“For the first time, we have been able to connect these specific high-risk cardiovascular diseases to a specific form of AMD, the one with subretinal drusenoid deposits (SDDs),” explains lead author R. Theodore Smith, MD, Ph.D., Professor of Ophthalmology at Mount Sinai, in a media release.
SDDs consist of fatty lipids that form beneath light-sensitive retina cells at the back of the eye, which can lead to vision loss, and detection can be difficult as it requires high-tech imaging scans.
“This study is the first strong link between the leading cause of blindness, AMD, and heart disease, the leading cause of death worldwide. Furthermore, we also have strong evidence for what actually happens: the blood supply to the eye is directly diminished by these diseases, either by heart damage that diminishes blood supply throughout the body, or from a blocked carotid artery that directly impedes blood flow to the eye,” Prof. Smith continues.
Heart disease can cause poor circulation and vision loss can occur due to poor circulation. As such, vision loss can be a warning sign or manifestation of an underlying vascular condition that has important public health implications, starting new paths to wide-scale screening that starts with the eyes.
“A poor blood supply can cause damage to any part of the body, and with these specific diseases, the destroyed retina and leftover SDDs are that damage. Retinal damage means vision loss, and can lead to blindness,” Smith adds.
Nearly 20 million Americans have some form of AMD, and cardiovascular disease is the number one killer around the globe. Age-related macular degeneration is the leading cause of blindness in those aged 65+. AMD arises from damage to the macula which is the central area of the retina responsible for driving vision and reading. Subretinal drusenoid deposits contain cholesterol and form in the retinal pigment epithelium (RPE), which there currently is no treatment for. Those with severe cardiovascular diseases and stroke have been found to be 9 times more likely to have SSDs.
“This work demonstrates the fact that ophthalmologists may be the first physicians to detect systemic disease, especially in asymptomatic patients,” says co-investigator Richard Rosen, MD, Chief of the Retina Service for the Mount Sinai Health System. “Detecting SDDs in the retina should trigger a referral to the individual’s primary care provider, especially if no previous cardiologist has been involved. It could prevent a life-threatening cardiac event.”
“This study has opened the door to further productive multidisciplinary collaboration between the Ophthalmology, Cardiology, and Neurology services,” says Jagat Narula, MD, Ph.D., Director of the Cardiovascular Imaging Program at the Zena and Michael A. Wiener Cardiovascular Institute at the Icahn School of Medicine at Mount Sinai.
“We should also focus on defining the disease severity by vascular imaging in cardiology and neurology clinics, and assess their impact on AMD and SDDs with retinal imaging. In this way, we can learn which vascular patients should be referred for detection and prevention of blinding disease.”
