Worsening Retinopathy Associated with Greater Incidence of Cardiovascular Disease

By Kristen Mulvihill

Scheie Vision Summer 2021

A recent study led by Juan E. Grunwald, MD, Professor of Ophthalmology, found that progression of retinopathy is strongly associated with a higher incidence of cardiovascular disease events in patients with chronic kidney disease. This finding suggests that patients with worsening retinopathy should be assessed for cardiovascular disease.

Retinopathy is a disease that damages the retina and can cause vision loss. There are many different types and severities of retinopathy, including diabetic retinopathy, hypertensive retinopathy, and retinopathy of prematurity. Cardiovascular disease (CVD), also referred to as heart disease, is a class of conditions involving the heart or blood vessels. Chronic kidney disease (CKD), which leads to renal failure, is often linked to higher rates of both retinopathy and CVD.

The study, published in the British Journal of Ophthalmology in February 2021, detailed findings from the Chronic Renal Insufficiency Cohort (CRIC) study. The research team, led by Dr. Grunwald, previously reported results from the Retinopathy in Chronic Renal Insufficiency (RCRIC) study, demonstrating a cross-sectional association between retinopathy and CVD in a group of participants with CKD.

In the CRIC prospective study, trained personnel obtained fundus photographs from both eyes of participants at two timepoints, separated by three and a half years. Graders and a retinal specialist assessed these photographs at a retinal image reading center for the presence and severity of any cause of retinopathy, as well as the diameters of major retinal vessels. Researchers then investigated the association between progression of retinopathy and concurrent incidence of CVD events, including heart failure, stroke, and peripheral artery disease.

The team discovered a strong correlation between worsening retinopathy and the simultaneous development of CVD. This association remained significant even after adjusting for established CVD and CKD risk factors—such as age, sex, smoking, etc.—suggesting that progression of retinopathy offers additional insight on CVD development beyond that provided by known risk factors. In addition, these results suggest that there may be common mechanisms that cause progression of eye and cardiovascular disease.

Since the progression of retinopathy is strongly associated with the prevalence of CVD, the study suggests that patients with worsening retinopathy should be assessed for CVD.

“Our results suggest that patients with kidney pathology should have their eyes examined and those who show progression of retinopathy should be carefully monitored for worsening of their cardiovascular disease,” said Dr. Grunwald.