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Retinal Nerve Fiber Layer Thickness Decrease in Obesity as a Marker of Neurodegeneration

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Abstract

Background

Idiopathic intracranial hypertension (IIH) is a serious condition that is frequently associated with irreversibly vision loss, having a higher incidence among obese women. Our aims were to screen subclinical IIH in obese patients scheduled to bariatric surgery using peripapillary retinal nerve fiber layer (RNFL) thickness and to evaluate if the findings demand the possible need of a preoperative evaluation in this population.

Methods

This study included 111 eyes from 36 obese patients (86% female, body mass index > 35 kg/m2) scheduled to bariatric surgery and 20 non-obese (body mass index < 25 kg/m2) age-matched controls. We measured sectorial and mean RNFL thickness in a 3.5-mm-diameter circular scan centered on the optic nerve head, using optical coherence tomography (Heidelberg Spectralis SD-OCT) in all participants. Multivariate linear regression was used for adjustments.

Results

No patient had subclinical IIH corresponding to increased RNFL thickness. However, in obese individuals, global peripapillary RNFL was thinner than in controls (104 ± 6 μm versus 99 ± 12 μm, p = 0.005). Overall, RNFL thickness was superior in the control group for all sectors. The differences reached significance for the nasal, temporal, superior temporal, and inferior temporal sectors. These differences remained even after adjusting for possible confounders (hypertension, dyslipidemia, diabetes, age, sleep apnea syndrome, and sex).

Conclusions

Routine screening asymptomatic obese patients undergoing bariatric surgery for IIH using RNFL thickness was not clinically relevant in our study. However, we found that severe obesity is associated with neurodegeneration independently of the other components of the metabolic syndrome, what may justify future investigation on the need of monitoring these patients.

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References

  1. World Health Organization (WHO). Global status report on noncommunicable diseases 2014. 2014.

  2. Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the global burden of disease study 2013. Lancet (London, England). 2014;384:766–81.

    Article  Google Scholar 

  3. Oliveira A, Araújo J, Severo M, et al. Prevalence of general and abdominal obesity in Portugal: comprehensive results from the National Food, nutrition and physical activity survey 2015-2016. BMC Public Health. 2018;18:614.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cefalu WT, Bray GA, Home PD, et al. Advances in the science, treatment, and prevention of the disease of obesity: reflections from a diabetes care editors’ expert forum. Diabetes Care. 2015;38:1567–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Cheung N, Wong TY. Obesity and eye diseases. Surv Ophthalmol. 2007;52:180–95.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Andrews LE, Liu GT, Ko MW. Idiopathic intracranial hypertension and obesity. Horm Res Paediatr. 2014;81:217–25.

    Article  CAS  PubMed  Google Scholar 

  7. Bruce BB, Biousse V, Newman NJ. Update on idiopathic intracranial hypertension. Am J Ophthalmol. 2011;152:163–9.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kilgore KP, Lee MS, Leavitt JA, et al. Re-evaluating the incidence of idiopathic intracranial hypertension in an era of increasing obesity. Ophthalmology. 2017;124:697–700.

    Article  PubMed  Google Scholar 

  9. Hruby A, Hu FB. The epidemiology of obesity: abig picture Adela. Pharmacoeconomics. 2016;33:673–89.

    Article  Google Scholar 

  10. Ibrahim AM, Ghaferi AA, Thumma JR, et al. Variation in outcomes at bariatric surgery centers of excellence. JAMA Surg. 2017;152:629–36.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Galvin JA, Van Stavern GP. Clinical characterization of idiopathic intracranial hypertension at the Detroit Medical Center. J Neurol Sci. 2004;223:157–60.

    Article  PubMed  Google Scholar 

  12. Frau J, Fenu G, Signori A, et al. A cross-sectional and longitudinal study evaluating brain volumes, RNFL, and cognitive functions in MS patients and healthy controls. BMC Neurol. 2018;18:67.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Eren Y, Kabatas N, Guven H, Comoglu S, Gurdal C. Evaluation of optic nerve head changes with optic coherence tomography in patients with idiopathic intracranial hypertension. Acta Neurol Belg 2018. https://doi.org/10.1007/s13760-018-1000-2

  14. OCT Sub-Study Committee for NORDIC Idiopathic Intracranial Hypertension Study Group OS-SC for the NIIHS, Auinger P, Durbin M, et al. Baseline OCT measurements in the idiopathic intracranial hypertension treatment trial, part I: quality control, comparisons, and variability. Invest Ophthalmol Vis Sci. 2014;55:8180–8.

    Article  Google Scholar 

  15. Radhakrishnan K, Ahlskog JE, Cross SA, et al. Idiopathic intracranial hypertension (pseudotumor cerebri). Insight. 1993;50:78–80.

    CAS  Google Scholar 

  16. Bonomi L, Marchini G, Marraffa M, et al. Vascular risk factors for primary open angle glaucoma: the Egna-Neumarkt Study. Ophthalmology. 2000;107:1287–93.

    Article  CAS  PubMed  Google Scholar 

  17. Vijaya L, Rashima A, Panday M, et al. Predictors for incidence of primary open-angle glaucoma in a south Indian population: the Chennai eye disease incidence study. Ophthalmology. 2014;121:1370–6.

    Article  PubMed  Google Scholar 

  18. Yamamoto S, Sawaguchi S, Iwase A, et al. Primary open-angle glaucoma in a population associated with high prevalence of primary angle-closure glaucoma: the kumejima study. Ophthalmology. 2014;121:1558–65.

    Article  PubMed  Google Scholar 

  19. Nangia V, Jonas JB, Matin A, et al. Prevalence and associated factors of glaucoma in rural central India. The Central India Eye and Medical Study. PLoS One. 2013;8:e76434.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Ramdas WD, Wolfs RCW, Hofman A, et al. Lifestyle and risk of develo** open-angle glaucoma. Arch Ophthalmol. 2011;129:767.

    Article  PubMed  Google Scholar 

  21. Khawaja AP, Chan MPY, Garway-Heath DF, et al. Associations with retinal nerve fiber layer measures in the EPIC-Norfolk Eye Study. Invest Ophthalmol Vis Sci. 2013;54:5028–34.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Zarei R, Anvari P, Eslami Y, et al. Retinal nerve fibre layer thickness is reduced in metabolic syndrome. Diabet Med. 2017;34:1061–6.

    Article  CAS  PubMed  Google Scholar 

  23. Tham Y-C, Cheng C-Y. Associations between chronic systemic diseases and primary open angle glaucoma: an epidemiological perspective. Clin Exp Ophthalmol. 2017;45:24–32.

    Article  PubMed  Google Scholar 

  24. Shi R, Guo Z, Wang F, et al. Alterations in retinal nerve fiber layer thickness in early stages of diabetic retinopathy and potential risk factors. Curr Eye Res. 2018;43:244–53.

    Article  PubMed  Google Scholar 

  25. Dogan B, Kazim Erol M, Dogan U, et al. The retinal nerve fiber layer, choroidal thickness, and central macular thickness in morbid obesity: an evaluation using spectral-domain optical coherence tomography. Eur Rev Med Pharmacol Sci. 2016;20:886–91.

    CAS  PubMed  Google Scholar 

  26. Budenz DL, Anderson DR, Varma R, et al. Determinants of normal retinal nerve fiber layer thickness measured by Stratus OCT. Ophthalmology. 2007;114:1046–52.

    Article  PubMed  Google Scholar 

  27. Ren J, Sowers JR, Zhang Y. Metabolic stress, autophagy, and cardiovascular aging: from pathophysiology to therapeutics. Trends Endocrinol Metab. 2018;29:699–711.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Tsubota K, Kawashima M, Inaba T, et al. The era of antiaging ophthalmology comes of age: antiaging approach for dry eye treatment. Ophthalmic Res. 2010;44:146–54.

    Article  PubMed  Google Scholar 

  29. Shiba C, Shiba T, Takahashi M, et al. Relationships among serum lipoprotein lipase mass, visceral fat, and retinal nerve fiber layer thickness. Graefes Arch Clin Exp Ophthalmol. 2015;253:1883–8.

    Article  CAS  PubMed  Google Scholar 

  30. Spielman LJ, Little JP, Klegeris A. Inflammation and insulin/IGF-1 resistance as the possible link between obesity and neurodegeneration. J Neuroimmunol. 2014;273:8–21.

    Article  CAS  PubMed  Google Scholar 

  31. Weisberg SP, McCann D, Desai M, et al. Obesity is associated with macrophage accumulation in adipose tissue. J Clin Invest. 2003;112:1796–808.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

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Authors and Affiliations

  1. PDICSS, Faculty of Medicine of Porto University (FMUP), Porto, Portugal

    Rita Laiginhas

  2. Department of Ophthalmology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal

    Rita Laiginhas & João Chibante

  3. Unit for Multidisciplinary Research in Biomedicine (UMIB), Endocrine, Cardiovascular and Metabolic Research, University of Porto, Porto, Portugal

    Marta Guimarães & Mário Nora

  4. Department of Anatomy, Institute of Biomedical Science Abel Salazar (ICBAS), University of Porto, Porto, Portugal

    Marta Guimarães

  5. Department of General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal

    Marta Guimarães & Mário Nora

  6. Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal

    Pedro Cardoso, Fernando Falcão-Reis & Manuel Falcão

  7. Department of Surgery, Centro Hospitalar e Universitário de São João, Porto, Portugal

    Hugo Santos-Sousa & John Preto

  8. Department of Surgery, Faculty of Medicine of Porto University (FMUP), Porto, Portugal

    Hugo Santos-Sousa

  9. Department of Surgery and Physiology, Faculty of Medicine of Porto University (FMUP), Porto, Portugal

    Fernando Falcão-Reis & Manuel Falcão

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  1. Rita Laiginhas
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  2. Marta Guimarães
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Correspondence to Manuel Falcão.

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The authors declare that they have no conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Laiginhas, R., Guimarães, M., Cardoso, P. et al. Retinal Nerve Fiber Layer Thickness Decrease in Obesity as a Marker of Neurodegeneration. OBES SURG 29, 2174–2179 (2019). https://doi.org/10.1007/s11695-019-03806-7

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  • DOI: https://doi.org/10.1007/s11695-019-03806-7

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