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Nicholas Maxwell Pfahler, Indre Bielskus, Michael Giovingo, Louis Pasquale, Nicholas J Volpe, Paul A Knepper; Systemic capillary abnormalities in age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1199. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Age-related macular degeneration (AMD) is a common and devastating ocular degenerative disease. Some evidence suggests that AMD, as with other ocular and neurodegenerative diseases such as primary open-angle glaucoma and Alzheimer’s disease, is associated with systemic vascular abnormalities. This study hypothesized that AMD patients exhibit increased systemic capillary abnormalities.
Nailfold capillary abnormalities were measured in 40 AMD and 75 aged control subjects without connective tissue disease using video capillaroscopy. Videos were taken of the fourth and fifth digits of each subject's nondominant hand and evaluated for hemorrhages, dilated capillaries > 50 μm, avascular zones > 200 μm, and degree of tortuosity by researchers masked to case status. Hemorrhages, dilated capillaries, and avascular zones were adjusted to counts per 100 capillaries. Tortuosity was assessed qualitatively on a 0-3 scale at specific intervals. AMD subjects were stratified by disease stage based on drusen and pigment abnormalities. Multivariable odds ratios and 95% confidence intervals were calculated using logistic regression analysis. Mann-Whiney U test was used for statistical analysis.
Hemorrhages, dilated capillaries, avascular zones, and tortuosity were each significantly increased in AMD patients compared with controls. The (mean±SD) number of hemorrhages was 2.16±1.68 for AMD cases and 0.54±1.87 for controls (p<0.0001). The number of dilated capillaries was 1.10±1.07 for AMD cases and 0.39±0.99 for controls (p<0.0001). The number of avascular zones was 0.76±0.75 for AMD cases and 0.22±0.81 for controls (p<0.0001). The capillary tortuosity score was 1.25±0.53 for AMD cases and 0.66±0.58 for controls (p<0.0001). All capillary outcomes were positively correlated with AMD severity. After adjustment for clinical variables, the presence of ≥1 hemorrhages, dilated capillaries, or avascular zones was associated with a 22.0-fold (95% CI, 8.1-59.7, p<0.0001), 6.9-fold (2.6-17.9, p<0.0001), and 7.6-fold (2.3-25.6, p<0.0001) increased odds of AMD, respectively. A tortuosity score ≥1.5 was associated with an 8.3-fold (2.5-27.7, p<0.0001) increased odds of AMD.
AMD patients exhibited increased systemic microvascular abnormalities which were correlated with AMD severity independent of confounding variables such as age, sex, race, hypertension, diabetes, or arthritis.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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