Cross-sectional Associations of Medication and Supplement Use With Retinal Vascular Diameter in the Beaver Dam Eye Study

Abstract

IMPORTANCE Retinal vessel diameters are being measured to examine their relationship with ocular and systemic disease and, in some studies, to calculate the risk of disease. Important factors that directly affect retinal vessel diameters, such as medication use, should be considered when estimating these associations.OBJECTIVE To quantify the association between selected medications and supplements and retinal vessel diameters. DESIGN, SETTING, AND PARTICIPANTS In a prospective cohort investigation, 4926 participants (aged 43-86 years at baseline) in the Beaver Dam Eye Study were evaluated every 5 years during 20 years of follow-up from 1988 to 2010. MAIN OUTCOMES AND MEASURES Central retinal arteriolar equivalent and central retinal venular equivalent measured from the Early Treatment Diabetic Retinopathy Study fundus photograph field 1.RESULTS After Bonferroni correction, the use of any blood pressure medication (β = 0.75; P = .04), specifically calcium channel blockers (β = −1.02; P < .001), was significantly associated with wider central retinal arteriolar equivalent adjusting for refraction, photograph focus, age, systolic blood pressure, height, examination phase, educational level, smoking and drinking histories, and presence of diabetes mellitus and emphysema. Use of prostaglandin analogues was marginally associated with narrower central retinal arteriolar equivalent (β = −2.04; P = .09); β-blockers (β = −1.02; P = .10) and oral corticosteroids (β = 2.13; P = .07) were marginally associated with changes in the central retinal venular equivalent.CONCLUSIONS AND RELEVANCE Several medications are associated with central retinal arteriolar and venular equivalents. Prostaglandin analogues, calcium channel blockers, and oral corticosteroids have the largest relative effects. After Bonferroni correction was applied, the use of calcium channel blockers was most strongly associated with change in the central retinal arteriolar equivalent. The presence of factors that are associated with retinal vessel diameters should be considered when using retinal vessel diameter as an outcome or when using these measures to assess the risk of systemic or ocular disease.

Review of the association between retinal microvascular characteristics and eye disease

“…Similarly, arteriolar dilation has been demonstrated in persons treated with statins (hydroxymethylglutaryl‐CoA reductase inhibitors) . These observations are consistent with data from the BMES where anti‐hypertensive use, particularly calcium channel blockers were associated with wider arterioles . The use of angiotensin‐converting enzyme inhibitors, thiazide diuretics and lipid‐lowering therapies has also demonstrated cross‐sectional associations with wider arterioles .…”

“…They found that the association between arteriolar narrowing and POAG was similar whether or not the subject was receiving treatment. Analysis of the BDES cohort showed that topical ocular hypotensives, particularly beta‐blockers and prostaglandin analogues were associated with narrowed arterioles and venules even though this population did not show link between glaucoma and narrowed vascular calibre . In clinic‐based studies, consistent effects of glaucoma therapy on vessel width have not been demonstrated.…”

“…Topical latanoprost has been shown to induce retinal arteriolar narrowing in a small cohort of 22 persons with type 1 diabetes; however, this did not correlate with a reduction in central retinal thickness with the authors advocating for further prospective study to assess whether this arterial constriction will translate into better outcomes in retinal hyperperfusion disease states . The effect of oral hypoglycaemics on the retinal microvasculature has been infrequently investigated and remains unreported in population‐based studies . Oral vildagliptin when used in addition to metformin in those with type 2 diabetes resulted in a reduction in arteriolar wall‐to‐lumen ratio after 6 months of therapy in a clinic‐based cohort …”

Diagnostic Ability of Retinal Vessel Diameter Measurements in Open-Angle Glaucoma

“…In addition, the combined use of aspirin and antihypertensive agents was found to be related to wider retinal arteriolar diameter by the Blue Mountains Eye Study. 56 Howard et al 57 also found an effect of systemic medications on RVD. Because most of the subjects with systemic hypertension had been on medications in this study, it could have affected our results.…”

Cup-to-disc and arteriole-to-venule ratios in preterm birth

“…On the other hand, all subjects in the control group had no history of cardiac or pulmonary disorders that might have affected vascular diameter. Among some medications including calcium channel blockers, prostaglandin analogs, β-blockers, and oral corticosteroids, which might have influenced vascular diameter, 18 beraprost sodium, a prostaglandin analog, was taken by one patient in the preterm group. In the control group, no one had a history of any drug associated with vessel width.…”