Cardiovascular Disease and Age-Related Macular Degeneration

To provide an update on the published associations between cardiovascular disease (CVD) and age-related macular degeneration (AMD).

Evidence-based perspective.

Review of literature and experience of authors.

CVD is the leading cause of death worldwide, and AMD is the leading cause of irreversible blindness among the elderly. Both these conditions are associated with hypertension and smoking. Thus, it was expected that patients with CVD might be at higher risk for AMD, and AMD would be closely associated with CVD. However, such a general association has never been shown in dozens of studies. Instead, current evidence suggests that there are associations only between certain subsets of CVD and AMD. A strong association was shown to exist between specific high-risk cardiovascular diseases (HRCVDs) that confer compromised choroidal perfusion and the presence of subretinal drusenoid deposit (SDD), not ordinary soft drusen, which are considered the hallmark of intermediate AMD. We propose that this compromised choroidal perfusion is the underlying mechanism driving the formation of SDDs. We also propose, more generally, that the formation of SDDs result from the disruption of the normal metabolic support between the choriocapillaris and photoreceptors (PRs). We recommend that HRCVDs need to be studied in association with genetic risk-alleles to better understand the association between decreased choroidal perfusion and AMD progression.

The strong association between SDDs to HRCVDs merits further investigation, especially in cardiovascular patients with SDDs carrying the high-risk alleles for AMD. Further prospective studies in both HRCVD and AMD patients are needed to elucidate the totality of clinical and genetic factors that drive AMD. These disease models can then be deployed to identify vasculopathic patients who need a retinal referral for AMD as well as AMD patients who need a cardiovascular workup to address undetected HRCVDs in patients with SDDs.