group until consensus was achieved. RESULTS Acute CRAO is a medical emergency. Systems of care should evolve to prioritize early recognition and triage of CRAO to emergency medical attention. There is considerable variability in management patterns among practitioners, institutions, and subspecialty groups. The current literature suggests that treatment with intravenous tissue plasminogen activator may be effective. Patients should undergo urgent screening and treatment of vascular risk factors. There is a need for high-quality, randomized clinical trials in this field.
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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.
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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
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Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Retinal and Ophthalmic Artery Occlusions Preferred Practice Pattern®. Ophthalmology 2020; 127:P259-P287. [DOI: 10.1016/j.ophtha.2019.09.028] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 11/30/2022] Open
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Giuffrè C, Cicinelli MV, Marchese A, Coppola M, Parodi MB, Bandello F. Simultaneous intravitreal dexamethasone and aflibercept for refractory macular edema secondary to retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2020; 258:787-793. [PMID: 31897703 DOI: 10.1007/s00417-019-04577-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/11/2019] [Accepted: 12/18/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To assess the functional and anatomical outcomes of concurrent administration of aflibercept injection and dexamethasone (DEX) implant in patients with macular edema (ME) secondary to retinal vein occlusion (RVO), refractory to each of the two drugs previously administered as monotherapy. Secondary outcomes included the number of retreatments required in a 12-month follow-up and safety. METHODS This is a prospective, interventional case series of consecutive patients with refractory ME secondary to RVO, followed over a year. One injection of aflibercept was followed by a DEX implant on the same day; retreatment was driven by the persistence of ME on SD-OCT at least 4 months after the previous combined therapy. Central retinal thickness (CRT), best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were collected at 1 month and then every 2 months until the end of follow-up. RESULTS Thirty eyes of 30 Caucasian patients were enrolled; mean duration of RVO before the first combined treatment was 25 ± 5 months (range 11 ± 30). Baseline BCVA was 0.73 ± 0.5 LogMAR, with no significant changes at 12 months (0.77 ± 0.51 μm, p = 0.2). Baseline CRT was 578.3 ± 161 μm, reducing to 352.5 ± 81 μm at 12 months (p = 0.003). Thirteen eyes (43.3%) required a second treatment. Twenty eyes (66.6%) showed no ME at the end of follow-up. One patient (3.3%) required topical IOP-lowering therapy during the study. CONCLUSION In eyes with ME secondary to RVO unresponsive to either aflibercept or DEX administered singularly, a combination therapy with simultaneous administration of aflibercept and DEX was effective in resolving ME, despite the absence of visual improvement. Earlier combined treatment in the course of the disease might lead to better functional outcomes.
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Affiliation(s)
- Chiara Giuffrè
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, via Olgettina 60, 20132, Milan, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, via Olgettina 60, 20132, Milan, Italy.
| | - Alessandro Marchese
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, via Olgettina 60, 20132, Milan, Italy
| | - Michele Coppola
- Ophthalmology Unit, Azienda Ospedaliera di Monza, Via G. B. Pergolesi, 33, 20900, Monza, Italy
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, via Olgettina 60, 20132, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, via Olgettina 60, 20132, Milan, Italy
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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.
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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
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14
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Leisser C, Findl O. Rate of strokes 1 year after retinal artery occlusion with analysis of risk groups. Eur J Ophthalmol 2019; 30:360-362. [PMID: 30782009 DOI: 10.1177/1120672119830925] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The risk of developing stroke after retinal artery occlusion was reported to be increased. The aim of our study was to assess the rate of strokes/transitory ischemic attacks after retinal artery occlusion in a European population and to identify the risk groups. METHODS All patients, diagnosed with branch or central retinal artery occlusion at our outpatient department since 2014, were asked to participate in this prospective case-control study. At the initial examination, the medical history was documented and 1 year after retinal artery occlusion, patients were called by telephone interview for assessment of the rate of strokes/transitory ischemic attack in the follow-up period. RESULTS In all, 30 eyes of 30 patients could be included. Among these, six patients had a stroke, one a transitory ischemic attack, and one an amaurosis fugax in the medical history before retinal artery occlusion. In the period 1 year after retinal artery occlusion, one patient had a re-stroke and one patient had a transitory ischemic attack, with amaurosis fugax in the medical history. Rates of strokes/transitory ischemic attack before and after retinal artery occlusion did not show significant differences between branch and central artery occlusion. CONCLUSION The number of strokes/transitory ischemic attacks within the first year is relatively low after retinal artery occlusion and patients that already had a previous stroke, transitory ischemic attack, and/or amaurosis fugax before retinal artery occlusion seem to have a higher risk for a cerebrovascular event after retinal artery occlusion.
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Affiliation(s)
- Christoph Leisser
- VIROS-Vienna Institute for Research in Ocular Surgery, A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
| | - Oliver Findl
- VIROS-Vienna Institute for Research in Ocular Surgery, A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
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15
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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.
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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
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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.
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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
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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.
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Martínez F, Furió E, Fabiá MJ, Pérez AV, González-Albert V, Rojo-Martínez G, Martínez-Larrad MT, Mena-Martín FJ, Soriguer F, Serrano-Ríos M, Chaves FJ, Martín-Escudero JC, Redón J, García-Fuster MJ. Risk factors associated with retinal vein occlusion. Int J Clin Pract 2014; 68:871-81. [PMID: 24548738 DOI: 10.1111/ijcp.12390] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS Retinal vein occlusion (RVO) is the most frequent retinal vascular disease after diabetic retinopathy in which arterial risk factors are much more relevant than venous factors. The objective was to evaluate the role of risk factors in the development of the first episode of RVO. SUBJECTS AND METHODS One hundred patients with RVO [mean age 56 years, 42% females and mean body mass index (BMI) 27.5 kg/m(2)] were recruited consecutively from the outpatient clinic of a tertiary hospital in Valencia (Spain). All subjects underwent clinical assessment including anthropometric and blood pressure measurements and laboratory test including homocysteine, antiphospholipid antibodies (aPLAs) and thrombophilia studies. In half of the subjects, a carotid ultrasonography was performed. Three control populations matched by age, sex and BMI from different population-based studies were used to compare the levels and prevalence of arterial risk factors. One cohort of young patients with venous thromboembolic disease was used to compare the venous risk factors. RESULTS Blood pressure levels and the prevalence of hypertension were significantly higher in the RVO population when compared with those for the general populations. There was also a large proportion of undiagnosed hypertension within the RVO group. Moreover, carotid evaluation revealed that a large proportion of patients with RVO had evidence of subclinical organ damage. In addition, homocysteine levels and prevalence of aPLAs were similar to the results obtained in our cohort of venous thromboembolic disease. CONCLUSIONS The results indicate that hypertension is the key factor in the development of RVO, and that RVO can be the first manifestation of an undiagnosed hypertension. Furthermore, the majority of these patients had evidence of atherosclerotic disease. Among the venous factors, a thrombophilia study does not seem to be useful and only the prevalence of hyperhomocysteinaemia and aPLAs is higher than in the general population.
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Affiliation(s)
- F Martínez
- Internal Medicine Department, Fundación de Investigación del Hospital Clínico de Valencia- INCLIVA, Hospital Clínico Universitario, Universidad de Valencia, Valencia, Spain; "Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología, Obesidad y Nutrición (CIBEROB)", Institute of Health Carlos III, Minister of Health, Madrid, Spain
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Leisser C, Christmann S, Bodsch A, Schrage N. Hyperhomocysteinämie bei Patienten/innen mit retinalen arteriellen Verschlüssen – gibt es Evidenz für einen Benefit einer therapeutischen Homocysteinsenkung? SPEKTRUM DER AUGENHEILKUNDE 2013. [DOI: 10.1007/s00717-013-0175-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Hypertension has profound effects on various parts of the eye. Classically, elevated blood pressure results in a series of retinal microvascular changes called hypertensive retinopathy, comprising of generalized and focal retinal arteriolar narrowing, arteriovenous nicking, retinal hemorrhages, microaneurysms and, in severe cases, optic disc and macular edema. Studies have shown that mild hypertensive retinopathy signs are common and seen in nearly 10% of the general adult non-diabetic population. Hypertensive retinopathy signs are associated with other indicators of end-organ damage (for example, left ventricular hypertrophy, renal impairment) and may be a risk marker of future clinical events, such as stroke, congestive heart failure and cardiovascular mortality. Furthermore, hypertension is one of the major risk factors for development and progression of diabetic retinopathy, and control of blood pressure has been shown in large clinical trials to prevent visual loss from diabetic retinopathy. In addition, several retinal diseases such as retinal vascular occlusion (artery and vein occlusion), retinal arteriolar emboli, macroaneurysm, ischemic optic neuropathy and age-related macular degeneration may also be related to hypertension; however, there is as yet no evidence that treatment of hypertension prevents vision loss from these conditions. In management of patients with hypertension, physicians should be aware of the full spectrum of the relationship of blood pressure and the eye.
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Affiliation(s)
- M Bhargava
- Singapore Eye Research Institute, National University of Singapore, Singapore
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22
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Fontenla García JR, Figueras Roca M. [Importance of vascular risk factors for retinal microvascular obstructive pathology]. Med Clin (Barc) 2010; 134:111-3. [PMID: 19896149 DOI: 10.1016/j.medcli.2009.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 09/23/2009] [Indexed: 11/25/2022]
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Liu GT, Volpe NJ, Galetta SL. Vision loss. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Affiliation(s)
- Michelle L. Baker
- From the Centre for Eye Research Australia (M.L.B., J.J.W., T.Y.W.), University of Melbourne, Victoria, Australia; the Department of Neurology (M.L.B., P.J.H.), Royal Melbourne Hospital, Victoria, Australia; the Centre for Vision Research (J.J.W.), University of Sydney, Sydney, Australia; and the Singapore Eye Research Institute (T.Y.W.), National University of Singapore, Singapore
| | - Peter J. Hand
- From the Centre for Eye Research Australia (M.L.B., J.J.W., T.Y.W.), University of Melbourne, Victoria, Australia; the Department of Neurology (M.L.B., P.J.H.), Royal Melbourne Hospital, Victoria, Australia; the Centre for Vision Research (J.J.W.), University of Sydney, Sydney, Australia; and the Singapore Eye Research Institute (T.Y.W.), National University of Singapore, Singapore
| | - Jie Jin Wang
- From the Centre for Eye Research Australia (M.L.B., J.J.W., T.Y.W.), University of Melbourne, Victoria, Australia; the Department of Neurology (M.L.B., P.J.H.), Royal Melbourne Hospital, Victoria, Australia; the Centre for Vision Research (J.J.W.), University of Sydney, Sydney, Australia; and the Singapore Eye Research Institute (T.Y.W.), National University of Singapore, Singapore
| | - Tien Y. Wong
- From the Centre for Eye Research Australia (M.L.B., J.J.W., T.Y.W.), University of Melbourne, Victoria, Australia; the Department of Neurology (M.L.B., P.J.H.), Royal Melbourne Hospital, Victoria, Australia; the Centre for Vision Research (J.J.W.), University of Sydney, Sydney, Australia; and the Singapore Eye Research Institute (T.Y.W.), National University of Singapore, Singapore
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25
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26
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Hoki SL, Varma R, Lai MY, Azen SP, Klein R. Prevalence and associations of asymptomatic retinal emboli in Latinos: the Los Angeles Latino Eye Study (LALES). Am J Ophthalmol 2008; 145:143-8. [PMID: 17981255 PMCID: PMC2219465 DOI: 10.1016/j.ajo.2007.08.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 08/21/2007] [Accepted: 08/22/2007] [Indexed: 12/17/2022]
Abstract
PURPOSE To study the prevalence and associations of asymptomatic retinal emboli in a cohort of Latinos and to compare these findings with those of previous population studies. DESIGN Population-based cross-sectional study. METHODS All participants in this study underwent a comprehensive eye examination, including fundus photography. Photographs were graded by trained masked graders. Lifestyle factors and medical history were obtained during extensive interviews. Blood pressure, serum glucose, and glycosylated hemoglobin were measured. Age- and gender-specific prevalence rates were calculated. Odds ratios (ORs) were calculated using stepwise logistic regression analyses to identify independent risk factor associated with asymptomatic retinal emboli. RESULTS Photographs gradable for retinal emboli were obtained from 5,959 participants. For all participants, the prevalence of definite asymptomatic retinal emboli was 0.4% (n = 26). Stepwise logistic regression analyses identified smoking (> five pack years; OR, 4.3) and history of coronary artery disease (OR, 2.8) to be associated independently with retinal emboli (P < .05). CONCLUSIONS We found a lower prevalence of asymptomatic retinal emboli compared with previous population-based studies. This could be secondary to the Los Angeles Latino Eye Study (LALES) population being younger, having lower blood pressure, and having fewer smokers than other studies. As in other studies, smoking emerges as the strongest association with retinal emboli.
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Affiliation(s)
- Susan Liu Hoki
- Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Rohit Varma
- Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Mei Ying Lai
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Stanley P Azen
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Ronald Klein
- Department of Ophthalmology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Abstract
Hypertension has a range of effects on the eye. Hypertensive retinopathy refers to retinal microvascular signs that develop in response to raised blood pressure. Signs of hypertensive retinopathy are frequently seen in adults 40 years and older, and are predictive of incident stroke, congestive heart failure, and cardiovascular mortality--independently of traditional risk factors. Hypertension is also a major risk factor for the development of other retinal vascular diseases, such as retinal vein and artery occlusion, and ischaemic optic neuropathy. High blood pressure increases the risk of both development of diabetic retinopathy and its progression. Adequate control of blood pressure has been proven in randomised clinical trials to reduce vision loss associated with diabetic retinopathy. Finally, hypertension has been implicated in the pathogenesis of glaucoma and age-related macular degeneration. Recognition of the ocular effects of blood pressure could allow physicians to better manage patients with hypertension, and to monitor its end-organ effects.
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Affiliation(s)
- Tien Yin Wong
- Centre for Eye Research Australia, University of Melbourne, Australia.
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Grosso A, Wong TY. Ocular manifestations of systemic arterial hypertension. EXPERT REVIEW OF OPHTHALMOLOGY 2006. [DOI: 10.1586/17469899.1.1.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wang JJ, Cugati S, Knudtson MD, Rochtchina E, Klein R, Klein BEK, Wong TY, Mitchell P. Retinal arteriolar emboli and long-term mortality: pooled data analysis from two older populations. Stroke 2006; 37:1833-6. [PMID: 16741179 DOI: 10.1161/01.str.0000226929.23297.75] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE To assess the relationship between retinal arteriolar emboli and mortality in older people. METHODS Pooled data from 2 population-based cohort studies. At baseline, the Beaver Dam Eye Study (BDES) examined 4926 persons 43 to 86 years of age (1988 to 1990), and the Blue Mountains Eye Study (BMES) examined 3654 persons 49 to 97 years of age (1992 to 1994). Retinal arteriolar emboli were assessed by grading retinal photographs using standardized methods. Deaths and causes of death were determined from death certificates or Australian National Death Index. Cox regression models were used to estimate mortality hazard ratios (HRs) associated with emboli, adjusting for age, gender, body mass index, hypertension, diabetes, smoking, serum total cholesterol, high-density lipoprotein cholesterol, study site, and past histories of stroke, angina, and acute myocardial infarct. RESULTS Of 8580 baseline participants, 8384 (98%) had retinal photographs available, and 111 showed retinal arteriolar emboli (BDES n=61; BMES n=50). Over 10 to 12 years, 2506 participants (30%) died, including 344 (4%) from stroke-related and 1315 (16%) from cardiovascular causes. The cumulative mortality rates were higher in participants with than without emboli (all-cause 56% versus 30%; stroke-related 12% versus 4.0%; cardiovascular 30% versus 16%). The increased mortality risk associated with emboli was independent of age, gender, other vascular risk factors, and past histories of stroke or heart disease for all-cause (multivariate-adjusted HR, 1.3; CI, 1.0 to 1.8) and stroke-related mortality (HR, 2.0; CI, 1.1 to 3.8) but not for cardiovascular mortality (HR, 1.2; CI, 0.8 to 1.7). CONCLUSIONS Our pooled data from 2 older populations suggest that retinal emboli predict a modest increase in all-cause and stroke-related mortality independent of cardiovascular risk factors.
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Affiliation(s)
- Jie Jin Wang
- University of Sydney Department of Ophthalmology, Centre for Vision Research, Westmead Hospital, the Westmead Millennium Institute, NSW, Australia.
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