The relation of retinal microvascular characteristics to age-related eye disease: the Beaver Dam eye study

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Abstract

Purpose

To examine the relationship between microvascular characteristics (central retinal artery equivalent [CRAE], central retinal vein equivalent [CRVE], arteriole-to-venule ratio [AVR], focal retinal arteriolar narrowing, arteriovenous [A/V] nicking, and retinopathy) associated with systemic hypertension and ocular disease (age-related maculopathy [ARM], three types of cataract, and open-angle glaucoma).

Design

Population-based cohort study.

Methods

Standardized grading of microvascular characteristics was performed at baseline on fundus photographs taken on 4,926 persons aged 43 to 86 years who participated in the Beaver Dam Eye study at the baseline examination. Age-related maculopathy, cataract, and glaucoma status were determined at baseline; ARM and cataract were again determined at 5-year and 10-year follow-up examinations using standard protocols.

Results

While controlling for age and sex, generalized retinal arteriolar narrowing (lowest quintile of CRAE) was associated with the 10-year cumulative incidence of retinal pigment epithelial (RPE) depigmentation (risk ratio [RR] 1st vs 5th quintile, 1.93; 95% confidence interval [CI], 1.11, 3.34) and, inversely, with incident nuclear cataract (RR, 0.71; 95% CI, 0.50, 0.99). Arteriovenous nicking was associated with the incidence of early ARM (RR, 2.39; 95% CI, 1.02, 5.57). Otherwise, there were no statistically significant associations of focal arteriolar narrowing or retinopathy with incident ARM or any type of age-related cataract and no relation of CRAE, focal arteriolar narrowing, A/V nicking, or retinopathy with the prevalence of glaucoma.

Conclusion

These data show that retinal vascular characteristics associated with hypertension are related to the incidence of ARM and nuclear cataract but not to prevalent glaucoma. Relationships, however, were weak and inconsistent.

Section snippets

Population

Methods used to identify and describe the population have appeared in previous reports.10, 11, 12, 13, 14 All data were collected with institutional review board approval in conformity with all country, federal, and state laws, and the study is in adherence with the tenets of the Declaration of Helsinki. In brief, a private census of the population of Beaver Dam, Wisconsin, was performed from September 15, 1987, to May 4, 1988, to identify all residents in the city or township of Beaver Dam who

Characteristics of the cohort

Characteristics of the cohort at baseline are presented in Table 1. The mean age was 62.0 years, the mean arterial blood pressure was 95.6 mm Hg, 970 (19.7%) of the cohort were current smokers, and 117 (2.4%) were heavy drinkers at baseline. Arteriovenous nicking was present in 68 (1.4%) and focal retinal arteriolar narrowing in 492 (10.2%) of the whole cohort. Retinopathy was present in 342 (7.8%) of those without diabetes. Early ARM was present in 890 (18.9%) and late ARM in 79 (1.7%).

Discussion

The data reported herein are unique in describing information regarding the associations of retinal microvascular disease (generalized and focal retinal arteriolar narrowing, venular dilation, and A/V nicking and retinopathy) and their associations with three age-related ocular diseases (ARM, cataract, and glaucoma) in a population-based cohort. A new computer-assisted grading technique based on measurements of individual retinal arteriolar and venular diameters from digitized photographs was

Supplementary files

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    The study was supported by National Institutes of Health (Bethesda, MD) Grant No. EY06594 (R. Klein, BEK Klein) and, in part, by Research to Prevent Blindness (R. Klein, Senior Scientific Investigator Award), New York, NY.

    Biosketches and/or additional material at www.ajo.com

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