Elsevier

Ophthalmology

Volume 120, Issue 1, January 2013, Pages 84-90
Ophthalmology

Original article
Retinal Vessel Caliber Is Associated with the 10-year Incidence of Glaucoma: The Blue Mountains Eye Study

https://doi.org/10.1016/j.ophtha.2012.07.007Get rights and content

Purpose

To examine associations between quantitatively measured retinal vessel caliber and the 10-year incidence of primary open-angle glaucoma (OAG).

Design

Population-based cohort study.

Participants

The Blue Mountains Eye Study examined 3654 persons at baseline and 2461 persons at either 5 years, 10 years, or both times. After excluding 44 subjects with OAG at baseline, 2417 participants at risk of OAG at the 5- or 10-year examinations were included.

Methods

Retinal vessel calibers of baseline retinal photographs were measured using a computer-based program and summarized as central retinal artery and vein equivalents (CRAE, CRVE). Incident OAG was defined as the development of typical glaucomatous visual field loss combined with matching optic disc rim thinning and an enlarged cup-to-disc (C:D) ratio of >0.7 or C:D asymmetry between the 2 eyes (≥0.3) at either the 5- or 10-year examination. Generalized estimating equation models were used to account for correlation between eyes while adjusting for glaucoma risk characteristics including intraocular pressure (IOP) or ocular perfusion pressure (OPP).

Main Outcome Measures

We assessed the 10-year incidence of OAG.

Results

There were 82 persons (104 eyes) who developed incident OAG over the 10-year follow-up. After adjusting for age, sex, family history of glaucoma, smoking, diabetes, hypertension, hypercholesterolemia, body mass index, spherical equivalent refraction, and C:D ratio, narrower CRAE was associated with higher risk of incident OAG (adjusted odds ratio [OR], 1.77; 95% confidence interval [CI], 1.12–2.79, per standard deviation decrease in CRAE). This association persisted after further adjustment for IOP (adjusted OR, 1.87; 95% CI, 1.14–3.05) or OPP (adjusted OR, 1.76; 95% CI, 1.11–2.78), and remained significant when analyses were confined to eyes with IOP <20 mmHg and C:D ratio <0.6 at baseline. There were no independent associations between CRVE and incident OAG.

Conclusions

Retinal arteriolar narrowing, quantitatively measured from retinal photographs, was associated with long-term risk of OAG. These data support the concept that early vascular changes are involved in the pathogenesis of OAG and suggest that computer-based measurements of retinal vessel caliber may be useful to identify people with an increased risk of developing the clinical stage of glaucoma.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Section snippets

Study Population

The BMES is a population-based cohort study of eye diseases and other health outcomes in an urban Australian population ≥49 years of age. Details of the BMES have been described elsewhere.1 Baseline participants (n = 3654) represented 82.4% of those eligible in 2 postcode areas of the Blue Mountains (New South Wales, Australia). This study was approved by the Western Sydney Area Health Service Human Research Ethics Committee; written, informed consent was obtained from all participants.

Of 3654

Results

There were 82 persons (104 eyes) who developed incident OAG by the 10-year follow-up; 23 persons developed OAG by the time of the 5-year follow-up examinations, and a further 59 persons developed OAG by the time of 10-year follow-up examination.

As shown in Table 2, persons who developed OAG over this period were older and had higher systolic and diastolic blood pressures or higher IOP at baseline; persons who developed OAG were also more likely to be female. The vertical C:D ratio at baseline

Discussion

It is well recognized that vascular risk factors have a potentially important role in the pathogenesis of OAG,3, 4 with many studies showing associations of glaucoma with hypertension, altered ocular hemodynamics (e.g., reduced blood flow), vasospasm, and systemic vascular diseases (e.g., migraine).3, 4 In this study, we showed that narrowed retinal arteriolar caliber, measured quantitatively from baseline photographs, is associated with a greater long-term risk of developing OAG in an older

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    Manuscript no. 2012-282.

    Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

    Supported by the Australian National Health & Medical Research Council, Project grants ID 974159, 211069, 457349, and the Centre for Clinical Research Excellence ID529923 – Translational Clinical Research in Major Eye Diseases; Centre for Eye Research Australia (CERA) receives Operational Infrastructure Support from the Victorian Government, Australia. This study was also supported by KAKENHI 22591960.

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