Subretinal drusenoid deposits are strongly associated with coexistent high-risk vascular diseases

Abstract

Background/aimsDemonstrate that subretinal drusenoid deposits (SDDs) in age-related macular degeneration (AMD) are linked to coexistent high-risk vascular diseases (HRVDs).MethodsCross-sectional 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 assigned by health history questionnaires into those with or without HRVDs, defined as: cardiac valve defect (eg, aortic stenosis), myocardial defect (eg, myocardial infarction) and stroke/transient ischaemic attack. Masked readers assigned subjects into two groups: SDD (with or without drusen) and drusen (only). Univariate testing was performed by χ2test. We built multivariate regression models to test relationships of coexistent HRVD to SDD status, lipid levels and other covariates.ResultsThe 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 SDDs and high-density lipoprotein (HDL) in the first two HDL quartiles remained significant for HRVD (p=9.8×10−5, 0.021, respectively). Multivariate regression model: SDDs and an HDL in Q1 or Q2 identified the presence of HRVD with the accuracy of 78.5%, 95% CI 72.2% to 84.0%.ConclusionsHigh-risk cardiovascular and neurovascular diseases were accurately identified in an AMD cohort from SDDs and HDL levels. The SDDs may be related to inadequate ocular perfusion resulting from the systemic vasculopathies. Further research with this paradigm is warranted and might reduce mortality and morbidity from vascular disease.

Internal Carotid Artery Stenosis and Ipsilateral Subretinal Drusenoid Deposits

“…We have previously shown that three categories of HRVDs are associated with SDDs: (1) myocardial dysfunction (congestive heart failure and myocardial infarction), (2) valvular heart disease, and (3) internal carotid artery pathology (ischemic stroke/transient ischemic attack). 10 The common postulated mechanism for SDD formation in all categories is associated choroidal hypoperfusion. In this study, we solely recruited patients with one of these entities, ischemic stroke with ICA stenosis, to evaluate whether carotid artery disease is significantly associated with ipsilateral choroidal thinning and SDDs.…”

“…In a recent study of 200 iAMD subjects, Ledesma-Gil et al 10 have further demonstrated that SDDs are strongly associated with three high-risk vascular disease (HRVD) categories within CVD and stroke: (1) myocardial dysfunction (congestive heart failure, myocardial infarction), (2) valvular heart disease, and (3) ischemic stroke/transient ischemic attack. These cardiovascular and neurovascular disorders pose a high risk for morbidity, mortality, and ophthalmic hypoperfusion, with decreased blood flow through the internal carotid artery (ICA), its ophthalmic artery (OA) branch, and the posterior ciliary arteries that emerge from the OA to supply the choroid.…”

Determinants of Incident Atherosclerotic Cardiovascular Disease Events and All-Cause Mortality in Patients With Age-Related Macular Degeneration: Prospective Cohort Study of UK Biobank

“…In a study conducted by Thomson et al,52 subretinal drusenoid deposits were found to have a robust association with CHD and stroke, whereas no such association was observed for drusen. A cross-sectional study of 200 well-characterized intermediate patients with AMD also suggested that specific high-risk vascular diseases were even more strongly associated with subretinal drusenoid deposits than drusen 53. The novel, albeit transparent mechanism, was postulated due to inadequate perfusions of the choroid secondary to CVD.…”

“…A cross-sectional study of 200 well-characterized intermediate patients with AMD also suggested that specific high-risk vascular diseases were even more strongly associated with subretinal drusenoid deposits than drusen. 53 The novel, albeit transparent mechanism, was postulated due to inadequate perfusions of the choroid secondary to CVD. Collectively, these studies along with the present work establish a significant relationship between AMD and ASCVD, providing evidence for the importance of controlling ASCVD and mortality in populations with AMD.…”

Correlation between ellipsoid zone thickness and the presence of subretinal drusenoid deposits in age-related macular degeneration

“… 5 Moreover, it has been shown that persons with SDDs are more likely to have visual impairment and increased mortality in a 15-year follow-up period when controlling for age and sex. 6 Recently, Ledesma-Gil et al found that SDDs, but not drusen, were associated with high-risk vascular diseases (HRVDs), 7 which may explain poorer survival in persons with SDDs. Moreover, this work suggests a direct link between impaired perfusion and the SDD phenotype of AMD—in fact, it establishes a new AMD paradigm in which SDDs are the direct result of hypoperfusion.…”