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Thasarat S Vajaranant, Joelle Hallak, Pauline M Maki, Mark A Espeland, Louis R. Pasquale, Barbara E K Klein, Stacy M Meuer, Stephen R Rapp, Mary N Haan; Increased optic nerve cupping as a marker for cognitive decline: the Women’s Health Initiative (WHI). Invest. Ophthalmol. Vis. Sci. 2018;59(9):4053. doi: https://doi.org/.
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Previous studies suggest a possible link between primary open-angle glaucoma (POAG) and Alzheimer’s disease (AD). Patients with AD, compared to those without AD, have increased cup-to-disc ratio (CDR) with a more severe and rapid progression of POAG at normal intraocular pressure (IOP). In this study, we determined if larger CDR predicted poor cognitive function in women without glaucoma or ocular hypertension.
We used data from the WHI-Sight Exam, designed to test the effect of hormone therapy (HT) on the prevalence of age-related macular degeneration. Large CDR was defined as CDR greater than 0.6 in either eye, based on stereoscopic optic nerve photographs, graded at the University of Wisconsin. Cognitive function was assessed by Modified Mini Mental State Exam (3MSE) annually in the WHI Memory Study. We excluded women with 1) no information on the optic nerve grading; 2) no 3MSE scores during year 1 to 4 following an eye exam, 3) ocular hypertension (Goldmann IOP > 23 mmHg) or 4) glaucoma medication use. A linear mixed model, using the glimmix procedure for non-normally distributed outcomes, was used for determining the association between large CDR in at least one eye and 3MSE scores, adjusting for, age, race, diabetes, body mass index, cardiovascular disease, smoking, HT randomization, education, and presence of diabetic retinopathy in either eye.
Final analysis included 2,293 women with baseline CDR, health data and MSE scores from years 1 to 4 following an eye exam (mean age was 69.47 ±3.59 years and 91.38% were Caucasian). Of those, 161 women had large CDR. The mean follow-up time was 2.3 ± 1.0 years. Mean 3MSE scores in women with or without large CDR were 95.4 ± 5.2 vs. 96.1 ± 4.3 for year 1; 96.1 ± 5.0 vs. 96.4 ± 4.9 for year 2; 95.8 ± 4.6 vs. 96.3 ± 4.9 for year 3, and 93.0 ± 9.2 vs. 95.0 ± 5.3 for year 4. The adjusted mixed linear regression model showed that women with large CDR at baseline had lower 3MSE scores over the 4-year follow up, compared with those without large CDR (Figure 1, p=0.02).
Our analysis suggested that post-menopausal women who had large CDR without glaucoma or ocular hypertension exhibited lower cognitive function over time. Further investigation with a larger sample size during follow-up is needed to confirm these findings.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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