A new study from New York Eye and Ear Infirmary of Mount Sinai demonstrates that patients with a specific form of age-related macular degeneration (AMD) may have either underlying heart damage from heart failure and heart attacks, or advanced heart valve disease, or carotid artery disease associated with certain types of strokes.
The findings, “Subretinal drusenoid deposits are strongly associated with coexistent high-risk vascular disease,” published in the journal BMJ Open Ophthalmology, are the first to identify which types of high-risk cardiovascular and carotid artery disease are linked to the eye disorder. The new study could prompt increased screening to save vision, diagnose undetected heart disease, and prevent adverse cardiovascular events.
“For the first time, we have been able to connect these specific high-risk cardiovascular diseases to a specific form of AMD, the one with subretinal drusenoid deposits (SDDs),” explained lead author R. Theodore Smith, MD, PhD, professor of ophthalmology at the Icahn School of Medicine at Mount Sinai.
“This study is the first strong link between the leading cause of blindness, AMD, and heart disease, the leading cause of death worldwide. Furthermore, we also have strong evidence for what actually happens: the blood supply to the eye is directly diminished by these diseases, either by heart damage that diminishes blood supply throughout the body, or from a blocked carotid artery that directly impedes blood flow to the eye. A poor blood supply can cause damage to any part of the body, and with these specific diseases, the destroyed retina and leftover SDDs are that damage. Retinal damage means vision loss, and can lead to blindness.”
Researchers analyzed the eyes of 200 AMD patients with retinal imaging to determine which patients had SDDs. Patients answered a questionnaire about their history of cardiovascular disease. Of the 200 patients, 97 had SDDs and 103 had drusen only. Forty-seven of the 200 had severe heart disease. Forty of the 47 had SDDs.
By contrast, of the 153 AMD patients who did not have these severe diseases, 57 had SDDs (43%). The researchers concluded that AMD patients with these severe cardiovascular diseases and stroke were nine times more likely to have SDDs than those without them.
“This work demonstrates the fact that ophthalmologists may be the first physicians to detect systemic disease, especially in asymptomatic patients,” said co-investigator Richard B. Rosen, MD, chief of the retina service for the Mount Sinai Health System. “Detecting SDDs in the retina should trigger a referral to the individual’s primary care provider, especially if no previous cardiologist has been involved. It could prevent a life-threatening cardiac event.”
“This study has opened the door to further productive multidisciplinary collaboration between the ophthalmology, cardiology, and neurology services,” said Jagat Narula, MD, PhD, director of the cardiovascular imaging program at the Zena and Michael A. Wiener Cardiovascular Institute at the Icahn School of Medicine at Mount Sinai. “We should also focus on defining the disease severity by vascular imaging in cardiology and neurology clinics, and assess their impact on AMD and SDDs with retinal imaging. In this way, we can learn which vascular patients should be referred for detection and prevention of blinding disease.”