Association of retinal vascular caliber and age-related macular degeneration in patients with the acquired immunodeficiency syndrome

PURPOSE. To evaluate the relationship between retinal vascular caliber and AMD in patients with AIDS. METHODS. Participants enrolled in the Longitudinal Study of the Ocular Complications of AIDS had retinal photographs taken at enrollment. Retinal vascular caliber (central retinal artery equivalent [CRAE] and central retinal vein equivalent [CRVE]) and intermediate-stage AMD were determined from these retinal photographs. Photographs were evaluated by graders at a centralized reading center, using the Age-Related Eye Disease Study grading system for AMD and semiautomated techniques for evaluating retinal vascular caliber. RESULTS. Of the 1171 participants evaluated, 110 (9.4%) had AMD and 1061 (90.6%) did not. Compared with participants without AMD, participants with AMD had larger mean CRAEs (151 ± 16 µm versus 147 ± 16 µm; P = 0.009) and mean CRVEs (228 ± 24 µm versus 223 ± 25 µm; P = 0.02). The unadjusted differences were: CRAE, 4.3 lm (95% confidence interval [CI] 1.1-7.5; P = 0.009) and CRVE, 5.5 lm (95% CI 0.7-10.3; P = 0.02). After adjustment for age, race/ethnicity, sex, human immunodeficiency syndrome (HIV) transmission category, smoking, enrollment and nadir CD4⁺ T cells, and enrollment and maximum HIV load, the differences between patients with and without AMD were as follows: CRAE, 5.4 lm (95% CI 2.3-8.5; P = 0.001) and CRVE, 6.0 lm (95% CI 1.4-10.6; P = 0.01). CONCLUSIONS. In patients with AIDS, AMD is associated with greater retinal arteriolar and venular calibers, suggesting a role for shared pathogenic mechanisms, such as persistent systemic inflammation.