Ten-year longitudinal changes in retinal microvascular lesions: the atherosclerosis risk in communities study.

Kleins Lab // Publications // Aug 01 2011

PubMed ID: 21529953

Author(s): Liew G, Campbell S, Klein R, Klein BE, Sharrett AR, Cotch MF, Wang JJ, Wong TY. Ten-year longitudinal changes in retinal microvascular lesions: the Atherosclerosis Risk in Communities Study. Ophthalmology. 2011 Aug;118(8):1612-8. doi: 10.1016/j.ophtha.2011.01.003. Epub 2011 Apr 29. PMID 21529953

Journal: Ophthalmology, Volume 118, Issue 8, Aug 2011

OBJECTIVE There are limited data on the natural history and longitudinal changes of retinal microvascular lesions. We examined 10-year changes in retinal microvascular lesions, focusing on those related to hypertension and shown to predict development of cardiovascular disease.

DESIGN Prospective cohort.

PARTICIPANTS We included 1120 middle-aged participants without diabetes of the Atherosclerosis Risk in Communities (ARIC) Study in 1993 to 1995 and again 10 years later in 2003 to 2005.

METHODS Retinal microvascular lesions were graded from retinal photographs using the same protocol at both examinations, with changes (incidence or disappearance) adjudicated by a side-by-side comparison of photographs. The study sample was stratified by carotid intima media thickness (IMT) and ARIC field center; thus, all analyses were weighted by these factors. Persons with diabetes were excluded because the frequency and pathophysiology of diabetic retinal lesions is different.

MAIN OUTCOME MEASURES Incidence and disappearance rates of lesions.

RESULTS The 10-year incidence of focal arteriolar narrowing, arteriovenous (AV) nicking, and retinopathy in persons without diabetes was 3.4% (95% confidence interval [CI], 2.3-4.9), 2.5% (95% CI, 1.6-3.9), and 2.2% (95% CI, 1.3-3.5) respectively. Over the 10-year period, of 32, 219, and 24 eyes with focal arteriolar narrowing, AV nicking and retinopathy at baseline, 50.3% (95% CI, 28.6-71.9), 40.7% (95% CI, 32.7-49.4), and 65.9% (95% CI, 42.4-83.5), respectively, disappeared. Higher baseline plasma fibrinogen and white cell counts were associated with incident focal arteriolar narrowing; antihypertensive medication use was associated with incident AV nicking, and higher diastolic blood pressure, carotid IMT, and white cell counts were associated with incident retinopathy. Higher fasting serum glucose was not significantly associated with incident retinopathy, although this may be related to the small number of lesions (odds ratio, 5.88; 95% CI, 0.74-46.64 per standard deviation difference).

CONCLUSIONS In this sample of middle-aged adults, new retinal microvascular lesions appeared at a rate between 2% and 4% over 10 years. A high percentage of lesions (≥40%) disappeared over the same period, suggesting considerable remodeling in the retinal microvasculature.

FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.