Source: Mount Sinai Hospital Patients with a certain form of age-related macular degeneration (AMD), the leading cause of blindness in the United States, are also more likely to have underlying heart damage from heart failure and heart attacks, or advanced valvular heart disease or carotid artery disease associated with with certain types of strokes, according to a new study from the New York Eye and Ear Infirmary of Mount Sinai. This research, published Nov. 17 in BMJ Open Ophthalmology, is the first to identify which types of high-risk cardiovascular and carotid artery disease are associated with the eye disorder. The findings could prompt increased screening to save sight, 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 (SDDs),” explains 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 actually happening: The blood supply to the eye is directly reduced by these diseases, either by heart damage that reduces blood supply to the entire body, or by a blocked carotid artery that directly blocks blood flow. in the eye. Poor blood supply can cause damage to any part of the body, and with these particular diseases, the damaged retina and SDD debris is that damage. Retinal damage means loss of vision and can lead to blindness.” AMD is the leading cause of vision loss and blindness in people over 65 and is the result of damage to the central area of the retina called the macula, which is responsible for reading and driving vision. A major form of early AMD consists of small yellow cholesterol deposits called drusen, which form under a part of the retina called the retinal pigment epithelium (RPE). They can deprive the retina of blood and oxygen, leading to vision loss. Drusen formation can be slowed with proper vitamin intake. 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 photosensitive cells of the retina, where damage occurs and vision is lost. There is no known cure for SDDs. Dr. Smith and a team of researchers at Mount Sinai first found that patients with cardiovascular disease or stroke were more likely to have CAD. This first-of-its-kind research was published in the July issue of Retina. This new study expands on this previous work by looking at a larger patient population and identifying the specific severe forms of heart disease and carotid artery disease that AMD SDDs caused. 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 only drusen. Forty-seven of the 200 had severe heart disease (19 had heart damage from heart failure or heart attack, 17 severe valvular disease, and 11 stroke originating in the carotid artery). Forty of 47 (86 percent) had SDD. In contrast, of the 153 AMD patients who did not have these serious diseases, 57 had CAD (43 percent). The researchers concluded that AMD patients with these serious cardiovascular diseases and stroke were nine times more likely to have SDDs than those without them. AMD is the leading cause of vision loss and blindness in people over 65 and is the result of damage to the central area of the retina called the macula, which is responsible for reading and driving vision. Image is public domain “This work demonstrates the fact that ophthalmologists can be the first physicians to detect systemic disease, especially in asymptomatic patients,” says co-investigator Richard B. Rosen, MD, Chief of the Retina Service for Mount Sinai Health System. “The detection of SDD in the retina should prompt a referral to the individual’s primary care provider, especially if no previous cardiologist has been involved. It could prevent a life-threatening heart attack.” “This study opened the door for further productive interdisciplinary collaboration between the departments of Ophthalmology, Cardiology and Neurology,” says Jagat Narula, MD, Ph.D., Director of the Cardiovascular Imaging Program at the Zena and Michael A. Wiener Cardiovascular Institute at the Icahn School of Medicine at Mount Sinai. “We should also focus on defining disease severity with vascular imaging in cardiology and neurology clinics and assess their impact on AMD and SDDs with retinal imaging. In this way we can learn 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 public domain See also Original Research: Open Access. “Subretinal Drasinoid Deposits Are Closely Associated with Coexisting High-Risk Vascular Disease” by Gerardo Ledesma-Gil et al. BMJ Open Ophthalmology Abstract Subretinal drasinoid deposits are strongly associated with co-existing high-risk vascular disease Background/goals Demonstrate that subretinal drusenoid deposits (SDD) in age-related macular degeneration (AMD) are associated with co-occurring high-risk vascular diseases (HRVDs). Methods Contemporary study. Two hundred AMD subjects (aged 51–100 years, 121 women, 79 men) were recruited. Spectral domain optical coherence tomography, autofluorescence and near-infrared reflectance imaging, and lipid profiles were obtained. Subjects were stratified by health history questionnaires into subjects with or without HRVD, defined as: heart valve defect (eg, aortic stenosis), myocardial defect (eg, myocardial infarction), and stroke/transient ischemic attack episode. Masked readers divided the subjects into two groups: SDD (with or without drusen) and drusen (only). Univariate testing was performed with the χ2 test. We constructed multivariable regression models to test the relationships of HRVD comorbidity with SDD, lipid levels, and other covariates. Results The prevalence of HRVD was 41.2% (40/97) and 6.8% (7/103) in the SDD and non-SDD groups, respectively (association 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 HDL quartiles remained significant for HRVD (p=9.8×10−5, 0.021, respectively). Multivariable regression model: SDD and an HDL at Q1 or Q2 identified the presence of HRVD with 78.5% accuracy, 95% CI 72.2% to 84.0%. conclusions High-risk cardiovascular and neurovascular diseases were accurately identified in an AMD group by SDD and HDL levels. SDDs may be related to insufficient ocular perfusion resulting from systemic vasculopathy. Further research with this paradigm is warranted and may reduce mortality and morbidity from vascular disease.
