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. 2012 Mar;130(3):350-6.
doi: 10.1001/archophthalmol.2011.360. Epub 2011 Nov 14.

Retinal microvascular signs and disability in the Cardiovascular Health Study

Dae Hyun Kim  1 , Paulo H M Chaves, Anne B Newman, Ronald Klein, Mark J Sarnak, Elizabeth Newton, Elsa S Strotmeyer, Gregory L Burke, Lewis A Lipsitz
Affiliations

Retinal microvascular signs and disability in the Cardiovascular Health Study

Dae Hyun Kim et al. Arch Ophthalmol. 2012 Mar.

Abstract

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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Figures

Figure 1
Figure 1
Kaplan-Meier Curve of Activity of Daily Living Disability-Free Survival By the Number of Retinal Signs
See this image and copyright information in PMC

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