The predictive value of retinal vascular findings for carotid artery atherosclerosis: are further recommendations with regard to carotid atherosclerosis screening needed?

Abstract

Vascular retinopathy is the consequence of vascular disease, and the retina is the only place where the arteries can be visualized directly. The purpose of this study was to evaluate the predictive value of retinal vascular findings for carotid artery atherosclerosis. From December 2009 to January 2011, the carotid intima-media thickness (IMT) and total plaque area (TPA) were measured in 179 consecutive patients, who received a fundoscopic examination. The patients were divided into groups as follows: normal retinal artery (normal; n = 44), diabetic retinopathy (DR; n = 25), retinal artery occlusion (RAO; n = 17), retinal vein occlusion (RVO; n = 67), and hypertensive retinopathy (HTN-R; n = 26). The subjects were classified according to the presence of an increased (≥ 1 mm) IMT and plaque. The values of the mean carotid IMT in the patients with vascular retinopathy (DR, 0.87 ± 0.14 mm; RAO, 1.18 ± 0.47 mm; RVO, 0.84 ± 0.14 mm; HTN-R, 0.90 ± 0.20 mm) were significantly increased compared with those in the normal subjects (0.77 ± 0.13 mm). A total 77 of 135 vascular retinopathy patients demonstrated an increased IMT (57 %), and 97 vascular retinopathy patients had carotid artery plaque (72 %). The relative risk of vascular retinopathy in the prediction of an increased IMT and the presence of plaque was 2.79 and 3.95, respectively. Although The TPA was significantly increased in the patients with RAO (1.87 ± 2.67 cm(2)) and RVO (0.27 ± 0.23 cm(2)) compared with the normal subjects (0.18 ± 0.23 cm(2), all Ps < 0.05), there was no significant difference in the ipsilateral carotid IMT and TPA of the affected eye compared with that of the contralateral eye. In conclusion, vascular retinopathy demonstrated a good predictive value in identifying asymptomatic carotid artery atherosclerosis, and this was not confined to the ipsilateral carotid artery of the affected eye. Further recommendations with regard to carotid atherosclerosis screening in patients with vascular retinopathy should be considered.

Risk of Retinal Artery Occlusion in Patients With End-Stage Renal Disease

“…10 Therefore, RAO is a frequently encountered complication of emboli formed from the carotid artery. In fact, Song et al 15 reported that the mean carotid intima-media thickness and total plaque area were significantly higher in patients with RAO than in those without. In addition, carotid atherosclerosis and plaque formation can lead to RAO through serotonin released by platelet aggregation on atherosclerotic plaques in the carotid artery.…”

“…12–14 Atherosclerotic plaques in the carotid artery are associated with both embolism and serotonin release, which are the leading causes of RAO. Meanwhile, Song et al 15 demonstrated that the mean carotid intima-media thickness and total plaque area are significantly greater in RAO patients than in the general population. Furthermore, microvascular disease, including a defective renal microcirculation, is a prominent pathological feature of ESRD.…”

The risk of acute coronary syndrome after retinal artery occlusion: a population-based cohort study

“…In patients with RAO, mean carotid intima-media thickness and total plaque area are significantly higher than those in patients without RAO 21. In fact, the majority of RAOs are caused by embolic occlusion (most common cause), haemorrhage into an atherosclerotic plaque, intraluminal thrombus, vasculitis or vasospasm 15 16 22 23.…”

Clinical Risk Factors Underlying the Occurrence of Retinal Vein Occlusion

“…The EDCC Study Group found that participants who rated themselves as presently above average in terms of physical activity had about 70% lower odds of BRVO than did those who rated themselves as below average (screening analysis) [13] . Song et al [32] showed that patients with RVO have an increased risk of asymptomatic ipsilateral carotid artery plaques, and those with BRVO often also have decreased aortic distensibility and elasticity, a finding frequently found in patients with atherosclerosis A strong association of current cigarette smoking (odds ratios 4.4) with incident retinal branch vein occlusion was found in Beaver Dam study [4] .…”