A higher level of glycemia, lower adherence to a healthy diet, lower cardiorespiratory fitness, smoking, and higher systolic blood pressure are cross-sectionally associated with lower retinal sensitivity in a population-based study – The Maastricht Study

Abstract

Purpose : Diabetic retinopathy is preceded by subtle functional neurodegenerative changes, including reduced light sensitivity "lower retinal sensitivity". It is not yet understood if potentially modifiable risk factors may be determinants of retinal sensitivity (RS). Using cross-sectional data from a cohort study, we investigated whether those risk factors were associated with RS.

Methods : We used data from The Maastricht Study, up to 5,255 participants, 50.5% men, age 59.7±8.7 years, and 22.6% with type 2 diabetes (T2D). We determined HbA1c (mmol/mol) and total cholesterol (mmol/L) in fasting plasma samples. We assessed dietary intake and alcohol consumption with a validated food frequency questionnaire, and smoking status via a questionnaire. We measured cardiorespiratory fitness, defined as the maximum power output adjusted for body mass. We measured 24-hour ambulatory blood pressure (mm Hg). We assessed waist circumference (cm) and physical activity (hours/day). We estimated the RS using Heidelberg Edge Perimeter and defined RS as the mean (peri)macular RS of both eyes. We used linear regression analyses with adjustment for potential confounders and tested for interaction by sex and T2D.

Results : After full adjustment, greater HbA1c, lower healthy diet score and cardiorespiratory fitness, and current versus never smoking were significantly associated with lower RS, per SD-β[95% CI], -0.05[-0.08; -0.02], -0.06[-0.09; -0.03], -0.05[-0.08; -0.01], and -0.14[-0.22; -0.06], respectively; greater 24-hour ambulatory systolic blood pressure was significantly associated with lower RS in individuals with, but not in individuals without, T2D -0.06[-0.12; -0.04]. In contrast, greater total cholesterol was significantly associated with greater RS 0.05[0.02; 0.08]. Alcohol consumption, antihypertensive medication use, lower physical activity, and greater waist circumference were not associated with RS. Sex did not modify the associations.

Conclusions : In this study, higher levels of glycemia or systolic blood pressure, lower adherence to a healthy diet, or cardiorespiratory fitness, and smoking were associated with a lower RS. Hence, early-stage prevention of these factors may contribute to the prevention of loss of RS and, ultimately, diabetic retinopathy.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.