Cheung Ning, Teo Kelvin, Zhao Wanting, Wang Jie Jin, Neelam Kumari, Tan Nicholas Y Q, Mitchell Paul, Cheng Ching-Yu, Wong Tien Yin
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, National University of Singapore, Singapore.
JAMA Ophthalmol. 2017 Oct 1;135(10):1023-1028. doi: 10.1001/jamaophthalmol.2017.2972.
To our knowledge, population-based data on retinal emboli are limited in Asia. Besides its associations with traditional cardiovascular risk factors and stroke, associations between retinal emboli and renal disease and function remain unclear.
To examine the prevalence of and risk factors for retinal emboli in a large, contemporary, multiethnic Asian population.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study was conducted from 2004 to 2011 and included a total of 10 033 Chinese, Malay, and Indian persons aged 40 to 80 years residing in the general communities of Singapore. Analyses were performed from November 2016 to February 2017.
Retinal emboli were ascertained from retinal photographs obtained from both eyes of all participants according to a standardized protocol. Age-standardized prevalence of retinal emboli was calculated using the 2010 Singapore adult population. Risk factors were assessed from comprehensive systemic and ophthalmic examinations, interviews, and laboratory investigations.
Retinal emboli.
Of the 10 033 participants, 9978 (99.5%) had gradable retinal photographs. Of these, 5057 (50.7%) were female, and 3375 (33.8%) were Indian. We identified 88 individuals (0.9%) with retinal emboli; the overall person-specific, age-standardized prevalence of retinal emboli was 0.75% (95% CI, 0.60-0.95), with the highest prevalence seen in the Indian cohort (0.98%), followed by the Chinese (0.73%) and Malay (0.44%) cohorts (P = .03). In multivariable-adjusted analysis, factors associated with prevalent retinal emboli included older age (per 5-year increase; odds ratio [OR], 1.22; 95% CI, 1.05-1.41), Indian ethnicity (compared with Malay ethnicity; OR, 3.58; 95% CI, 1.95-6.60), hypertension (OR, 1.95; 95% CI, 1.03-3.70), chronic kidney disease (OR, 2.05; 95% CI, 1.15-3.64), creatinine level (per SD increase; OR, 1.13; 95% CI, 1.05-1.21), glomerular filtration rate (per SD increase; OR, 0.67; 95% CI, 0.51-0.86), and history of stroke (OR, 3.45; 95% CI, 1.70-6.99).
Based on 88 individuals among 9978 participants of 3 major Asian ethnic populations, retinal emboli were most commonly seen in Indian persons and associated with conventional cardiovascular risk factors, stroke, and chronic kidney disease. Therefore, its presence may signal vascular embolic event and damage not only in the brain but also in the kidneys. If these data are confirmed in longitudinal studies, they would suggest that persons with retinal emboli may require both general cardiovascular and renal assessment.
据我们所知，亚洲地区基于人群的视网膜栓子数据有限。除了与传统心血管危险因素和中风有关外，视网膜栓子与肾脏疾病及功能之间的关联仍不明确。
在一个大型、当代、多民族的亚洲人群中，研究视网膜栓子的患病率及其危险因素。
设计、地点和参与者：这项基于人群的横断面研究于2004年至2011年进行，共纳入了10033名年龄在40至80岁之间、居住在新加坡普通社区的华人、马来人和印度人。分析于2016年11月至2017年2月进行。
根据标准化方案，从所有参与者双眼拍摄的视网膜照片中确定视网膜栓子。使用2010年新加坡成年人口数据计算视网膜栓子的年龄标准化患病率。通过全面的全身和眼科检查、访谈及实验室检查评估危险因素。
视网膜栓子。
在10033名参与者中，9978人（99.5%）有可分级的视网膜照片。其中，5057人（50.7%）为女性；3375人（33.8%）为印度人。我们识别出88例视网膜栓子个体（0.9%）；总体个体特异性、年龄标准化视网膜栓子患病率为0.75%（95%CI，0.60 - 0.95），印度人群体患病率最高（0.98%），其次是华人（0.73%）和马来人（0.44%）群体（P = 0.03）。在多变量调整分析中，与视网膜栓子患病相关的因素包括年龄较大（每增加5岁；比值比[OR]，1.22；95%CI，1.05 - 1.41）、印度族裔（与马来族裔相比；OR，3.58；95%CI，1.95 - 6.60）、高血压（OR，1.95；95%CI，1.03 - 3.70）、慢性肾脏病（OR，2.05；95%CI，1.15 - 3.64）、肌酐水平（每标准差增加；OR，1.13；95%CI，1.05 - 1.21）、肾小球滤过率（每标准差增加；OR，0.67；95%CI，0.51 - 0.86）以及中风病史（OR，3.45；95%CI，1.70 - 6.99）。
在9978名来自3个主要亚洲族裔群体的参与者中，有88例视网膜栓子个体。视网膜栓子在印度人中最为常见，且与传统心血管危险因素、中风和慢性肾脏病相关。因此，其存在可能不仅预示着脑部血管栓塞事件及损伤，还可能提示肾脏的血管栓塞事件及损伤。如果这些数据在纵向研究中得到证实，这将表明患有视网膜栓子的人可能需要进行全面的心血管和肾脏评估。
