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Fundus Photography as a Convenient Tool to Study Microvascular Responses to Cardiovascular Disease Risk Factors in Epidemiological Studies
Published on: October 22, 2014
Retinal microvascular signs and disability in the Cardiovascular Health Study
Dae Hyun Kim1, Paulo H M Chaves, Anne B Newman
1Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. dkim2@bidmc.harvard.edu
Insights
Retinal microvascular changes are linked to increased difficulty with daily activities. These changes may be partly explained by executive dysfunction and other symptoms of frontal subcortical dysfunction.
Area of Science:
- Ophthalmology
- Geriatrics
- Neurology
Background:
- Retinal microvascular changes are associated with systemic conditions and cognitive decline.
- Understanding these changes' impact on daily functioning is crucial for aging populations.
Purpose of the Study:
- To investigate the association between retinal microvascular signs and incident disability in performing activities of daily living (ADL).
- To explore potential mediation by cerebral microvascular disease and frontal subcortical dysfunction symptoms.
Main Methods:
- Prospective cohort study of 1487 community-dwelling older adults (mean age 78).
- Assessed retinal signs, carotid intima-media thickness, and incident ADL disability over a median follow-up of 3.1 years.
- Examined mediation by brain imaging, executive function, gait speed, and depressive mood.
Main Results:
- Participants with two or more retinal signs had a significantly higher rate of ADL disability (aHR, 1.45; P < .001).
- No interaction was found with advanced carotid atherosclerosis.
- The association was partially mediated by executive dysfunction, slow gait, and depressive symptoms, but not cerebral microvascular disease.
Conclusions:
- Microvascular disease has significant pathophysiologic and prognostic implications for age-related disability.
- Retinal photography's role in clinical risk prediction requires further investigation.
Objective:
To study the associations of retinal microvascular changes, which are associated with systemic conditions and cognitive decline, with disability in performing activities of daily living (ADL).
Design:
Prospective cohort study of 1487 community-dwelling participants in the Cardiovascular Health Study (mean age, 78 years) who were free of ADL disability and had available data on retinal signs and carotid intima-media thickness at the 1998-1999 visit. Main outcome measures were incident ADL disability, defined as self-reported difficulty in performing any ADL, by the presence of retinal signs and advanced carotid atherosclerosis, defined by carotid intima-media thickness in the 80th percentile or more or 25% or more stenosis, and potential mediation by cerebral microvascular disease on brain imaging or by executive dysfunction, slow gait, and depressive mood, which are symptoms of frontal subcortical dysfunction.
Results:
During the median follow-up of 3.1 years (maximum, 7.8 years), participants with 2 or more retinal signs had a higher rate of disability than those with fewer than 2 retinal signs (10.1% vs 7.1%; adjusted hazard ratio, 1.45; 95% confidence interval, 1.24-1.69; P < .001). There was no evidence of interaction by advanced carotid atherosclerosis (P > .10). The association seemed to be partially mediated by executive dysfunction, slow gait, and depressive symptoms but not by cerebral microvascular disease on brain imaging.
Conclusions:
These results provide further support for the pathophysiologic and prognostic significance of microvascular disease in age-related disability. However, it remains to be determined how to best use retinal photography in clinical risk prediction.
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