No Acute Effect of Smoking on Peripapillary and Macular Vessel Density in Healthy Middle-aged Smokers:

Smoking Intensity is Associated With Progressive Optic Nerve Head Vessel Density Loss in Glaucoma

PRCIS

A lifetime history of greater smoking consumption was associated with faster vessel density loss over time. Smoking intensity should be considered when assessing the risk of glaucoma progression, as well as its management.

PURPOSE

To investigate the relationship of smoking and smoking intensity, with the rate of optic nerve head (ONH) whole image capillary density (wiCD) loss in primary open angle glaucoma (POAG) and glaucoma suspect patients.

METHODS

In this longitudinal study, patients with POAG who had at least 2 years of follow-up and optical coherence tomography angiography (OCTA) performed at a minimum of 4 visits were selected for study. The smoking intensity was calculated as the pack-year at the baseline OCTA. Univariable and multivariable linear mixed models were used to determine the effect of each parameter on the rates of wiCD loss over time. Nonlinear least-squares estimation with piecewise regression model was used to investigate the cutoff point for the relationship between wiCD loss and smoking intensity.

RESULTS

One hundred sixty-four eyes (69 glaucoma suspect and 95 POAG) of 110 patients were included with a mean (95% CI) follow-up of 4.0 (3.9 to 4.1) years. Of the 110 patients, 50 (45.5%) had a reported history of smoking. Greater smoking intensity was associated with faster wiCD loss [-0.11 (-0.23 to 0.00)] %/year per 10 pack-year higher; P =0.048) after adjusting for covariates. The wiCD thinning became significantly faster when smoking intensity was greater than 22.2 pack-years. Smoking had no effect on the rate of wiCD thinning in patients who smoked <22.2 pack-years during their lifetime.

CONCLUSIONS

A history of greater smoking consumption was associated with faster vessel density loss, suggesting smoking intensity as a potential risk factor for glaucoma.

Effects of firsthand tobacco smoking on retinal vessel caliber: a systematic review and meta-analysis

PURPOSE

To review the effects of firsthand tobacco smoking on central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) of firsthand tobacco smokers.

METHODS

We performed a search on EMBASE and PubMed for studies up to 15th July 2022. Two independent reviewers selected studies with baseline data of CRAE and CRVE of current smokers, nonsmokers, and former smokers. Initial search identified 893 studies, of which 10 were included in the meta-analysis. Two independent reviewers extracted data from the included studies. The quality of studies was assessed by the Newcastle-Ottawa Scale.

RESULTS

In this meta-analysis, 7431 nonsmokers, 2448 current smokers and 5786 former smokers, as well as 7404 nonsmokers, 2430 current smokers and 5763 former smokers were included in CRAE and CRVE analysis respectively. Nonsmokers had narrower CRVE (Weighted mean difference [WMD], -12.15; 95% CI, -17.33 - -6.96) and CRAE (WMD, -4.77; 95% CI, -7.96 - -1.57) than current smokers, and narrower CRVE (WMD, -3.08; 95% CI, -6.06 - -0.11) than former smokers. Current smokers had wider CRVE (WMD, 10.42; 95% CI, 7.80 - 13.04) and CRAE (WMD, 7.05; 95% CI, 6.65 - 7.46) than former smokers. Subgroup analysis and sensitivity analysis were performed.

CONCLUSION

Firsthand tobacco smoking resulted in wider CRAE and CRVE in current and former smokers, particularly in CRVE, and such changes may not be reversible after smoking cessation. Therefore, retinal vessel caliber may reflect the effects of firsthand tobacco smoking and be used to estimate the risk of cardiovascular diseases.

Associations of smoking and alcohol consumption with the development of open angle glaucoma: a retrospective cohort study

OBJECTIVES

To investigate the associations of alcohol consumption and smoking with the development of perimetric glaucoma in patients with suspected glaucoma.

DESIGN

A retrospective cohort study of patients suspected to have glaucoma enrolled in the Diagnostic Innovations in Glaucoma Study (DIGS) and the African Descent and Glaucoma Evaluation Study (ADAGES).

SETTING

Three tertiary glaucoma centres in the USA.

PARTICIPANTS

825 eyes of 610 patients with glaucoma suspect eyes with normal visual fields (VF) at baseline were followed over an average of 9 years from the DIGS and ADAGES studies.

OUTCOME MEASURES

Development of glaucoma was defined as occurrence of three consecutive abnormal VF tests during follow-up. Univariable and multivariable Cox regression models were used to investigate lifestyle-related factors associated with development of VF loss over time.

RESULTS

VF tests were abnormal three times in a row in 235 (28.5%) eyes. Alcohol consumption was associated with a higher risk of developing glaucoma (HR 1.57, 95% CI 1.03 to 2.38, p=0.037). In men, the risk of developing glaucoma in alcohol drinkers (HR 1.92, 95% CI 1.00 to 3.68, p=0.048) was greater than non-alcohol drinkers. In individuals of African descent, the risk of developing glaucoma in alcohol drinkers (HR 1.79, 95% CI 1.02 to 3.15, p=0.043) was greater than non-alcohol drinkers. Age was a modifier of the relationship between smoking and glaucomatous VF defects (p=0.048). The risk of developing glaucoma in smokers (HR 1.73, 95% CI 1.10 to 2.72, p=0.019) was greater than never smokers after adjustment for confounding factors in older patients (age >61 years).

CONCLUSION

Alcohol consumption was associated with an increased risk of developing glaucoma, particularly in men and individuals of African descent. The risk of developing glaucoma among smokers suspected of having glaucoma was influenced by age, with older individuals having a higher risk than younger people.

TRIAL REGISTRATION NUMBER

NCT00221897 and NCT00221923.

Effects of Smoking on Optic Nerve Head Microvasculature Density in Glaucoma

PRCIS

Decreased superficial whole image capillary density was observed in open angle glaucoma (OAG) patients with high smoking intensity.

PURPOSE

To investigate the effects of smoking on optic nerve head capillary density measured by optical coherence tomography angiography in patients with OAG.

METHODS

In this retrospective cross-sectional study, perimetric and preperimetric glaucoma patients enrolled in the Diagnostic Innovations in Glaucoma Study (DIGS) with optical coherence tomography angiography follow-up were included. Univariable and multivariable linear mixed analysis were performed to determine the effects of different variables on the superficial whole image capillary density.

RESULTS

A total of 432 eyes of 271 glaucoma patients comprising 63 preperimetric (106 eyes) and 208 perimetric OAG (326 eyes) were included. A history of tobacco consumption was reported in 105 (38.8%). Among smokers, mean (95% confidence interval) smoking intensity was 12.8 (10.2, 15.5) pack-years. After adjusting for age, glaucoma severity and other confounders, each 10 pack-year increase in smoking intensity (95% confidence interval) was associated with -0.54 (-1.06, -0.02) % lower whole image capillary density ( P =0.041).

CONCLUSIONS

Smoking intensity is associated with reduced optic nerve vessel density in glaucoma.

Quantitative assessment of macular and circumpapillary retinal vessel density across all stages of Leber hereditary optic neuropathy using swept source optical coherence tomography angiography

PURPOSE

To investigate the macular and circumpapillary retinal microvasculature across all stages of Leber hereditary optic neuropathy (LHON) using swept source optical coherence tomography angiography (OCTA).

METHODS

This prospective, multicentre, cross-sectional, observational study analysed a total of 119 eyes of 60 patients with molecularly confirmed LHON across all stages and 120 eyes of 60 control subjects. Optical coherence tomography angiography maps centred on the fovea and optic disc were obtained to measure vessel densities (VDs) in the macular superficial (SCP) and deep (DCP) capillary plexuses, and the radial peripapillary capillary plexus (RPCP) respectively.

RESULTS

In asymptomatic eyes, only the SCP showed significant changes on average (B coefficient = -0.72, 95% CI = -1.34 to -0.10, p = 0.022) or in sectors representing the papillomacular bundle (PMB) (B coefficient = -1.17, 95% CI = -2.23 to -0.11, p = 0.031). However, in chronic eyes, the greatest magnitude of change was found in the temporal sector of the RPCP (B coefficient = -12.36, 95% CI = -14.49 to -10.23, p < 0.001). The RPCP showed the strongest correlations with visual acuity (VA, logarithm of the minimum angle of resolution; R = -0.677, p < 0.001) and structural parameters (R = 0.747, p < 0.001).

CONCLUSIONS

Retinal VD changes in the circumpapillary region of the PMB appear later than in the macula but end up being more profound and correlate better with VA and structural parameters. Further studies are needed to assess the clinical utility of retinal VDs as potential LHON biomarkers.

[Optical coherence tomography angiography and cardiovascular diseases. An overview of the current knowledge]

BACKGROUND

Cardiovascular diseases (CVD) are the leading cause of death worldwide. The observability of retinal vessel changes in the context of CVD by funduscopy has been known for a long time. Optical coherence tomography angiography (OCTA) is a novel technique for noninvasive detailed imaging and quantification of the retinal microcirculation. The OCTA enables the visualization of vascular changes in a simple and well-reproducible way. Its applications are not limited to the field of ophthalmology. In recent years, several experimental and clinical studies have been published on vascular changes detectable with OCTA in CVD. This review summarizes the most important findings of these studies.

METHODS

This work is based on a comprehensive review of the literature and on the presentation of own data.

RESULTS

Nowadays, OCTA studies are available for many diseases of the cardiovascular spectrum. This indicates that systemic vascular diseases are associated with changes in the retinal microcirculation. These changes can be visualized and reproducibly quantified with OCTA. In many diseases subclinical changes, which are detectable by OCTA, occur before the underlying disease causes otherwise measurable changes or noticeable symptoms for the patient.

CONCLUSION

The OCTA is a promising imaging method in the context of CVD in both scientific and clinical applications. It can be used for the diagnostics and quantification of retinal vascular changes. Further studies will show whether OCTA can be of assistance in the estimation of individual systemic cardiovascular risk profiles.

Evaluation of subclinical alterations in retinal layers and microvascular structures with OCT and OCTA in healthy young short-term smokers

PURPOSE

To detect the changes that can be determined with optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in young and short-term smokers.

METHOD

In this cross-sectional, observational, and comparative study, 45 "healthy" smokers and 45 healthy non-smoker control participants were included. Those with a smoking history between 1 year to 5 years and an average of 10-30 cigarettes per day were included in the study. OCT and OCTA measurements were made at least 60 min after smoking and at least 8 h after caffeine-containing beverages in order to end the effect of nicotine on systemic and retinal blood flow in the smoking group.

RESULTS

The mean smoking period was 2.2 ± 0.13 years. Mean macular thickness(MMT), retinal nerve fiber layer(RNFL), and choroidal thickness(Cht) were significantly lower in the smoker group, while ganglion cell-inner plexiform layer(GC-IPL) thickness was higher. Vessel density(VD) values were similar between groups, while perfusion density(PD) values were significantly higher in the smoker group. There were significant correlations between MMT and outer VD, outer PD, foveal avascular zone(FAZ) perimeter and circularity index. FAZ area and central VD and PD were inversely correlated. Also, FAZ circularity index and subfoveal, nasal, and temporal ChTs were positively correlated.

CONCLUSION

Despite the short-term smoking, ischemic effects were observed in retinochoroidal and vascular structures.

Optical coherence tomography angiography in glaucoma: analysis of the vessel density-visual field sensitivity relationship

Glaucoma, a well-defined group of progressive optic neuropathies is one of the leading causes of irreversible blindness worldwide. In order to stop or slow down the progression of glaucomatous vision deterioration, intraocular pressure reduction by medical, laser or surgical treatment is needed. To ensure that treatment is efficient and tailored to the actual needs both cross sectional evaluation of disease severity and measurement of rate of progression are essential. Currently staging and progression are investigated with visual field and retinal thickness measurements. Perimetry, however, is influenced by several biological factors which are not related to glaucoma, and the use of retinal thinning is limited by floor effect. Therefore, clinical application of optical retinal coherence tomography angiography, a new and rapidly developing non-invasive measurement of the capillary perfusion in the various retinal layers, respectively, is now in the focus of clinical glaucoma research. This comprehensive review summarizes the current knowledge on one of the most important research areas in optical coherence tomography angiography in glaucoma, the relationship between retinal capillary perfusion and the spatially corresponding visual field threshold sensitivity.

Evaluation of the acute effects of cigarette smoking on the eye of non-Smoking healthy young male subjects by optical coherence tomography angiography

Purpose: Investigation of the acute effects of cigarette smoking on the eye using optical coherence tomography angiography (OCTA) on young healthy non-smoking male subjects.Materials and methods: The right eye of 25 healthy non-smoking male subjects were included in this study. Selected parameters of the macular and circumpapillary vasculature were measured, including macular flow indices, foveal avascular zone, vessel densities of macula and optic disc using OCTA. The measurements of the subjects were performed on the first day without smoking at 0 min, 5 min, 30 min and 60 min. Measurements were repeated at the same regime on the second day after smoking. Paired samples t-test and repeated measures one-way analysis of variance test was used for the statistical analysis.Results: The repeated measures analysis of variance test using the Bonferroni adjustment demonstrated a significant change for superficial and deep foveal vessel density, flow area of choriocapillaris, and circumpapillary capillary density following smoking (range of p value was <0.001-0.004). Intraocular pressure, foveal avascular zone area, flow area of outer retina and foveal non-flow area of superficial layer measurements did not have any significant changes following smoking (range of p value was 0.192-0.812).Conclusion: In non-smoking cases, even smoking only one cigarette significantly decreased the vessel density parameters at the acute period. Even though there was an increase in measured parameters shortly after smoking, it had lessened when compared to non-smokers, even one hour following smoking.

Optical coherence tomography angiography-derived flow density: a review of the influencing factors

Research interest in the possibility of quantifying macular and optic nerve head perfusion through optical coherence tomography angiography (OCTA) is rapidly advancing. Numerous scientific trials have furthered our understanding of the capabilities and the limitations of this novel technology, while applying OCTA to various ocular pathologies. In recent years, different parameters such as age, gender, intraocular pressure, spherical equivalent, physical activity, systemic diseases, and medication have been shown to have a significant impact on quantitative OCTA metrics. Since OCTA is likely to remain a "hot topic" in the near future, it is crucial to be aware of influencing factors in order to ensure correct interpretation of imaging results. This article reviews the factors currently known to influence flow density (FD) as measured by OCTA in healthy eyes.

Immediate effects of smoking on optic nerve and macular perfusion measured by optical coherence tomography angiography

The aim of this study was the assessment of the relationship between cigarette smoking and optic nerve and macular vessel density measured by optical coherence tomography angiography. We examined 30 eyes from 30 healthy habitual smokers. The examination was performed using a high-speed and high-resolution spectral-domain optical coherence tomography RTVue XR Avanti with AngioVue (Optovue, Fremont, CA, USA) with a split-spectrum amplitude-decorrelation angiography algorithm. Blood pressure, heart rate, vascular density in the area of the optic nerve head (4.5*4.5 mm) and vascular density with the foveal avascular zone in the central macula (3.0*3.0 mm) were measured and analyzed before, immediately after and 30 minutes after cigarette smoking. Quantitative measurements were carried out by AngioAnalytics Phase 7 software. Immediately after smoking both heart rate and blood pressure increased significantly (p < 0.001) compared to values before smoking and then significantly decreased after 30 minutes comparing to values obtained right after smoking (p < 0.001). The mean area of the foveal avascular zone, parafoveal vessel density, and peripapillary vessel density did not change significantly. Our results show no immediate influence of smoking on vessel density parameters measured by specific OCTA machine in healthy habitual smokers.