Abstract
Purpose :
Cardiovascular disease is the number one cause of death in the world, and frequently goes unnoticed until the occurrence of serious events such as heart attack or stroke. Therefore, early detection of occult cardiovascular disease, prior to catastrophic illness, is critical. We sought to determine whether retinal ischemic perivascular lesions (RIPLs), which are anatomical biomarkers of subclinical microvascular ischemia in the retina, can be used to detect occult cardiovascular disease.
Methods :
We identified individuals with no significant retinal pathologies and who had RIPLs detected on spectral domain optical coherence tomography (SD-OCT) scans during routine retinal examination in our clinic. We excluded individuals with pre-existing cardiovascular disease, diabetes, and those who did not have a follow-up medical visit. Additionally, we excluded patients with any retinal pathology including diabetic retinopathy. We reviewed the medical chart and present the medical outcome of subjects who had subsequent cardiovascular workup prompted by RIPLs detection.
Results :
We identified thirty-six patients, with incidental RIPL identification on SD-OCT at the time of examination. A total of 25 patients were excluded. Of the 11 subjects that were included, 5 were males and 6 were females. Ages ranged from 44 to 80 years. The eleven subjects with no prior history of cardiovascular disease, other than essential HTN, followed up with their primary care physician or cardiologist for age-appropriate cardiovascular work-up. Of these, newly diagnosed cardiovascular disease was identified in 8 individuals (72.7%), including three-vessel CAD, significant carotid artery stenosis, soft carotid plaque, reduced cardiac ejection fraction, patent foramen ovale, cerebral infarction, subclavian steal syndrome and undiagnosed or uncontrolled HTN. Two patients subsequently underwent invasive procedures including coronary artery bypass grafting (CABG) and carotid artery stent placement. Three patients were started on new medical therapy for their conditions, and two were advised to undergo periodic follow up.
Conclusions :
Our findings indicate that presence of RIPLs, which are anatomical markers of prior retinal ischemic infarcts, may indicate the need for cardiovascular referral which in some cases can lead to important interventional management.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.