Skip to main content
construction release_alert
Scholars@Duke will be undergoing maintenance April 11-15. Some features may be unavailable during this time.
cancel

Prevalence and Associations of Retinal Emboli With Ethnicity, Stroke, and Renal Disease in a Multiethnic Asian Population: The Singapore Epidemiology of Eye Disease Study.

Publication ,  Journal Article
Cheung, N; Teo, K; Zhao, W; Wang, JJ; Neelam, K; Tan, NYQ; Mitchell, P; Cheng, C-Y; Wong, TY
Published in: JAMA Ophthalmol
October 1, 2017

IMPORTANCE: To our knowledge, population-based data on retinal emboli are limited in Asia. Besides its associations with traditional cardiovascular risk factors and stroke, associations between retinal emboli and renal disease and function remain unclear. OBJECTIVE: To examine the prevalence of and risk factors for retinal emboli in a large, contemporary, multiethnic Asian population. DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study was conducted from 2004 to 2011 and included a total of 10 033 Chinese, Malay, and Indian persons aged 40 to 80 years residing in the general communities of Singapore. Analyses were performed from November 2016 to February 2017. INTERVENTIONS OR EXPOSURES: Retinal emboli were ascertained from retinal photographs obtained from both eyes of all participants according to a standardized protocol. Age-standardized prevalence of retinal emboli was calculated using the 2010 Singapore adult population. Risk factors were assessed from comprehensive systemic and ophthalmic examinations, interviews, and laboratory investigations. MAIN OUTCOMES AND MEASURES: Retinal emboli. RESULTS: Of the 10 033 participants, 9978 (99.5%) had gradable retinal photographs. Of these, 5057 (50.7%) were female, and 3375 (33.8%) were Indian. We identified 88 individuals (0.9%) with retinal emboli; the overall person-specific, age-standardized prevalence of retinal emboli was 0.75% (95% CI, 0.60-0.95), with the highest prevalence seen in the Indian cohort (0.98%), followed by the Chinese (0.73%) and Malay (0.44%) cohorts (P = .03). In multivariable-adjusted analysis, factors associated with prevalent retinal emboli included older age (per 5-year increase; odds ratio [OR], 1.22; 95% CI, 1.05-1.41), Indian ethnicity (compared with Malay ethnicity; OR, 3.58; 95% CI, 1.95-6.60), hypertension (OR, 1.95; 95% CI, 1.03-3.70), chronic kidney disease (OR, 2.05; 95% CI, 1.15-3.64), creatinine level (per SD increase; OR, 1.13; 95% CI, 1.05-1.21), glomerular filtration rate (per SD increase; OR, 0.67; 95% CI, 0.51-0.86), and history of stroke (OR, 3.45; 95% CI, 1.70-6.99). CONCLUSIONS AND RELEVANCE: Based on 88 individuals among 9978 participants of 3 major Asian ethnic populations, retinal emboli were most commonly seen in Indian persons and associated with conventional cardiovascular risk factors, stroke, and chronic kidney disease. Therefore, its presence may signal vascular embolic event and damage not only in the brain but also in the kidneys. If these data are confirmed in longitudinal studies, they would suggest that persons with retinal emboli may require both general cardiovascular and renal assessment.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

JAMA Ophthalmol

DOI

EISSN

2168-6173

Publication Date

October 1, 2017

Volume

135

Issue

10

Start / End Page

1023 / 1028

Location

United States

Related Subject Headings

  • Stroke
  • Singapore
  • Risk Factors
  • Retinal Diseases
  • Retinal Artery
  • Prevalence
  • Photography
  • Ophthalmology & Optometry
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Cheung, N., Teo, K., Zhao, W., Wang, J. J., Neelam, K., Tan, N. Y. Q., … Wong, T. Y. (2017). Prevalence and Associations of Retinal Emboli With Ethnicity, Stroke, and Renal Disease in a Multiethnic Asian Population: The Singapore Epidemiology of Eye Disease Study. JAMA Ophthalmol, 135(10), 1023–1028. https://doi.org/10.1001/jamaophthalmol.2017.2972
Cheung, Ning, Kelvin Teo, Wanting Zhao, Jie Jin Wang, Kumari Neelam, Nicholas Y. Q. Tan, Paul Mitchell, Ching-Yu Cheng, and Tien Yin Wong. “Prevalence and Associations of Retinal Emboli With Ethnicity, Stroke, and Renal Disease in a Multiethnic Asian Population: The Singapore Epidemiology of Eye Disease Study.JAMA Ophthalmol 135, no. 10 (October 1, 2017): 1023–28. https://doi.org/10.1001/jamaophthalmol.2017.2972.
Cheung, Ning, et al. “Prevalence and Associations of Retinal Emboli With Ethnicity, Stroke, and Renal Disease in a Multiethnic Asian Population: The Singapore Epidemiology of Eye Disease Study.JAMA Ophthalmol, vol. 135, no. 10, Oct. 2017, pp. 1023–28. Pubmed, doi:10.1001/jamaophthalmol.2017.2972.
Cheung N, Teo K, Zhao W, Wang JJ, Neelam K, Tan NYQ, Mitchell P, Cheng C-Y, Wong TY. Prevalence and Associations of Retinal Emboli With Ethnicity, Stroke, and Renal Disease in a Multiethnic Asian Population: The Singapore Epidemiology of Eye Disease Study. JAMA Ophthalmol. 2017 Oct 1;135(10):1023–1028.

Published In

JAMA Ophthalmol

DOI

EISSN

2168-6173

Publication Date

October 1, 2017

Volume

135

Issue

10

Start / End Page

1023 / 1028

Location

United States

Related Subject Headings

  • Stroke
  • Singapore
  • Risk Factors
  • Retinal Diseases
  • Retinal Artery
  • Prevalence
  • Photography
  • Ophthalmology & Optometry
  • Middle Aged
  • Male