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Retinal microvascular changes and MRI signs of cerebral atrophy in healthy, middle-aged people

From the Singapore National Eye Center and National University of Singapore (Dr. Wong); Department of Ophthalmology, University of Melbourne (Dr. Wong); Department of Ophthalmology (Drs. Wong, R. Klein, and B.E.K. Klein, and L.D. Hubbard), University of Wisconsin, Madison; Department of Medicine (Dr. Mosley), University of Mississippi Medical Center, Jackson; Department of Epidemiology (Dr. Sharrett), Johns Hopkins University, Baltimore, MD; and Department of Biostatistics (Dr. Couper), University of North Carolina, Chapel Hill.

Address correspondence and reprint requests to Dr. T.Y. Wong, Department of Ophthalmology, Centre for Eye Research Australia, University of Melbourne, 32 Gisborne Street, East Melbourne 3002, Australia; e-mail: ophwty{at}nus.edu.sg

Objective: To examine the relation of retinal microvascular abnormalities and MRI signs of cerebral atrophy in healthy middle-aged people.

Methods: A population-based, cross-sectional study involved 1,684 persons aged 51 to 72 years who had cerebral MRI and retinal photography in 1993 to 1995. Sulcal and ventricular size were quantified from the MRI scans and coded as grades 0 to 9, with sulcal widening (SW) and ventricular enlargement (VE) defined as grades 3 or higher. The presence or absence of retinopathy, microaneurysms, hemorrhages, and other characteristics were defined from retinal photographs using a standardized protocol. Generalized arteriolar narrowing was defined from a computer-assisted measurement of arteriolar diameters from digitized photographs.

Results: Persons with retinopathy had higher sulcal (p = 0.001) and ventricular (p = 0.03) grades than persons without retinopathy. After adjusting for age, gender, race, mean arterial blood pressure, diabetes, cigarette smoking, common carotid artery intima–media thickness, and other vascular risk factors, retinopathy was significantly associated with SW (odds ratio [OR], 1.9; 95% CI, 1.2, 3.0) and VE (OR, 1.5; 95% CI, 1.0, 2.3). These associations persisted even in people without diabetes or hypertension (OR 1.9, 95% CI, 0.8, 4.4 for SW; OR 2.7, 95% CI, 1.2, 6.5 for VE). Other retinal arteriolar characteristics (arteriovenous nicking, focal and generalized arteriolar narrowing) were not related to sulcal or ventricular grade.

Conclusions: In healthy, middle-aged people, retinopathy is independently associated with sulcal and ventricular enlargement on MRI. This finding is compatible with the hypothesis that microvascular characteristics may influence the development of cerebral atrophic changes.

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