Summary: People with subretinal drusenoid deposits (SDD), a form of age-related macular degeneration, are more likely to have underlying heart damage from heart failure or heart attacks, or other forms of cardiovascular disease associated with an increased risk of stroke.
Source: Mount Sinai Hospital
Patients with a specific form of age-related macular degeneration (AMD), one of the leading causes of blindness in the United States, are also very likely to have either underlying heart damage due to heart failure and heart attacks, either advanced heart valve disease or carotid disease. arterial disease associated with certain types of strokes, according to a new study from the New York Eye and Ear Infirmary of Mount Sinai.
This research, published on November 17 in BMJ Open Ophthalmologyis the first to identify the types of high-risk cardiovascular and carotid diseases that are linked to the eye disorder.
The results could spur increased screening to save vision, diagnose undetected heart disease and prevent adverse cardiovascular events.
“For the first time, we were able to link these specific high-risk cardiovascular diseases to a specific form of AMD, that with subretinal drusenoid deposits (SDD),” says lead author R. Theodore Smith, MD, Ph. .D. ., professor of ophthalmology at the Icahn School of Medicine at Mount Sinai.
“This study is the first strong link between the leading cause of blindness, AMD, and heart disease, the leading cause of death worldwide. In addition, we also have strong evidence of what is really happening: the blood supply to the eye is directly diminished by these diseases, either by damage to the heart which decreases blood supply throughout the body, or by a blocked carotid artery that directly impedes blood flow to the eye. eye.
Poor blood supply can damage any part of the body, and with these specific diseases, the destroyed retina and the remaining SDS are these damages. Retinal damage means loss of vision and can lead to blindness.
AMD is the leading cause of visual impairment and blindness in people over 65 and results from damage to the central area of the retina called the macula, which is responsible for reading and motor vision.
A major form of early AMD consists of small yellow deposits of cholesterol called drusen, which form under a part of the retina called the retinal pigment epithelium (RPE). They can starve the retina of blood and oxygen, leading to vision loss. Drusen formation can be slowed by appropriate vitamin supplementation.
The other major form of early AMD, subretinal drusenoid deposits (SDD), is less well known and requires high-tech retinal imaging to detect. These deposits contain a different form of cholesterol and form above the RPE and just below the light-sensitive cells of the retina, where damage occurs and vision is lost. There is no known treatment for SDD.
Dr. Smith and a team of Mount Sinai researchers initially found that patients with cardiovascular disease or stroke were more likely to have TDS. This research, the first of its kind, was published in the July issue of Retina.
This new study builds on that earlier work, looking at a broader patient population, and identifies the specific severe forms of heart disease and carotid artery disease that caused SDD in AMD.
The researchers analyzed the eyes of 200 AMD patients with retinal imaging to determine which patients had SDD. Patients answered a questionnaire about their history of cardiovascular disease. Of the 200 patients, 97 had SDD and 103 had drusen only.
Forty-seven of the 200 had severe heart disease (19 had heart damage from heart failure or heart attack, 17 had severe valve disease, and 11 had stroke from the carotid artery).
Forty of 47 (86%) had SDD. On the other hand, of the 153 patients with AMD who did not have these serious diseases, 57 had SDD (43%).
The researchers concluded that AMD patients with these severe cardiovascular diseases and strokes were nine times more likely to have TDS than those who did not.
“This work demonstrates that ophthalmologists may be the first physicians to detect systemic disease, particularly in asymptomatic patients,” says co-investigator Richard B. Rosen, MD, chief of Mount Health System’s retina service. Sinaï.
“Detection of SDD in the retina should trigger a referral to the individual’s primary care provider, especially if no cardiologist has been previously involved. This could prevent a life-threatening cardiac event.
“This study has opened the door to more productive multidisciplinary collaboration between ophthalmology, cardiology, and neurology departments,” said Jagat Narula, MD, Ph.D., director of the cardiovascular imaging program at Zena and Michael A Wiener Cardiovascular Institute at the Icahn School of Medicine at Mount Sinai.
“We should also focus on defining disease severity by vascular imaging in cardiology and neurology clinics, and assessing their impact on AMD and SDD with retinal imaging. This way we can know which vascular patients should be referred for detection and prevention of blinding disease.
About this vision and cardiovascular disease research news
Author: Press office
Source: Mount Sinai Hospital
Contact: Press Office – Mount Sinai Hospital
Image: Image is in public domain
Original research: Open access.
“Subretinal drusenoid deposits are strongly associated with coexisting high-risk vascular disease” by Gerardo Ledesma-Gil et al. BMJ Open Ophthalmology
Subretinal drusenoid deposits are strongly associated with concurrent high-risk vascular disease
Demonstrate that subretinal drusenoid deposits (SDD) in age-related macular degeneration (AMD) are linked to coexisting high-risk vascular diseases (HRVD).
Cross-sectional study. Two hundred AMD subjects (aged 51 to 100 years; 121 women, 79 men) were recruited. Spectral domain optical coherence tomography, near-infrared autofluorescence and reflectance imaging, and lipid profiles were obtained. Subjects were categorized by medical history questionnaires among those with or without HRVD, defined as: heart valve abnormality (eg, aortic stenosis), myocardial abnormality (eg, myocardial infarction), and stroke stroke/transient ischemic attack. The masked readers divided the subjects into two groups: SDD (with or without drusen) and drusen (only). The univariate test was performed by χ2 test. We constructed multivariate regression models to test relationships between coexisting HRVD status and SDD status, lipid levels, and other covariates.
The prevalence of HRVD was 41.2% (40/97) and 6.8% (7/103) in the SDD and non-SDD groups, respectively (correlation of SDD with HRVD, p = 9 × 10−9, OR 9.62, 95% CI 4.04 to 22.91). Multivariate regressions: only SDD and high-density lipoprotein (HDL) in the first two quartiles of HDL remained significant for HRVD (p = 9.8 × 10−5, 0.021, respectively). Multivariate regression model: SDD and an HDL at Q1 or Q2 identified the presence of HRVD with an accuracy of 78.5%, 95% CI 72.2% to 84.0%.
High-risk cardiovascular and neurovascular diseases were accurately identified in an AMD cohort based on SDD and HDL levels. SDD may be related to inadequate ocular perfusion resulting from systemic vasculopathies. Further research with this paradigm is warranted and may reduce mortality and morbidity from vascular disease.
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