Valvular Heart Disease Associated With AMD Subset

The subretinal drusenoid deposit (SDD) form of age-related macular degeneration (AMD) is associated with valvular heart disease (VHD) and reduced systemic perfusion via cardiac index (CI), according to a study published in the European Journal of Ophthalmology. This information could support perfusion hypotheses of SDD pathogenesis.

AMD, which is the most common cause of legal blindness, features SDDs as a primary lesion associated with the disease. A previous study had found an association between SDDs and high risk vascular disease in patients with intermediate AMD (iAMD), but this study relied on self-reported data. This study used transthoracic echocardiograms (TTEs) to measure the health of the 4 major cardiac valves, to assess the theory that cardiac dysfunction and VHD are associated with SDDs with or without soft drusen.

Blue eye | Image credit: Liudmila Dutko - stock.adobe.com

The current study used a cross-sectional study as the basis of its post-hoc analysis, featuring 200 patients with iAMD from the Mount Sinai School of Medicine and Vitreous Retina Macula Consultants of New York, both in New York City. All data were collected between August 2019 and November 2021, with the COVID-19 pandemic prompting a break of 14 months. All patients were aged 51 to 100 years and had iAMD in at least 1 eye, and patients with bilateral advanced AMD or other retinal degenerations and retinal vascular diseases were excluded.

All participants had spectral domain optical coherence tomography (SD-OCT) images taken, which were all analyzed for SDDs. TTEs were collected from the electronic medical record of all patients. The most recent TTE was used if there were more than 1, and CI was calculated using the TTE when possible.

There were 65 patients with TTEs among the 200 in the cross-sectional study, with 38 classified in the SDD group and 27 classified in the non-SDD group. The mean (SD) ages of the participants were 79.78 (8.94) years in the SDD group and 81.26 (7.66) years in the non-SDD group.

Nineteen of the patients in the SDD group had a presence of any moderate severity of VHD compared with 4 patients in the non-SDD group, and SDDs were found in all patients with multivalvular VHD. Aortic regurgitation of moderate severity or higher and mitral regurgitation of moderate severity or higher were more frequent in patients with SDDs. The presence of aortic sclerosis (ASc) was found in 29 patients in the SDD group vs 12 in the non-SDD group; mitral annular calcification (MAC) was found in 19 patients in the SDD group vs 6 in the non-SDD group. This result showed a significant association between ASc, MAC, and SDD.

SDDs were associated with thinner choroids, with mean oculus uterque (OU) in the SDD group being 143.03 (49.14) μm vs the non-SDD group having a mean OU of 179.04 (70.29) μm. SDDs were also associated with a decreased CI, as patients in the non-SDD group had normal levels compared with the decreased levels of the SDD group.

There were some limitations to this study, including that it had 65 participants with only 48 tested for CI, which is a small sample size. Additionally, raw images for TTEs were not available for review by the cardiologist. Smoking within the previous 6 months and being a woman were more prevalent in the SDD group, with these factors more commonly associated with SDDs and VHDs. However, the univariate analysis found these factors to not be statistically significant.

"All together these findings imply that an ophthalmologist detecting SDDs on exam should prompt referral to a cardiologist standard work-up for vascular diseases," the researchers concluded. "Policy should embrace the power of such directed screenings for earlier detection of blinding and life-threatening disease in public health."

Reference

Fei Y, Jo JJ, Chen S, et al. Quantifying cardiac dysfunction and valvular heart disease associated with subretinal drusenoid deposits in age-related macular degeneration. Eur J Ophthalmol. Published online March 28, 2024. doi:10.1177/11206721241244413