Retinal Abnormalities Indicate Increased Stroke Risk: Presented at AAO

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Title: Retinal Abnormalities Indicate Increased Stroke Risk: Presented at AAO
URL: http://www.pslgroup.com/dg/2173D2.htm
Doctor's Guide
November 15, 2007

By Cameron Johnston

NEW ORLEANS, LA -- November 15, 2007 -- Patients who are at risk of a stroke often display ocular warning signs that could be detected in a general eye examination and could serve as a basis for counselling the patient about life-style modifications, according to study findings.

These signs should indicate to the examining eye doctor that the patient has other systemic health problems and that the patient may be a high-risk candidate for other serious medical events, said Wayne Cornblath, Neuro-Ophthalmologist, Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States.

Dr. Cornblath made this presentation at a late-breaking symposium on November 13 at the annual meeting of the American Academy of Ophthalmology (AAO).

"The eyes are a portal to the brain and can tell us a lot about patients who are at risk of a stroke, or other cerebrovascular events," he said.

In a study cited by Dr. Cornblath, approximately 10,000 American men and women (age range 51 - 72 years) underwent complete retinal photography and grading for retinal microvascular abnormalities and were then followed for an average of 3.5 years. During that followup time, 110 incident strokes were recorded. In the study, any form of micro aneurysm on the retina was associated with a 3.11 relative risk of stroke, even after adjustments were made for age, sex, race, and the presence or absence of diabetes or hypertension.

Blot haemorrhages and flame haemorrhages on the retina were associated with a 2.55 and 2.26 relative risk respectively, while "cotton wool spots" were associated with a three-fold increase in the risk of stroke. Arteriovenous nicking is associated with a 1.6 relative risk of stroke, Dr. Cornblath added.

While little can be done to rectify the microvascular abnormalities once they appear, there is much that can be done to reduce the patient's overall risk of stroke. These steps are the same as for other patients who are at risk of a cerebrovascular event. For example, the accepted definition of hypertension is blood pressure of 140/90 mm Hg. However, if an ophthalmologist detects any signs of retinal vascular abnormalities, immediate steps should be taken to reduce the patient's blood pressure, Dr. Cornblath said.

A 2003 consensus statement stated that a reduction in blood pressure of 10/5 mm Hg will lower the risk of stroke, regardless of the patient's baseline blood pressure.

Cholesterol reduction should be recommended for patients who exhibit any of these ocular abnormalities since that too will help lower the patient's risk of stroke, he added. "Lowering blood pressure and cholesterol, and the appropriate use of anti-platelet therapy can help reduce the patient's risk of cerebrovascular events," he said.

At the same time, Dr. Cornblath said, some common treatments should be avoided. For example, carotid stenting, which is becoming more popular for people with occluded carotid arteries, has been found to be 2.5 times more risky that carotid endarterectomy.

"I think that at this time, stents should only be used in the setting of a clinical trial," Dr. Cornblath told the audience. As an aside, he added that more than 70% of carotid endarterectomies are being performed on asymptomatic patients and, therefore, are doing nothing to prevent the patient from having a stroke, perhaps even placing the patient at higher risk of additional morbidities and death.

[Presentation title: Retinal Abnormalities Predict Significant Risk of Stroke. Late Breaker]

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