Correlation of subretinal drusenoid deposits (SDD) and serum risk factors for cardiovascular disease (CVD)

Abstract

Purpose : Age-related macular degeneration (AMD), a leading cause of blindness, is characterized by the formation of drusen. Subretinal drusenoid deposits (SDD) sit over the retinal pigment epithelium, are a proven risk factor for AMD, and can be visualized on cross-sectional spectral domain optical coherence tomography (SD-OCT). We are evaluating the relationship between SDD and serum risk factors for cardiovascular disease (CVD) in AMD.

Methods : 58 subjects (ages of 50-90), diagnosed with AMD on two successive examinations, were recruited prospectively, provided blood samples and underwent SD-OCT. The presence of SDD was determined on SD-OCT by an experienced examiner, and a panel of serum risk factors performed: Total Cholesterol (TC), Triglycerides (TG), HDL, VLDL, LDL Direct and high sensitivity C-reactive protein (hs-CRP). Independent t-tests were performed on these results.

Results : 25 of 58 subjects were found to have SDD present on SD-OCT. Independent t-tests demonstrated a significant association (p<0.05) of high TC (>149 mg/dL) (p=0.01) and low HDL (<39mg/dL) (p=0.02) in subjects with SDD compared to subjects without SDD. Post hoc analysis showed that of patients with high TC, 52% had SDD and 22% did not have SDD present (p=0.02); of patients with low HDL, 4% had SDD, 12% did not (p=0.04); of patients with high LDL-direct, 72% had SDD and 55% did not have SDD (p=0.05). Results for TG and hsCRP were inconclusive.

Conclusions : The relationship of TC and AMD is inconsistently reported in the literature, with no demonstrated difference between the phenotypes of AMD. Our results demonstrate that high TC is a specific and significant risk factor for AMD with SDD compared to AMD without SDD. High TC is also a strong risk factor for CVD. Therefore, the leading cause of blindness (AMD) can now be connected to the leading cause of death (CVD) through its SDD phenotype, which may be an effective ophthalmic predictor for future CVD. High LDL is a strong risk for CVD as well, and the risk for SDD also approached significance. High HDL is a known risk for AMD, and per our study, may confer even greater risk for SDD. One limitation of our study is that the groups were not matched for other independent CVD risk factors such as hypertension and smoking history, which could have confounded associations with SDD.

This is a 2020 ARVO Annual Meeting abstract.