Localized Retinal Nerve Fiber Layer Defects and Stroke

Wang, Dandan; Yang, Li; Wang, Chunxue; Xu, Liang; You, Qi Sheng; Wang, Ya Xing; Zhao, Lifeng; Wei, Wen Bin; Wang, Wenjuan; Jonas, Jost B.

doi:10.1161/strokeaha.113.004629

Cited by 55 publications

(53 citation statements)

References 28 publications

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“…24 In a hospital-based study, localized RNFLDs were significantly associated with acute or preceding cerebral stroke after adjusting for arterial blood pressure and other factors associated with stroke or localized RNFLDs. 25 These preceding cross-sectional hospital-based studies, the experimental monkey study, and the present longitudinal populationbased investigations agree on the association between localized RNFLDs and arterial hypertension and cerebral stroke. It suggests that localized RNFLDs should be searched for in any patients with arterial hypertension and/or at risk for stroke.…”

Section: Discussionsupporting

confidence: 86%

Ten-Year Incidence of Retinal Nerve Fiber Layer Defects: The Beijing Eye Study 2001/2011

Ren

Wang

et al. 2015

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. We examined the 10-year incidence of localized retinal nerve fiber layer defects (RNFLDs) and associated factors in adult Chinese.METHODS. The population-based longitudinal Beijing Eye Study, which included 4439 subjects (age, 40þ years) in 2001, was repeated in 2011 with 2695 subjects participating (66.4% of the survivors). Color fundus photographs taken at baseline and 10 years later were examined for localized RNFLDs, defined as wedge-shaped defects running toward the optic disc.RESULTS. Fundus photographs were available for 2422 (89.9%) subjects. Incident-localized RNFLDs were detected in 114/2422 persons (4.7% 6 0.2%) or 139/4867 eyes (2.9% 6 0.2%). A total of 25 (22%) persons had incident-localized RNFLDs bilaterally, and 89 (78%) persons unilaterally. Among the 114 persons with incident RNFLDs, 78 persons showed newly developed localized RNFLDs, while 36 subjects showed an enlargement of a preexisting localized RNFLD. In binary logistic regression analysis, a higher 10-year incidence of localized RNFLDs was significantly associated with a higher prevalence of arterial hypertension (P ¼ 0.002; odds ratio [OR], 2.31; 95% confidence interval (CI), 1.35, 3.97), higher diastolic blood pressure (P ¼ 0.02; OR, 1.02; 95% CI, 1.004,1.04), higher prevalence of previous cerebrovascular infarctions (P ¼ 0.007; OR, 2.61; 95% CI, 1.30, 5.22), younger age (P ¼ 0.01; OR, 0.97; 95% CI, 0.94, 0.99), higher prevalence of diabetic retinopathy (P ¼ 0.001; OR, 4.70; 95% CI, 1.92, 11.5), higher prevalence of open-angle (P < 0.001; OR, 39.8; 95% CI, 19.7, 80.5) and angle-closure (P < 0.001; OR, 21.3; 95% CI, 7.90, 57.5) glaucoma, and thinner retinal nerve fiber layer (P < 0.001; OR, 0.97; 95% CI, 0.95, 0.98).CONCLUSIONS. The 10-year incidence of localized RNFLDs in adult Chinese is 4.7% 6 0.2%. It is strongly associated with arterial hypertension and higher prevalence of cerebrovascular infarcts, in addition to ocular reasons, such as glaucoma and diabetic retinopathy. Ophthalmologically normal subjects with incident-localized RNFLDs may be screened for arterial hypertension and cerebrovascular infarcts.Keywords: retinal nerve fiber layer, stroke, glaucoma, optic nerve, optic disc, Beijing Eye Study T he optic nerve as cerebral fascicle has its origin in the retinal ganglion cell layer. Its axons extend from the inner retina through the optic disc, optic nerve, and optic tract to the lateral geniculate ganglion. Any optic nerve damage affects the retinal nerve fiber layer (RNFL) through the loss of optic nerve fibers. The RNFL has conventionally been examined by ophthalmoscopy or on color fundus photographs. [1][2][3][4][5] The visibility of the RNFL shows a specific pattern with usually the best visibility in the temporal inferior arcade, followed by the temporal superior arcade, nasal superior arcade, and nasal inferior arcade. 6 The distribution of the RNFL visibility correlates with the thickness of the RNFL as measured by histomorphometry or confocal scanning laser tomography, with the diameter of the retinal arter...

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Section: Discussionsupporting

confidence: 86%

Ten-Year Incidence of Retinal Nerve Fiber Layer Defects: The Beijing Eye Study 2001/2011

Ren

Wang

et al. 2015

Invest. Ophthalmol. Vis. Sci.

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“…Injuries in neurovascular coupling mechanism, which is important in the brain homeostasis, are also present in pathologic conditions such as stroke, subarachnoid hemorrhage, and dementias. 37 Recent surveys have found that localized RNFL defects are also associated with neurodegenerative diseases such as stroke 38 or small vessel disease 39 ; they are also associated with arterial hypertension. 40 In this regard, RNFL defect in diabetes seems to be one manifestation other than DR, which could be used as one of the surrogate markers of impaired neurovascular coupling in neurodegenerative disease.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Retinal Nerve Fiber Layer Defect in Nonglaucomatous Eyes With Type II Diabetes

Jeon

Kwon

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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PURPOSE.To investigate the characteristics of retinal nerve fiber layer (RNFL) defects associated with type II diabetes.METHODS. Forty nonglaucomatous eyes with type II diabetes and 54 eyes with early open angle glaucoma that exhibited a localized RNFL defect and 42 eyes from age-and sex-matched nondiabetic, nonglaucomatous controls were imaged with red-free fundus photography and optical coherence tomography (Cirrus HD-OCT, Carl Zeiss Meditec). The area under the receiver operating characteristic curves of eyes with diabetes was compared with that of eyes with glaucoma. When an RNFL defect on fundus photographs was identified in the quadrant, clock-hour, temporal-superior-nasal-inferior-temporal (TSNIT), deviation, and thickness maps, it was considered a true detection. RESULTS.In eyes with diabetes, the RNFL defects were located more frequently in the superior hemisphere than they were in those with glaucoma (P < 0.001). The angular locations of RNFL defects in eyes with diabetes (56.1 6 12.78) were significantly farther from the fovea compared with those in glaucoma (44.3 6 17.38; P < 0.001); in addition, the width of RNFL defects in diabetes (5.1 6 2.38) was significantly narrower than those in glaucoma (20.8 6 12.38; P < 0.001). The best parameter discriminating RNFL defects in diabetes from those in glaucoma was width of RNFL defect (0.955), followed by rim area (0.844), and average RNFL (0.791). The thickness map showed a sensitivity (70%) and specificity (69.1%), superior to those of all other maps in eyes with diabetes.CONCLUSIONS. The narrow width and identification of RNFL defect in thickness map obtained with Cirrus HD-OCT seems to be an effective tool for detecting RNFL defects in diabetes.

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“…Focal retinal nerve fiber layer defects, thought to represent prior ischemic insults to the retina, were more common in both cross sectional and cohort stroke groups versus a cohort derived control group. (46) This may be a surrogate marker for prior RAO, though guidelines do not currently recommend secondary stroke prevention on this basis.…”

Section: Relationship Between Chronic Retinal Microvascular Disease Amentioning

confidence: 99%

Retinal Vascular Changes are a Marker for Cerebral Vascular Diseases

Moss

2015

Curr Neurol Neurosci Rep

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The retinal circulation is a potential marker of cerebral vascular disease because it shares origin and drainage with the intracranial circulation and because it can be directly visualized using ophthalmoscopy. Cross sectional and cohort studies have demonstrated associations between chronic retinal and cerebral vascular disease, acute retinal and cerebral vascular disease and chronic retinal vascular disease and acute cerebral vascular disease. In particular, certain qualitative features of retinopathy, retinal artery occlusion and increased retinal vein caliber are associated with concurrent and future cerebrovascular events. These associations persist after accounting for confounding variables known to be disease-causing in both circulations, which supports the potential use of retinal vasculature findings to stratify individuals with regards to cerebral vascular disease risk.

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Localized Retinal Nerve Fiber Layer Defects and Stroke

Cited by 55 publications

References 28 publications

Ten-Year Incidence of Retinal Nerve Fiber Layer Defects: The Beijing Eye Study 2001/2011

Ten-Year Incidence of Retinal Nerve Fiber Layer Defects: The Beijing Eye Study 2001/2011

Characteristics of Retinal Nerve Fiber Layer Defect in Nonglaucomatous Eyes With Type II Diabetes

Retinal Vascular Changes are a Marker for Cerebral Vascular Diseases

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