Association of retinal bioparameters and periodontal disease: a cross-sectional analysis from the UK Biobank cohort

Abstract

Purpose : Periodontal disease (PD) is a chronic inflammatory disorder of the gums and supporting bony tissues, affecting greater than 50% of the global adult population. Although primarily an oral condition, considerable evidence links PD with systemic illnesses, such as cardiovascular disease and dementia. Allowing direct visualisation of the central nervous system and vascular tissue, the retina represents an in-vivo model for stratifying neurodegenerative and cardiovascular risk. Here, we examined the association between PD and differences in various retinal vascular and neural bioparameters.

Methods : This was a cross-sectional analysis of data from the United Kingdom Biobank (UKBB). Our primary outcome measures were retinal vascular (arteriolar and venular) calibre, as well as, macular retinal nerve fibre layer (mRNFL) and ganglion cell-inner plexiform layer (mGCIPL) thickness, as derived from colour fundus photography (CFP) and optical coherence tomography (OCT), respectively. Secondary outcomes included retinal fractal dimension and retinal vascular distance tortuosity. CFP data was analyzed using the open-source deep-learning model, AutoMorph, and OCT data was segmented using the Topcon Advanced Boundary Segmentation Tool. Analyses were summarised as regression coefficients.

Results : In a cohort of 39,353 individuals, there were 1,487 with PD and 37,866 controls. After adjustment for confounders, PD was associated with reduced thickness of the mGCIPL (-0.46μm, 95% CI -0.88, -0.04, p=0.033), but not mRNFL (-0.12μm, 95% CI -0.26, 0.02. p=0.09). This association was modified by age, when stratifying by decile age groups, existing in those aged 60-69 years, but not those who were younger. Among retinovascular indices, PD was significantly associated with increased venular calibre (0.09, 95% CI 0.03,0.15, p=0.003), but not arteriolar calibre, fractal dimension, or distance tortuosity. Retinal venular calibre was not modified by age.

Conclusions : PD is associated with thinner mGCIPL, specifically in individuals aged 60 and older. Moreover, PD is also associated with increased retinal venular calibre, and this is preserved across age groups. Our work identifies quantifiable differences in retinal vascular morphology and sublayer thickness in individuals with PD and offers potential for future studies investigating the prognostic value of these markers on both oral and systemic disease.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.