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Effect of systemic hypertension on foveolar choroidal blood flow in age related macular degeneration
  1. T I Metelitsina,
  2. J E Grunwald,
  3. J C DuPont,
  4. G-S Ying
  1. Department of Ophthalmology, Scheie Eye Institute, School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
  1. Correspondence to: Juan E Grunwald MD, Scheie Eye Institute, 51 North 39th Street, Philadelphia, PA 19104, USA; juangrun{at}mail.med.upenn.edu

Abstract

Aim: To investigate the effect of systemic hypertension (SH) on the foveolar choroidal circulation in patients with age related macular degeneration (AMD).

Methods: This study included 163 study eyes with early AMD characteristics of 124 AMD patients. Study eyes had visual acuity of 20/40 or better, drusen ⩾63 µm, and/or RPE hypertrophy. 56 of the AMD patients had a history of SH and 47 of these patients were receiving antihypertensive medications. Laser Doppler flowmetry (Oculix) was used to assess relative choroidal blood velocity (ChBVel), volume (ChBVol), and flow (ChBFlow) in the centre of the fovea of the study eyes. Differences in the mean haemodynamic parameters between groups of eyes were assessed using analysis of variance (ANOVA) and a test of linear trend, with adjustment for the correlation between eyes of the same patient.

Results: AMD patients with SH showed decreased ChBFlow in comparison with those without SH (ANOVA, p = 0.02). This association was maintained after adjustments for multiple factors (p = 0.04).

Conclusions: AMD patients with SH have lower ChBFlow than those without SH. This decrease in choroidal blood circulation may help explain the mechanism by which systemic hypertension may contribute to the progression of AMD and the development of choroidal neovascularisation.

  • AMD, age related macular degeneration
  • ANOVA, analysis of variance
  • BP, blood pressure
  • ChBFlow, choroidal blood flow
  • ChBVel, choroidal blood velocity
  • ChBVol, choroidal blood volume
  • CNV, choroidal neovascularisation
  • LDF, laser Doppler flowmetry
  • RBCs, red blood cells
  • RE, retina section
  • RPE, retinal pigment epithelium
  • SH, systemic hypertension
  • systemic hypertension
  • age related macular degeneration
  • choroidal blood flow
  • laser Doppler flowmetry
  • AMD, age related macular degeneration
  • ANOVA, analysis of variance
  • BP, blood pressure
  • ChBFlow, choroidal blood flow
  • ChBVel, choroidal blood velocity
  • ChBVol, choroidal blood volume
  • CNV, choroidal neovascularisation
  • LDF, laser Doppler flowmetry
  • RBCs, red blood cells
  • RE, retina section
  • RPE, retinal pigment epithelium
  • SH, systemic hypertension
  • systemic hypertension
  • age related macular degeneration
  • choroidal blood flow
  • laser Doppler flowmetry

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Footnotes

  • This investigation was supported by the National Institutes of Health grant NEI EY12769 and 5 P30 EY 01583, the Vivian Simkins Lasko Research Fund, the Nina C Mackall Trust, and an unrestricted grant from Research to Prevent Blindness.

  • Competing interests: none declared

  • The authors have no proprietary interest related to this manuscript.

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