Session Title: Quick Fire Free Paper Session
Session Date/Time: Saturday 17/02/2018 | 11:45-13:00
Paper Time: 12:25
Venue: Ballroom II & III.
First Author: : R.Schlingemann NETHERLANDS
Co Author(s): : M. Bosscha D. Steel R. Van Noorden S. Lesnik Oberstein I. Klaassen
Multiple metabolic, genetic and environmental factors have been involved in the pathophysiology of AMD. Some studies have linked homocysteine, vitamin D and lipid metabolism to AMD. We intend to study the prevalence of changes in these parameters in our population with late AMD and its correlation with visual acuity, number of antiVEGF injections and anatomical OCT characteristics.
Ophthalmology department, Hospital Professor Doutor Fernando da Fonseca EPE, Lisbon, Portugal
37 eyes of 24 patients with neovascular AMD were analyzed. The patient’s homocysteine, 25-hydroxyvitamin D, cholesterol (total, HDL, LDL) and triglycerides were dosed and compared with a control population that was adjusted to age, gender and ethnicity. We excluded patients with chronic kidney disease, chronic corticosteroid use and osteoarticular diseases. We registered visual acuity (VA), AMD phenotype, number of injections and we measured the retinal neuroepithelium in the OCT in 5 points: subfoveal and 1000µm superior, inferior, temporal and nasal to the fovea. We correlated the VA and number of injections with the levels of the laboratorial parameters (Spearman correlation) and we studied the association of laboratorial levels and OCT neuroepithelium thickness (ANOVA).
Mean VA in the AMD subgroup was 0,37±0,36. AMD patients had statistically significant lower levels of 25-hydroxyvitamin D (mean 20,47±7,93 ng/mL) when compared to controls (mean 26,23±9,07 ng/mL) (p=0,027). In the population with AMD there was also a higher proportion of patients with severe deficit of vitamin D (<10 ng/mL), with 12.50% of patients in this category; 70.83% had a moderate deficit of vitamin D (10-29 ng/mL) and 9,60% with normal levels (≥30 ng/mL). There were no statistically significant differences in the homocysteine, cholesterol and triglycerides among AMD patients and controls. We have not found any correlation between the VA or the number of antiVEGF injections with the studied laboratorial parameters. When studying the correlation of the laboratorial parameters and the OCT retinal neuroepithelium thickness, we found that lower levels of 25-hydroxyvitamin D were associated with a lower neuroepithelium thickness in the superior (p=0.009), inferior (p=0.000) and nasal (p=0.001) points. It is also of note that in patients with AMD and disciform scar (n=9), only 1 patient had normal levels of 25-hydroxyvitamin D, with the remaining patients with moderate (n=6) or severe deficit (n=2).
Despite being in a Mediterranean country, our population had a deficit of 25-hydroxyvitamin D and AMD patients exhibited statistically significant lower levels of this parameter when compared to controls. Though we have not found a correlation between the VA or the number of injections with lower levels of 25-hydroxyvitamin D, we found that there is an association between this parameter and lower retinal neuroepithelium thickness in 3 out of the 5 evaluated retinal points. Additionally, almost all patients with disciform scar had 25-hydroxyvitamin D deficit. These results, though preliminary, suggest that perhaps 25-hydrovitamin D deficit is associated with more severe anatomical changes in neovascular AMD. Future works with a higher number of individuals are necessary to establish these conclusions.