Evaluation of Coronary Heart Disease as a Risk Factor for Sight Threatening Reticular Pseudodrusen.

Abstract

Purpose : Reticular pseudodrusen (RPD) has been identified as a strong risk factor for the late stages of age-related macular degeneration (AMD). Associations between RPD and coronary heart disease (CHD) have also been reported, mainly from small case-control studies carried out in ophthalmic clinics. This study investigated the association of CHD as a risk factor for RPD within a predominantly CHD cohort.

Methods : This study used data from the SCOT-HEART trial, a multicentre randomised controlled trial investigating the additional benefit of computed tomography coronary angiography and calcium scores compared to standard care on patients who were being assessed for suspected angina due to CHD. CHD was categorised as mild, moderate or obstructive. Data was used from a sub-study in which 534 participants in Edinburgh and Dundee had ultra-widefield (UWF) retinal imaging acquired with an Optos P200C scanning laser ophthalmoscope in addition to the normal trial procedures. At least one eye was gradable from 532 participants. Specific features of AMD in UWF images were graded according to the ‘Study-specific Grading Procedures for Optos Peripheral Retina AMD (OPERA) study,’ guidelines. Standardised grading grids were used to record the spatial location of AMD features, including the presence of RPD. Multiple variable confounder adjusted regression models were used to assess the association between RPD and CHD.

Results : The 534 participants ranged in age from 27-75 years (mean 58 years. SD 9.52); 56% were male and 425 (80%) ≥50 years. Within the study sample, 178 (33.3%) had no CHD, 182 (34.1%) had hypertension and 42 (24.4%) had neither CHD nor hypertension. RPD was prevalent in 30 participants (5.63%) and out of this group was bilaterally present in 23. Most participants with bilateral RPD also had drusen > 125µm (early AMD) present. Logistic regression analysis indicated after the adjustment for potential confounders (age, gender, smoking habit, drusen > 125µm) that there was no significant association between CHD and RPD (odds ratio [OR] 0.97; 95% Confidence Interval [CI] (0.39-2.43); p= 0.95). There was a significant association between RPD and drusen >125µm (OR 2.69; 95% CI (1.11-6.49); p= 0.03).

Conclusions : From the data analysed there appears little evidence of a relationship between CHD and RPD. As in other studies, when present, RPD was often associated with early AMD features.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.