A higher level of glycemia, high alcohol consumption, lower adherence to a healthy diet, and use of antihypertensive medication, an index of history of hypertension, are cross-sectionally associated with lower RNFL thickness in a population-based study – The Maastricht Study

Abstract

Purpose : Diabetic retinopathy is preceded by subtle neurodegenerative changes, including retinal nerve fiber layer (RNFL) thinning. Presently it remains unclear whether potentially modifiable risk factors may be determinants of RNFL thinning. We investigated, using prospectively-collected cross-sectional data from an observational cohort study, whether potentially modifiable risk factors were associated with RNFL thickness.

Methods : We used cross-sectional data from The Maastricht Study (up to 5,255 participants,49.0% men,mean±SD age59.5±8.7 years, and 23.3% with type 2 diabetes [T2D; T2D oversampled by design]). We assessed RNFL thickness with optical coherence tomography (i.e. mean peripapillary RNFL thickness of both eyes). We used linear regression analyses with adjustment for potential confounders; and tested for interaction by sex and T2D (yes/no).

Results : After full adjustment, greater HbA1c and lower healthy diet score were significantly associated with lower RNFL thickness (per SD, standardized beta [95% CI], -0.05 [-0.08; -0.02] and -0.03 [-0.06; -0.00], respectively); high (>2 units/ day for men or >1 unit/day for women) versus none alcohol consumption was significantly associated with lower RNFL thickness (-0.09 [-0.18; -0.00]); antihypertensive medication use was significantly associated with lower RNFL thickness (-0.12 [-0.19; -0.05]); and greater 24-hour ambulatory systolic blood pressure and greater total cholesterol were, respectively, significantly associated with lower and greater RNFL thickness in individuals with, but not in individuals without, T2D (in individuals with T2D, -0.06 [-0.13; 0.00]; 0.09 [0.03; 0.16]). Smoking,cardiorespiratory fitness, accelerometer-assessed physical activity, and waist circumference were not associated with RNFL thickness. Sex did not modify associations under study.

Conclusions : This population-based study found that a higher level of glycemia, lower adherence to a healthy diet, high alcohol consumption, and a history of hypertension, estimated from the use of antihypertensive medication, were associated with a lower RNFL thickness. Hence, early-stage prevention of these adverse factors may contribute to the prevention of RNFL thinning, and, ultimately, diabetic retinopathy.

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