Retinal and choriocapillaris perfusion are associated with ankle-brachial-pressure-index and Fontaine stage in peripheral arterial disease

Abstract

The purpose of this prospective case–control study was to assess whether parameters of retinal and choriocapillaris perfusion are altered in patients with peripheral arterial disease (PAD). Patients with PAD and healthy controls were imaged with swept-source optical coherence tomography angiography (OCT-A). Macula centered 3 × 3 mm OCT-A scans were acquired, binarized and perfusion was evaluated for vessel density (VD) and choriocapillaris non-perfused area. Clinical examination and non-invasive assessment included Fontaine staging, ankle-brachial-pressure-index (ABI) and vascular color-coded Doppler sonography. Fifty-two patients with PAD and 23 healthy controls were included. Superficial retinal VD was reduced in patients compared to controls (difference = − 0.013, p = 0.02), decreased with higher Fontaine stage (p = 0.01) and correlated with ABI (r = 0.42, p < 0.0001, 95% confidence interval [CI] 0.23–0.58). Choriocapillaris non-perfused area was larger in patients compared to controls (difference = 3.64%, p = 0.002, 95% CI 1.38–5.90%) and significantly correlated with ABI (r = − 0.22, p = 0.03, 95% CI − 0.40– − 0.03). Multivariate multiple regression analysis revealed a significant association of all OCT-A parameters with ABI and of deep retinal vessel density and choriocapillaris non-perfused area with Fontaine stage. In this first study of retinal and choroidal perfusion in patients with PAD we found both retinal and choroidal perfusion to be significantly impaired. OCT-A parameters could aid as indirect imaging biomarkers for non-invasive PAD staging and monitoring.

Optical coherence tomography angiography quantitative analysis of retinal and choroidal microvasculature in patients with dyslipidemia

“…An impaired retinal network has been demonstrated in these systemic diseases, which may be the result of an alteration of retinal autoregulation. [3][4][5][6]17 In our study, we demonstrated a significant diminution of VD in the foveal region at CC in both 6 mm × 6 mm and 4,5 mm × 4,5 mm cubes of OCTA in the DL group. Furthermore, we observed a significant decrease of total VD in the CC in the 6 mm × 6 mm cube in patients with DL.…”

“…An impaired retinal network has been demonstrated in these systemic diseases, which may be the result of an alteration of retinal autoregulation. 3–6,17…”

“…Retinal microangiopathy is highly correlated to the development of CVD and is associated with systemic disorders such as arterial hypertension (HTN) and DM. [3][4][5][6] Nevertheless, several population-based studies failed to demonstrate a compatible association between the alteration of retinal microvasculature on color fundus photographs and serum lipids. Blue Mountains Eye Study and Atherosclerosis Risk in Communities study found that arteriolar narrowing was secondary to lower HDL levels, but not to higher LDL or cholesterol total levels.…”

Ankle-brachial index and ocular diseases in a Russian population

“…Third, arteriosclerosis may be associated more with retinal vessel-derived parameters or vascular disease such as retinal vein occlusion than with the other major ocular disease addressed in the present study. In a recent study, Wintergerst and colleagues reported on correlations between the ABI and the retinal and choriocapillaris vascular density as measured by optical coherence tomographic angiography [ 32 ]. Since however, we did not measure the diameters and tortuosity of the retinal vessels, we could not assess a correlation between arteriosclerosis, as measured by the ABI, and retinal vessel-derived variables.…”

Multiple instance learning detects peripheral arterial disease from high-resolution color fundus photography

“…As the underlying cause (atherosclerosis) affects all arteries in the body we theorized that vascular alterations are also present in the retinal arterial vessels. In fact, our previous work linked vascular abnormalities on ocular optical coherence tomography angiography (OCT-A) to PAD 4 . In our current work, we aim to investigate whether a similar link can be made with results from color fundus photography (CFP), a widely available and non-invasive imaging modality in which no specific findings characteristic for PAD have been described so far 5 .…”