Prevalence of Ocular Fundus Pathology in Patients with Chronic Kidney Disease

Abstract

Background and objectives: The objective of this study was to describe the prevalence of ocular fundus pathology in the Chronic Renal Insufficiency Cohort (CRIC) study, a multicenter, longitudinal study of individuals with varying stages of chronic kidney disease (CKD).Design, setting, participants, & measurements: In this cross-sectional study, 45°digital photos of the disc and macula in both eyes were obtained by nonophthalmologic personnel using a nonmydriatic Canon CR-DGI fundus camera in 1936 individuals who participated in the CRIC study. Photographs were assessed in a masked manner by graders and a retinal specialist at a central photograph reading center. The purpose of this review was to inform participants quickly of conditions that warranted a complete eye examination by an ophthalmologist.Results: Among the 1936 participants who were photographed, 1904 (98%) had assessable photographs in at least one eye. Eye pathologies that required a follow-up examination by an ophthalmologist were identified in 864 (45%) of these 1904 participants. These eye pathologies included, among others, retinopathy (diabetic and/or hypertensive), a finding that was observed in 482 (25%) of these 1904 participants. Three percent (65 participants) of the 1904 participants had serious eye conditions that required urgent follow-up and treatment. Lower estimated GFR and cardiovascular disease were associated with greater eye pathology. Estimated GFR <30 ml/min per 1.73 m 2 was associated with a three times higher risk for retinopathy.Conclusions: We found a high prevalence of fundus pathology in participants with CKD. This finding supports recommendations for regular complete eye examinations in the CKD population.

Retinopathy and Progression of CKD

“…respectively. This eGFR slope is somewhat lower than the slope in the CRIC study because participants that had eye photographs were healthier than CRIC participants that did not get photographs (3).…”

“…CKD is associated with substantial morbidity (1), including eye disease (2,3). We previously reported a strong independent, cross-sectional association between the severity of retinopathy and the level of kidney dysfunction (4).…”

Ocular findings in the chronic renal failure

“…Several patients from the study received urgent laser treatment in the retina. [41][42][43] Nine cases underwent successful cataract surgery.…”

Tear function in patients with chronic renal failure undergoing hemodialysis

“…Eye findings associated with chronic renal disease include conjunctival erythema, metastatic calcification on the ocular surface, conjunctival degenerations such as pinguecula, dry eye, band keratopathy, corneal endothelial impairments, uremic optic neuropathy, pseudotumor cerebri, uremic amaurosis, age-related macular degeneration (AMD) and cataracts. [1][2][3][4][5][6][7][8][9][10][11] Dry eye is a multifactorial disease of the ocular surface. It results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface.…”