Retina points to systemic diseases

Orlando, FL-A number of retinal conditions that do not necessarily require immediate treatment provide clues to potentially more serious systemic diseases, such as hypertension and diabetes, said Steven Ferrucci, OD, FAAO, chief of optometry, Sepulveda VA Ambulatory Care Center, North Hills, CA. Retinal manifestations of systemic disease may be found in retinopathy, branch and central occlusions, and retinal plaques. Dr. Ferrucci discussed retinal clues to systemic diseases in a lecture at the annual meeting of the American Optometric Association.

Associations with hypertension

Treatment of mild hypertensive retinopathy consists of monitoring the fundus every 12 months and a referral to a primary care provider. Papilledema is a medical emergency. "Get that patient out of your office to get their blood pressure managed immediately," he said.

Branch retinal vein occlusion (BRVO) may also result from hypertension. "The management of a BRVO is somewhat controversial because it has a good prognosis if left untreated. Studies have shown that almost 60% of patients with a BRVO have 20/40 or better vision after a year," Dr. Ferrucci said. "Certainly treatment is indicated at times, but very often monitoring the patient and seeing what their eye will do is a valid course of action."

Central retinal vein occlusion (CRVO) has very strong, age-dependent systemic associations. In individuals over age 50, the most common etiologies are hypertension and diabetes, with chronic lung disease a distant third, while injury and hyperlipidemia are more likely risk factors in younger patients. CRVO can present as ischemic, the more serious form, or non-ischemic; about 30% of non-ischemic cases worsen with time and become ischemic. The ischemic form is often characterized by reduced IOP, afferent pupillary defect, papilledema, and visual acuity <20/200.

The visual prognosis for patients with CRVO is not good, although it is better in non-ischemic cases. A significant threat for patients with CRVO is neovascular glaucoma, which occurs in 14% to 20% of all cases, but 60% of ischemic cases, Dr. Ferrucci said.