Smoking Status Linked With Microvascular Changes, Even Without Diabetic Retinopathy

Researchers used OCT-A imaging to reveal changes to the microvasculature of patients with and without retinopathy who smoke.

The following article is a part of conference coverage from the American Academy of Ophthalmology 2020, being held virtually from November 13 to 15, 2020. The team at Ophthalmology Advisor will be reporting on the latest news and research conducted by leading experts in ophthalmology. Check back for more from the AAO 2020.

Smoking can cause significant negative changes to the retinal microvasculature, creating a need for more efficient ophthalmic evaluation among these patients, according to research presented at the American Academy of Ophthalmology 2020 annual meeting, held virtually November 13 to 15, 2020.

The investigators conducted a retrospective, cross-sectional study to evaluate how smoking affects the microvasculature in patients with diabetes with no visible retinopathy. Participants included 1099 eyes from 1099 adults with diabetes, including 750 never smokers, 198 former smokers, and 151 current smokers. Participants underwent screening for retinopathy between April 2018 and September 2019, where software was used to calculate the foveal avascular zone, perfusion density (PD), and vessel length density. Imaging was performed using optical coherence tomography angiography (OCT-A).

Multivariate regression analysis demonstrated significant negative association between smoking history and full and inner PD (β = -0.38 for both; 95% CI, -0.76 to -0.0044 and -0.74 to -0.027, respectively) and full and inner vessel length density (β = -0.21, and -0.24, respectively; 95% CI, -0.40 to -0.015 and -0.46 to -0.022, respectively). 

The investigators pointed to a couple of limitations. They included the potential for residual confounding and the inability of their imaging analysis software to measure OCT-A parameters derived from vasculature structures deeper than the superficial capillary plexus.

“Smoking is associated with deleterious changes in the microvasculature of diabetic patients with no visible retinopathy,” the researchers concluded. “These patients may benefit from more expeditious ophthalmic evaluation.”

The presenters add that OCT-A imaging of patients with no clinical DR may be uniquely suited to evaluate the true effect of smoking on the retina in this population. 

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Haq Z, Stewart JM. Effect of smoking on OCT-A parameters in diabetic patients without retinopathy. Presented at: American Academy of Ophthalmology 2020 Annual Meeting; November 13-15, 2020. Abstract PO455.