Is arterial stiffness in the carotid artery associated with choroidal thinning in patients with pseudoxanthoma elasticum or controls?

Sara Risseeuw; Jonas Bartstra; Jeannette Ossewaarde-van Norel; Lennart J Geurts; Catherina H Z Li; Saskia M Imhof; Wilko Spiering; Pim A de Jong; Redmer van Leeuwen

doi:10.1111/aos.14346

Is arterial stiffness in the carotid artery associated with choroidal thinning in patients with pseudoxanthoma elasticum or controls?

Acta Ophthalmol. 2020 Aug;98(5):492-499. doi: 10.1111/aos.14346. Epub 2020 Jan 13.

Authors

Sara Risseeuw¹, Jonas Bartstra², Jeannette Ossewaarde-van Norel¹, Lennart J Geurts², Catherina H Z Li¹, Saskia M Imhof¹, Wilko Spiering³, Pim A de Jong², Redmer van Leeuwen¹

Affiliations

¹ Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
² Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
³ Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.

PMID: 31943777
DOI: 10.1111/aos.14346

Abstract

Purpose: Patients with pseudoxanthoma elasticum (PXE) develop calcification of Bruch's membrane (BM) and choroidal thinning, as well as calcification of intracranial arteries, leading to arterial stiffness. We investigated whether arterial stiffness is associated with choroidal thinning in PXE patients, besides the presumed effect of BM calcification.

Methods: Cross-sectional study with 75 PXE patients and 40 controls. Macular choroidal thickness was measured using optical coherence tomography scans. Functional magnetic resonance imaging was used to calculate the pulsatility index (PI) of the carotid siphon as a measure of arterial stiffness. Associations between PI and choroidal thickness were investigated using linear mixed effects models adjusted for age and ocular axial length. Furthermore, we investigated choroidal thickness in relation to the presence of retinal pigment epithelium (RPE) atrophy, its topographical distribution and age.

Results: Median age was 58 years (IQR 53-66) in PXE patients and 62 years (IQR 56-67) in controls (p = 0.08). Pseudoxanthoma elasticum (PXE) patients had a thinner choroid than controls (138 μm versus 248 μm, p < 0.01). No association was observed between PI and choroidal thickness in PXE patients (β = -1.6, 95% CI -59.4 to 54.5) nor in controls (β =-47.6, 95% CI -129.7 to 31.9). In PXE patients, RPE atrophy was associated with a thinner choroid (p < 0.01). Also, the nasal choroid was thinner than the temporal choroid, and choroidal thickness already decreased with age in PXE eyes without RPE atrophy.

Conclusion: There was no independent association between measures of arterial stiffness and choroidal thinning in PXE patients and controls. Probably, changes in BM lead to choroidal thinning in PXE.

Keywords: angioid streaks; arterial stiffness; arteriosclerosis; choroidal thickness; internal carotid artery; pseudoxanthoma elasticum; pulsatility index.