Let Your Eye Doctor Take Care Of Your Heart!

Abstract

Purpose: : Coronary artery diseases (CAD) remain a major health problem. Risk factors will alter the micro-vascularisation (MV) and the function of the endothelium long before anomalies in the large vessels become clinically apparent. Retinal fundus (RF) examination offers a unique opportunity to evaluate the MV circulation and in many ways could serve as a "window" to detect pre-clinical signs of CAD that could not be easily assessed by other means. Our objective was to evaluate a new retinal MV score (RMVS) to quantify the extent of MV disease and to correlate it with the risk factors associated with CAD.

Methods: : Eighty patients (56 males and 24 females aged 60±5 yrs) with at least one risk factor of CAD [35% Diabetes (DB), and 45% hypertension (HTN)] were enrolled in this study. Patients were subjected to the standard CAD clinical evaluation protocol as well as RF examination with a non-midriatic digital camera. The data thus obtained (i.e. A/V ratios, vessel tortuosity and the RF background anomalies) served to calculate the RMVS, where the score ranged from 0 (normal RF) to 4 (most severe anomalies). In a subgroup of patients, retinal electrophysiology (standard flash and multifocal electroretinograms) was also obtained.

Results: : : RMVS scores of 0, 1, 2 and 3 and 4 combined were observed in 12, 14, 18, and 36 patients respectively. Among the risk factors evaluated, only a high diastolic blood pressure and low HDL levels were associated with higher RMVS ( p=0.04 and p=0.02 respectively). These associations remained significant in both men and women and in patients with and without DB or HTN. A high RMVS was also associated with a significant 40% decrease in scotopic b-wave amplitude and delayed peak time response and a reduced mfERG (r = -0.52, p<0.05).

Conclusions: : In this small group of patients, the retinal micro-vascular score was correlated with 2 important risk factors for CAD (diastolic blood pressure and low HDL). The observed micro-vascular anomalies were also associated with functional retinal anomalies. Based on these very promising preliminary results, we feel confident to state that the structural (especially blood vessels) and functional assessment of the retina offer a unique diagnostic window on the health status of the coronary arteries that are otherwise clinically more difficult to evaluate and done so at a significantly cheaper cost for the health system and safer for the patients.

Clinical Trial: : http://www.clinicaltrials.gov NCT01027988

Keywords: retina • clinical (human) or epidemiologic studies: systems/equipment/techniques • visual development