Background and Purpose: We aimed to find the relationship between retinal nerve fiber layer (RNFL) thickness and the relevant risk factors of different stroke subtypes of TOAST classification, in order to make a better primary prevention of stroke.
Method: The study population came from the first follow- up of the Asymptomatic Polyvascular Abnormalities Community study (APAC) population. We finished the questionnaire of epidemiological information and medical history during the baseline time, and finished the physical and laboratory examination, transcranial doppler, carotid ultrasound, cognitive functional scale and ophthalmological optical coherence tomography (OCT) examination to measure the thickness of RNFL and whether there exists intracranial artery stenosis (ICAS), extracranial artery stenosis (ECAS) or cognitive impairment. Then we discuss the association between RNFL thickness and the risk factors of stroke mentioned above.
Results: We included 5440 participants at baseline and 3376 finished the follow- up eventually. The average thickness of RNFL was 101.89± 10.53 μm. As RNFL became thinner, the percentage of older age, male sex and hypertension became higher (P<0.001). We also found out that ICAS and ECAS, especially ECAS increased as RNFL become thinner (OR:0.982,95% CI:0.969- 0.996,P= 0.011), and the severity of ECAS became worse when RNFL was thinner (P=0.001), and retinal central arteriolar was narrower (P=0.003). What is more, RNFL thickness is associated with cognitive impairment as well (P< 0.05).
Conclusion: The thickness of RNFL is associated with stroke risk factors, such as older age, male sex and hypertension. As RNFL became thinner, the prevalence of ICAS and ECAS, which are the main cause of LAA stroke, became higher, and the severity of ECAS became worse. The thinner RNFL was also relevant with cognitive impairment, which is common in the SAO stroke. The results provide a new point of view on stroke classification and prevention.