The eye-ground examination as a possible method for cardiovascular risk assessment
Keywords:
cardiovascular risk, eye fundus, retinal changes, general practitioner’s office, direct ophthalmoscopyAbstract
Background: The aim of this research was to find out, whether arteriolar changes, found during an eye examination, predict high risk of a cardiovascular event, independently from the cardiovascular risk factors using the coronary risk tables.
Methods: The cross-sectional study involved 100 patients: 50 consecutive patients with arterial hypertension and 50 consecutive attenders without arterial hypertension. Excluding criteria were: age younger than 40 and older than 70, diabetes, cataract or usage of eye-drops for lowering high ocular pressure. Retinal examination was performed using the method of direct ophthalmoscopy at dilated pupil. The considered retinal changes were: generalized arteriolar narrowing, focal arteriolar narrowing, arteriovenous nicking and widened light reflex, but we were also looking for the presence of retinopathy (hemorrhages, exudates, optic disc swelling). The cardiovascular risk was calculated using tables of coronary risk. A risk of 20% or more in the next 10 years was considered as high risk for a cardiovascular event.
Results: The mean age of participants was 53.5 years (SD 7.6 years). 17 (17%) participants had high coronary risk (i.e. equal or higher than 20%, according to the tables of coronary risk). Retinal changes were present in 54 (54%) participants, and were more common in the group of hypertensive patients (p = 0.001). In the univariate analysis all four types of microvascular changes were associated with at least 20% coronary risk, but in multivariate analysis two types of retinal changes, arteriovenous nicking (OR = 9.136, 95% CI from 1.696 to 49.216) and focal arteriolar narrowing (OR = 5.885, 95% CI from 1.204 to 28.758), were associated with high cardiovascular risk.
Conclusions: Microvascular changes are common among middle aged people attending general practice. The presence of any retinal changes, but especially focal arteriolar narrowing and arteriovenous nicking, predicts high cardiovascular risk. If these results are ever confirmed on a larger sample, the eye-ground examination could be an additional method of cardiovascular risk assessment in a general practitioner’s office.
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