Retinal nerve fiber layer defect and cerebral small vessel disease

PURPOSE. To determine whether retinal nerve fiber layer defect (RNFLD) is associated with cerebral small vessel diseases (SVDs) and to identify risk factors for RNFLD. METHODS. A total of 4421 Korean subjects who underwent health checkups including brain magnetic resonance imaging (MRI) and fundus photography between January 2008 and October 2009 were included in this study. Co-morbid systemic diseases including hypertension, diabetes mellitus, and stroke or ocular diseases were evaluated using detailed questionnaires and medical records. Two experienced ophthalmologists assessed RNFLD on fundus photographs, according to the definition that describes the condition as marked thinning or absence of retinal nerve fiber layer bundles. RESULTS. RNFLD was detected in 238 of 4395 eligible subjects, and the estimated prevalence was 5.4%. Multivariate regression analysis results showed the prevalence of RNFLD to be significantly higher in hypertensive subjects (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.28 -2.34), in those with cerebral SVD based on MRI (OR, 1.58; 95% CI, 1.17-2.12), and in male (OR, 1.47; 95% CI, 1.10 -1.96) and older subjects (OR, 1.02; 95% CI, 1.00 -1.03). Among the cases of cerebral SVD, white matter lesions (WMLs) were associated with RNFLD, whereas lacunar infarctions were not significantly associated with it. CONCLUSIONS. The results indicate that RNFLD may be related to the presence of cerebral SVD, particularly WMLs. Furthermore, being older and male and having hypertension increase the risk of RNFLD.