Subretinal Drusenoid Deposits Linked to Carotid Artery Stenosis

A presentation during the recent American Society of Retina Specialists (ASRS) annual meeting highlighted a study that demonstrated that patients with a specific symptom of age-related macular degeneration (AMD) are also highly likely to have either underlying heart damage from heart failure and heart attacks, or advanced heart valve disease or carotid artery disease associated with certain types of strokes.

In this exclusive MedPage Today video, Emanuel Mordechaev, BA, a retina research fellow at the New York Eye and Ear Infirmary of Mount Sinai, explains the study and the clinical significance of the results.

Following is a transcript of his remarks:

Hello, my name is Emanuel Mordechaev. I’m a retina research fellow at the New York Eye and Ear Infirmary of Mount Sinai, and also a medical student applying into ophthalmology.

So I want to tell all of you about a study that we’re doing at Mount Sinai Hospital. It’s a cross-sectional study where we’re looking at patients that have ischemic stroke and we want to evaluate them for certain lesions in the eye — in the back of the eye, the retina. And these lesions are known as subretinal drusenoid deposits, or SDDs.

So in age-related macular degeneration — or AMD — there are two main types of lesions, one of which is called soft drusen, and the other one is subretinal drusenoid deposit, or SDDs. And essentially what we’re looking at is we want to see if patients with ischemic stroke have a higher incidence of SDD lesions.

We suspect that these lesions are due to decreased blood flow to the eyes. So that could be from internal carotid artery stenosis in patients with ischemic stroke. It could be from anything that decreases blood flow to the eyes, whether it’s a myocardial infarction, some valvular heart disease like aortic stenosis, things of that nature.

So what we found is that patients with ischemic stroke and internal carotid artery stenosis have a much higher incidence of subretinal drusenoid deposits on the same side. So it makes logical sense if you think about it, say the left internal carotid artery is stenosed, that causes decreased blood flow to the choroid or to the vasculature that supplies the retina. And that’s why we see the lesions on the same side of the internal carotid artery stenosis. We found a significant association with that.

So it’s a very promising finding, because now we can use OCT — or optical coherence tomography — to look for these lesions in the eye. It’s essentially an ultrasound of the eye. So we use this OCT, and if you see these lesions in someone’s eye, it could be an indicator that they have some underlying vascular disorder such as internal carotid artery stenosis.

It’s actually pretty interesting because we had one patient in their 40s, a male, who thought he was perfectly healthy. And then we did an OCT and we found these SDD lesions and we asked him, do you have any cardiovascular disease? And he said, not that I’m aware of. And then we did a carotid echo and he had 40% ICA [internal carotid artery] stenosis, and now he started on aspirin. So an OCT test of the eye was able to diagnose him with cardiovascular disease and potentially saved his life because now he’s taking aspirin.

So it’s very interesting. We hope that we can implement OCT imaging of the eyes to evaluate patients for SDD lesions. And if SDDs are found, we could potentially save lives by doing a thorough vascular workup such as carotid echo or an echocardiogram to look for aortic stenosis and lesions such as that.

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