Age-Related Macular Degeneration (AMD) and Systemic Vascular Disease

Author Type(s)

Student

Document Type

Abstract

Publication Date

6-2023

Journal Title

Investigative Ophthalmology & Visual Science

Abstract

Purpose : We have recently studied subjects with age-related macular degeneration (AMD) and found that subretinal drusenoid deposits (SDDs) are strongly associated with stroke, congestive heart failure (CHF), and myocardial infarction (MI). This study evaluates vasculopathic subjects for SDDs to further test our hypothesis that ocular hypoperfusion is involved in SDD pathophysiology.

Methods : Eighty-six subjects, ages 49 to 91, were recruited in a cross-sectional study at Mount Sinai Hospital. They were admitted for ischemic stroke (31) or cardiac diagnoses/procedures (55) such as CHF, MI, and/or coronary catheterization. Spectral-domain optical coherence tomography (SD-OCT) was performed on all subjects, with scans read for SDDs (Y/N) by two masked graders. Charts were reviewed for complete ophthalmic, cardiac, and neurovascular histories. Cardiac index (CI), arrhythmias, and internal carotid artery (ICA) stenosis status were also obtained. Subjects were placed in two categories for ICA stenosis: Yes (34; 14 stroke, 20 cardiac) and No (23; 15 stroke, 8 cardiac), with 29 excluded for unknown ICA status (2 stroke, 27 cardiac). Chi square testing was done on categorical variables such as ICA stenosis to determine correlation with SDDs. Mean CI values among subjects with and without SDDs were compared by an unpaired t test.

Results : SDD incidence among stroke (8/31) and cardiac (18/55) subjects was 26% and 33%, respectively. Chi square testing revealed three significant associations with SDDs: ICA stenosis, female sex, and arrhythmias. SDDs were present in 16/34 subjects with ICA stenosis vs 2/23 subjects without ICA stenosis (p = 0.0022), in 17/36 females vs 9/50 males (p = 0.0036), and in 19/49 subjects with arrhythmias vs 7/37 subjects without arrythmias (p = 0.0471). Subjects with SDDs had a significantly lower mean CI (2.10 L/min/m2) vs those without SDDs (2.52 L/min/m2, p = 0.0379).

Conclusions : SDDs are prevalent in cardiac and stroke subjects. The known greater incidence of SDDs among females may reflect their better survival from vascular disease. New, specific associations with SDDs are identified herein. These are ICA stenosis, arrhythmias, and lower CI, all of which support our hypothesis that decreased ocular perfusion drives SDD formation. SDDs may serve as a biomarker of underlying vasculopathy, prompting vascular evaluation as well as retina referral for vision preservation.

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