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Kiersten Snyder, Amirfarbod Yazdanyar, Aditi Mahajan, Glenn Yiu; The Cilioretinal Artery is Protective Against Choroidal Neovascularization in Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2372.
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To determine if the presence and location of a cilioretinal artery may affect the risk of developing advanced age-related macular degeneration (AMD) in the age-related eye disease study (AREDS).
Fundus photographs of 3647 AREDS participants were reviewed by two masked graders for the presence or absence of a cilioretinal artery, and if any branch extend within 500 mm of the center of the macula. Multivariate regression analyses were used to determine the association of the cilioretinal artery and vessel location, adjusted for age, sex, and smoking status, with the incidence of choroidal neovascularization (CNV) or central geographic atrophy (GA), as well as AMD severity score, for eyes at randomization and for eyes at risk at 5 years.
Among AREDS participants, 26.9% of subjects had a cilioretinal artery in one eye, and 8.4% had the vessel in both eyes. Subjects with no cilioretinal arteries had a higher proportion of AMD category 4 (P = 0.02). At randomization, eyes with a cilioretinal artery had a lower incidence of CNV (5.0% vs. 7.6%, OR 0.66, P = 0.001), but no difference in central GA (1.1% vs 0.8%, OR 1.33, P = 0.310). In eyes without late AMD, those with a cilioretinal artery also had a lower AMD severity score (3.00 ± 2.35 vs. 3.19 ±2.40, P = 0.019). At 5 years, eyes at risk without CNV or central GA at baseline and with a cilioretinal artery had lower rates of progression to CNV (4.1% vs 5.5%, OR 0.75, P = 0.050), but no difference in developing central GA (2.2% vs. 2.7%, OR 0.83, P = 0.354) or change in AMD severity score (+0.65 ± 1.55 vs. +0.73 ± 1.70, P = 0.112). Comparison of fellow eyes in subjects with a unilateral cilioretinal artery confirms a lower incidence of neovascular AMD (4.7% vs. 7.2%, P = 0.012).
The presence of a cilioretinal artery may be protective against the development of CNV, but not GA. This finding suggests a hemodynamic contribution to neovascular AMD pathogenesis.
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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