ASSOCIATION BETWEEN COPD SEVERITY AND RETINAL MICROVASCULAR CHANGES: A CROSS-SECTIONAL STUDY

Abstract

Background Chronic obstructive pulmonary disease (COPD) is associated with systemic inflammation, endothelial dysfunction and chronic hypoxemia, mechanisms that may also affect the retinal microcirculation. Optical coherence tomography angiography (OCTA) provides a non-invasive method for quantifying retinal vascular density. Previous clinical studies have reported lower retinal vessel density in more severe COPD, supporting investigation of the lung–retina relationship.
Aim To assess the association between COPD severity and retinal microvascular parameters measured by OCTA in patients with stable COPD.
Methods A hospital-based cross-sectional observational study was structured according to the collected data. A fixed cohort of 100 adults with spirometry-confirmed COPD was evaluated. Demographic characteristics, smoking exposure, BMI, COPD duration, oxygen saturation, spirometry and OCTA parameters were recorded. Patients were classified into GOLD 1–4 groups according to post-bronchodilator FEV1% predicted. OCTA measurements included superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density in the whole image, foveal, parafoveal and perifoveal regions, together with radial peripapillary capillary (RPC) density and foveal avascular zone (FAZ) area.
Results The cohort had a mean age of 64.8 ± 9.1 years and was predominantly male (82%). Mean FEV1 was 48.7 ± 17.2% predicted. Retinal microvascular density progressively decreased with increasing COPD severity. Mean foveal SCP density was 22.8 ± 5.1% in GOLD 1, 21.5 ± 5.0% in GOLD 2, 19.0 ± 4.7% in GOLD 3 and 16.4 ± 4.5% in GOLD 4. Mean foveal DCP density was 39.1 ± 6.5%, 37.0 ± 6.2%, 33.1 ± 6.0% and 29.2 ± 5.6%, respectively. The differences were statistically significant. FEV1% predicted and resting SpO₂ showed positive correlations with foveal and parafoveal vessel density, whereas mMRC score and smoking exposure showed inverse correlations.
Conclusion Greater COPD severity was associated with lower retinal microvascular density in this cohort. OCTA may provide a non-invasive window into systemic microvascular alterations associated with COPD.