Patients with the eye condition paracentral acute middle maculopathy (PAMM) would benefit from further investigation, as their risk of heart attacks and strokes may be greater than previously shown, suggests a new study led by researchers at Moorfields Eye Hospital NHS Foundation Trust.

The investigating team looked at 78 patients diagnosed with PAMM, a clinical sign of impaired blood supply to the macula that can be detected by a routine retinal scan using optical coherence tomography (OCT). Half of PAMM patients had forms of retinal vascular disease that can cause sudden sight loss, including retinal vein occlusion and retinal artery occlusion, requiring further systemic investigation.

Interestingly, patients with PAMM but no retinal vascular disease were found to have a higher prevalence of cardiovascular disease and sickle cell disease, emphasising the need for thorough systemic evaluation as part of PAMM management. There is currently a lack of definitive and comprehensive guidance on the management of patients with a PAMM lesion, particularly when it presents in apparently healthy individuals.

Co-lead author Laxmi Raja said: “PAMM is a widely recognised condition; however, there are significant discrepancies in how it is managed. Our aim is to pave the way to formulating a robust management pathway to not only optimise patients’ vision but also their overall systemic health.”

Fellow lead author Celeste Limoli added: “To our knowledge, this is the largest multi-ethnic cohort study to evaluate potential causes and associations of PAMM and to establish a baseline of the sociodemographic profile of these patients. Our research indicates that the presence of a PAMM lesion in the retina of an otherwise apparently healthy eye should prompt further investigation to identify the most likely underlying causes.”

The study has been published in the American Journal of Ophthalmology. The cohort comprised NHS patients attending Moorfields between 2014 and 2021 who had received a provisional diagnosis of PAMM from either attending accident and emergency or scheduled clinic appointments.

The work is the latest example from Moorfields of world-leading research using retinal images to detect risk of systemic conditions such as cardiovascular disease, contributing to the exciting field of “oculomics”.

Although the importance of retinal vascular changes is well known for detection and management of diseases such as diabetic retinopathy, the significance of such changes has not yet been established for PAMM, and effective guidelines for investigating and managing patients are currently lacking. In this study, the authors make a step forward in identifying potential areas for targeting management of patients with PAMM.

The Moorfields’ research team is now working to evaluate the risk of cardiovascular events in patients presenting with PAMM and identify changes to risk over time.

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