Alterations in peripapillary neurovascular structures in patients with intermittent claudication

Peripapillary retina nerve fibre layer (RNFL) alterations in patients with peripheral artery disease (PAD) are hypothesised to share a pathway with the general pathophysiology of atherosclerosis. Depending on the severity of ischaemia in their extremities, these patients may be asymptomatic or have intermittent claudication.

This study aimed to evaluate structural and vascular alterations in the peripapillary region of asymptomatic patients with PAD and those with intermittent claudication.

An observational cross-sectional study was conducted involving 68 patients with PAD who visited the cardiovascular surgery outpatient clinic and 40 age- and sex-matched healthy controls. One eye per participant was examined. Peripapillary RNFL thickness, radial peripapillary capillary density, and ankle-brachial index were assessed. Participants were categorised based on the Rutherford classification, with higher categories indicating more severe ischaemia: asymptomatic (Rutherford 0) in one group and mild to severe claudication (Rutherford 1-3) in another.

Average radial peripapillary capillary density was significantly reduced in patients with PAD and intermittent claudication compared to controls (p < 0.001), whereas no significant difference was found between asymptomatic patients and controls. Patients with PAD exhibited significantly lower peripapillary RNFL thickness in the inferonasal, nasal inferior, and nasal superior quadrants than the controls (p < 0.05), although average RNFL thickness was not associated with the Rutherford classification. Ankle-brachial index showed a weak positive association with average radial peripapillary capillary density in patients with PAD (R = 0.325, p = 0.007).

Decreased peripapillary vessel density was associated with a lower ankle-brachial index. Patients with PAD and intermittent claudication showed lower peripapillary vessel density than controls. These findings suggest that peripapillary microvascular impairments, likely linked to atherosclerosis, are more pronounced in patients with ischaemic limbs.