Foveolar Choroidal Circulation and Choroidal Neovascularization in Age-Related Macular Degeneration

Metelitsina, T.I.; Grunwald, Juan E.; DuPont, Joan; Ying, Gui‐Shuang; Brucker, Alexander J.; Dunaief, Joshua L.

doi:10.1167/iovs.07-0526

Cited by 135 publications

(114 citation statements)

References 21 publications

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“…13 Systemic BP abnormalities may play a role in AMD by inducing choroidal perfusion abnormalities. Indeed, reduced choroidal blood flow has been reported in AMD, 55,56 and an association of low choroidal blood flow with history of hypertension was observed in AMD patients. 57 The main strength of our study is the population basedsample with the repeated assessment of BP, measured at four occasions over a 7-year period.…”

Section: Discussionmentioning

confidence: 96%

Long-Term Blood Pressure and Age-Related Macular Degeneration: The ALIENOR Study

Cougnard‐Grégoire

Delyfer

Korobelnik

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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PURPOSE.To explore the association of AMD with long-term average blood pressure (BP) parameters, including pulse pressure (PP). METHODS.The ALIENOR study is a population-based study on age-related eye diseases in 963 residents of Bordeaux, France, aged 73 years or older. AMD was graded from nonmydriatic color retinal photographs, in three exclusive stages: no AMD (1015 eyes), large soft distinct drusen and/or large soft indistinct drusen and/or reticular drusen and/or pigmentary abnormalities (early AMD, 276 eyes), and late AMD (66 eyes). BP parameters were measured at four occasions over a 7-year period. PP was defined as systolic BP minus diastolic BP. Associations of AMD with BP parameters were estimated using generalized estimating equation logistic regressions. Statistical analyses included 702 subjects (1357 eyes) with complete data. RESULTS.After adjustment for age, sex, educational level, smoking, body mass index, plasma HDL and LDL cholesterol, CFH Y402H, ApoE2, ApoE4, and ARMS2 A69S polymorphisms, elevated PP was significantly associated with an increased risk of late AMD (odds ratio [OR] ¼ 1.37 for a 10-mm Hg increase, 95% confidence interval [CI]: 1.03-1.82). Associations were similar for late atrophic and late neovascular AMD (OR ¼ 1.39, 95% CI: 1.01-1.92, P ¼ 0.04, and OR ¼ 1.43, 95% CI: 0.90-2.23, P ¼ 0.13, respectively). Association with early AMD was in the same direction but did not reach statistical significance (OR ¼ 1.12, 95% CI: 0.98-1.28). Early and late AMD were not significantly associated with systolic or diastolic BP, hypertension, or use of antihypertensive medications.CONCLUSIONS. This study suggests that high PP may be associated with increased risk for AMD. (Invest Ophthalmol Vis Sci. 2013;54:1905-1912) DOI:10.1167/iovs.12-10192 A ge-related macular degeneration (AMD) is the leading cause of visual impairment and blindness in the elderly in North America and other Western countries. 1 The resulting loss of vision is associated with significant limitations in activities of daily living, while life expectancy is still increasing. AMD is a multifactorial disease, resulting from both nonmodifiable factors (age, sex, genetic susceptibility) and modifiable factors (smoking, nutrition). The control of these modifiable factors may represent a preventive means to reduce its incidence. Among these factors, cardiovascular risk factors, including smoking, 3-9 abdominal obesity, 4,7,10,11 and blood pressure (BP), 12-18 have received much attention for their potential role in the development and progression of AMD. However, except for smoking, epidemiological studies have reported conflicting results, particularly for BP, as some studies [13][14][15][16][17][18] found associations between higher risk of AMD and elevated blood pressure, while others did not. 7,8,10,[19][20][21][22][23] Studies that explored the impact of BP on cardiovascular diseases have demonstrated that long-term average BP is a better determinant of risk for cardiovascular disease events, 24,25 as the effect of high BP seems...

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Section: Discussionmentioning

confidence: 96%

Long-Term Blood Pressure and Age-Related Macular Degeneration: The ALIENOR Study

Cougnard‐Grégoire

Delyfer

Korobelnik

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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“…According to the World Health Organization, diabetes prevalence has quadrupled since 1980, and 422 million adults are now living with some form of diabetes, and even this number is projected to rise rapidly [1, 2]. As per the Liverpool declaration, many European countries have implemented systematic screening programs for diabetic retinopathy (DR) to minimize the risk of visual impairment [3]. The fact that DR no longer represents the leading cause in blindness among working-age adults in the UK confirms the importance of timely detection and treatment of the disease [4].…”

Section: Introductionmentioning

confidence: 99%

Automated Screening for Diabetic Retinopathy – A Systematic Review

Nørgaard

Grauslund

2018

Ophthalmic Res

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Purpose: Worldwide ophthalmologists are challenged by the rapid rise in the prevalence of diabetes. Diabetic retinopathy (DR) is the most common complication in diabetes, and possible consequences range from mild visual impairment to blindness. Repetitive screening for DR is cost-effective, but it is also a costly and strenuous affair. Several studies have examined the application of automated image analysis to solve this problem. Large populations are needed to assess the efficacy of such programs, and a standardized and rigorous methodology is important to give an indication of system performance in actual clinical settings. Methods: In a systematic review, we aimed to identify studies with methodology and design that are similar or replicate actual screening scenarios. A total of 1,231 publications were identified through PubMed, Cochrane Library, and Embase searches. Three manual search strategies were carried out to identify publications missed in the primary search. Four levels of screening identified 7 studies applicable for inclusion. Results: Seven studies were included. The detection of DR had high sensitivities (87.0–95.2%) but lower specificities (49.6–68.8%). False-negative results were related to mild DR with a low risk of progression within 1 year. Several studies reported missed cases of diabetic macular edema. A meta-analysis was not conducted as studies were not suitable for direct comparison or statistical analysis. Conclusion: The study demonstrates that despite limited specificity, automated retinal image analysis may potentially be valuable in different DR screening scenarios with a relatively high sensitivity and a substantial workload reduction.

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“…[1][2][3] Thinning of the choroid, decreased choroid blood vessel density, and reduced choroid blood circulation precede the pathogenesis of both early and late stages of AMD. [3][4][5][6] It is intriguing to consider the possible role of choriocapillaris degradation in drusen formation between the Bruch's membrane and the retinal pigment epithelium and chronic inflammation with activated macrophages found in the choroid from patients with AMD. 7,8 It has also been suggested that proinflammatory and angiogenic cytokines released from activated macrophages/monocytes in the choroid contribute to progression to the more severe neovascular stage of AMD.…”

mentioning

confidence: 99%

Connexin43 Mimetic Peptide Improves Retinal Function and Reduces Inflammation in a Light-Damaged Albino Rat Model

Guo

Nor

Danesh‐Meyer

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. Drugs that regulate connexin43 (Cx43) gap junction channels can reduce the spread of injury and improve functional outcomes after nervous system trauma. In the eye, Cx43 expression increases in the choroid following light damage. The aim of this study was to investigate whether Cx43 hemichannel block could preserve retinal function postinjury. RESULTS. Light-damaged rat eyes had (1) reduced neuronal responses in both the rod and cone pathways and (2) marked inflammatory responses in the choroid and retina. Peptide5 significantly preserved function of photoreceptoral and postphotoreceptoral neurons in these animals. This was evident 24 hours after injury and 2 weeks later, as shown by improved mixed a-wave and mixed b-wave amplitudes, isolated rod PII and PIII amplitudes, and cone PII responses when compared with sham-treated controls. Retinal thinning and inflammation were also significantly reduced in Peptide5-treated eyes when compared with sham-treated controls.CONCLUSIONS. Blocking Cx43 hemichannels after light damage can significantly improve functional outcomes of neurons in both the rod and cone photo-transduction pathways in the light-damaged animal model, likely by reducing choroid inflammation and suppressing the glial-mediated inflammatory response. These data may have relevance for the treatment of conditions such as diabetic retinopathy and age-related macular degeneration.

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Foveolar Choroidal Circulation and Choroidal Neovascularization in Age-Related Macular Degeneration

Abstract: The development of CNV and visual loss are associated with lower choroidal circulatory parameters at baseline. In addition, the results suggest that decreases in the foveolar choroidal circulation precede the development of CNV in AMD and may play some role in its development.

Cited by 135 publications

References 21 publications

Long-Term Blood Pressure and Age-Related Macular Degeneration: The ALIENOR Study

Long-Term Blood Pressure and Age-Related Macular Degeneration: The ALIENOR Study

Automated Screening for Diabetic Retinopathy – A Systematic Review

Connexin43 Mimetic Peptide Improves Retinal Function and Reduces Inflammation in a Light-Damaged Albino Rat Model

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