Asymptomatic carotid artery stenosis and retinal nerve fiber layer thickness. A community-based, observational study

Abstract

PurposeTo examine whether an abnormally thin retinal nerve fiber layer (RNFL) is associated with cerebrovascular insufficiency.DesignCommunity-based study.MethodsThe Asymptomatic Polyvascular Abnormalities in Community Study included Chinese aged 40+ years and without histories of cerebrovascular incidents or coronary heart disease. Using transcranial Doppler and carotid duplex ultrasound examination, we assessed presence and degree of an intracranial arterial stenosis (ICAS) and extracranial carotid arterial stenosis (ECAS) and we measured the RNFL thickness by spectral-domain optical coherence tomography.ResultsThe study included 3,376 participants with a mean age of 54.3±10.3 years. Thinner RNFL was significantly correlated with a higher prevalence of ECAS (P = 0.035; standardized regression coefficient beta:-0.04; non-standardized regression coefficient B:-0.99; 95% confidence intervals(CI):-1.90,-0.07), after adjusting for age (P<0.001;beta:-0.25;B:-0.26;95%CI:-0.30,-0.22), gender (P = 0.001;beta:-0.07;B:-1.36;95%CI:-2.14,-0.58) and blood concentration of low-density lipoproteins (P = 0.03;beta:0.04;B:0.52;95%CI:0.05,0.98). In a reverse manner, prevalence of ECAS was associated with a thinner RNFL thickness (P = 0.007; odds ratio (OR):0.99; 95%CI:0.98,0.99) after adjusting for older age (P<0.001;OR:1.06;95%CI:10.05,10.7), higher prevalence of ICAS (P = 0.01;OR:1.34;95%CI:1.07,1.69) and higher prevalence of carotid artery plaques (P<0.001;OR:9.18;95%CI:6.93,12.2), and higher blood concentration of total cholesterol (P = 0.03;OR:1.12;95%CI:1.01,1.23). In univariate analysis, an increasing degree of ECAS was significantly correlated with a thinner RNFL.ConclusionsHigher prevalence and degree of ECAS were correlated with thinner RNFL and vice versa. Patients with abnormally thin RNFL without ocular disease may undergo carotid artery examination to detect asymptomatic carotid artery stenosis. Examination of the RNFL is useful for the diagnosis of cerebrovascular disease.

Changes in retinal flow density measured by optical coherence tomography angiography in patients with carotid artery stenosis after carotid endarterectomy

“…also failed to find a significantly reduced RNFL thickness in patients with CAS 7 , a community-based study recently published by Wang et al . does describe reduced RNFL thicknesses in patients with CAS 4 . In functional tests, Kofoed et al .…”

“…Management of vascular risk factors, antiplatelet therapy and different surgical procedures (carotid endarterectomy, carotid angioplasty and stenting) are therapeutic options available for the management of carotid artery stenosis. Detection of stenosis of the carotid artery is therefore especially important in neurologically asymptomatic patients 2 – 4 . In current guidelines, the degree of stenosis is an important surrogate measure for stroke risk and indication for intervention.…”

Retinal layers and visual conductivity changes in a case series of microangiopathic ischemic stroke patients

“…Previous SD-OCT studies have reported a reduction of the RNFL in cerebrovascular disorders like asymptomatic internal carotid artery stenosis [29] and moyamoya angiopathy [11]. But so far, to our knowledge there is only very little data on SD-OCT and mfVEP changes in microangiopathic ischemic stroke patients.…”

The Relationship Between Nailfold Microcirculation and Retinal Microcirculation in Healthy Subjects

“…The previous studies also showed elevated plasma endothelin-1 was associated retinal vein occlusions, anterior ischemic optic neuropathy, and glaucoma ( Iannaccone et al, 1998 ; Flammer et al, 2001 ; Li et al, 2016 ). And the higher degree of carotid arterial stenosis contributed to the thinner RNFL thickness ( Wang et al, 2017 ). However, at present, the study of nailfold microcirculation in ocular diseases is limited.…”