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Published on: December 19, 2019
Health screening program revealed risk factors associated with development and progression of papillomacular bundle
Sung Uk Baek1,2, Won June Lee3,4, Ki Ho Park5,6
1Department of Ophthalmology, Hallym University College of Medicine, Anyang, Korea.
Background/Aims:
The papillomacular bundle (PMB) area is an important anatomical site associated with central vision. As preventive medicine and health screening examinations are now becoming commonplace, the incidental detection of papillomacular bundle defect (PMBD) on fundus photography has been increasing. However, clinical significance of incidental PMBD has not been well documented to date. Thus, through long-term and longitudinal observation, we aimed to investigate the risk factors for the development and progression of PMBD and its predictive role associated with systemic diseases and glaucoma.
Methods:
This longitudinal study included subjects who had undergone standardized health screening. We retrospectively reviewed patients for whom PMBD had been detected in fundus photography and followed up for more than 5 years. For a comparative analysis, non-PMBD groups of age- and gender-matched healthy controls were selected.
Results:
A total of about 67,000 fundus photographs were analyzed for 8.0 years, and 587 PMBD eyes were found. Among them, 234 eyes of 234 patients who had had fundus photographs taken for more than 5 years were finally included. A total of 216 eyes (92.3%) did not progress during the 8.1 ± 2.7 years, whereas 18 eyes (7.7%) showed progression at 7.6 ± 2.9 years after initial detection. A multivariate logistic regression analysis using 224 non-PMBD healthy controls revealed low body mass index (BMI < 20 kg/m2), systemic hypertension, and sclerotic changes of retinal artery as the significant risk factors for the development of PMBD. Regarding PMBD progression, low BMI, concomitant retinal nerve fiber layer defect (RNFLD) at non-PMB sites, optic disc hemorrhage, and higher vertical cup/disc ratio were individual significant risk factors.
Conclusion:
PMBD is associated with ischemic effects. Although the majority of PMBD do not progress, some of cases are associated with glaucomatous damage in a long-term way. PMBD might be a personalized indicator representing ischemia-associated diseases and a predictive factor for diagnosis and preventive management of glaucoma.
Insights
Papillomacular bundle defects (PMBD) are linked to ischemia. While most PMBDs are stable, some progress and may indicate glaucoma risk, highlighting their role in predicting systemic and eye diseases.
Area of Science:
- Ophthalmology
- Medical Imaging
- Preventive Medicine
Background:
- The papillomacular bundle (PMB) area is crucial for central vision.
- Incidental detection of papillomacular bundle defects (PMBD) is increasing due to routine health screenings.
- The clinical significance and progression of incidental PMBD require further investigation.
Purpose of the Study:
- To investigate risk factors for the development and progression of PMBD.
- To assess the predictive role of PMBD in relation to systemic diseases and glaucoma.
- To understand the long-term clinical significance of incidentally detected PMBD.
Main Methods:
- Longitudinal study analyzing over 67,000 fundus photographs from health screenings.
- Retrospective review of patients with PMBD detected on fundus photography, followed for over 5 years.
- Comparison with age- and gender-matched healthy controls without PMBD.
Main Results:
- Of 234 included eyes with PMBD, 92.3% showed no progression over 8.1 years.
- Significant risk factors for PMBD development included low BMI, systemic hypertension, and retinal artery sclerosis.
- Risk factors for PMBD progression included low BMI, retinal nerve fiber layer defects, optic disc hemorrhage, and higher vertical cup/disc ratio.
Conclusions:
- PMBD is associated with ischemic effects and may indicate underlying systemic vascular issues.
- While most PMBDs are stable, a subset can progress and are linked to glaucomatous damage.
- PMBD serves as a potential indicator for ischemia-associated diseases and a predictive factor for glaucoma management.
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