Obstructive Sleep Apnea Linked to Retinopathy and Recalcitrant Retinal Vascular Disease

Researchers sought to discern associations between obstructive sleep apnea (OSA) and several overlapping patterns of retinal vascular disease. The results were presented at the American Society of Retina Specialists (ASRS) 2021 Annual Meeting.

This retrospective observational study assessed OSA associated retinopathy in three overlapping patterns: venous stasis, recalcitrant macular edema (ME), and posterior retinal ischemia. The study analyzed 49 patients with OSA between January 2010 and December 2020. Retinal diagnoses included 28 patients with diabetic macular edema (DME), 12 patients with retinal vein occlusion (RVO) with ME, 15 patients with proliferative diabetic retinopathy (PDR), and nine patients with recurrent vitreous hemorrhage (VH).

According to the results, retinal findings led to the diagnosis and management of OSA in 86% of patients. The researchers noted that, surprisingly, 39% of patients with OSA were not obese. The findings of venous stasis retinopathy included posterior and peripheral blot intraretinal hemorrhages (94%), venous dilation and tortuosity (35%), RVO (incident, bilateral, or multiple in the same eye; 25%), and recurrent VH (18%). The researchers observed that retinal findings of recalcitrant ME included diffuse DME with sparse microaneurysms, schisis-like outer retinal ME, and resistance to laser and injection therapies in the absence of vitreoretinal interface disease. The results showed that retinal findings of posterior ischemia included extensive cotton wool spots (10%), multiple patches of capillary dropout with intact peripheral perfusion on widefield fluorescein angiography (59%), and iris neovascularization.

Overall, the study found that OSA treatment resulted in cessation of recurrent VH in 100% of patients, reduced diffuse ME in almost 82% of patients, and increased interval or cessation of intravitreal anti-VEGF treatments in 100% of patients.

“OSA produces ophthalmic findings that overlap with other common retinal diagnoses, including hypertensive retinopathy, diabetic retinopathy, RVO, VH, and ME. The ophthalmologist can play a key role in identifying OSA by the three patterns of retinal manifestations. Treatment of OSA can facilitate control of ophthalmic and comorbid systemic diseases,” the researchers concluded.

Source: Sisk R, et al. Obstructive Sleep Apnea is an Important Cause of Retinopathy and Recalcitrant Retinal Vascular Disease. Published for ASRS 2021; October 8-12, 2021, San Antonio, TX.