Retinal Vasculature: A Window on the Brain

See related article, pp 706–711 Ong et al1 studied 2907 participants in the Atherosclerosis Risk in Communities Study, who were free of diabetes mellitus, stroke, or coronary artery disease at baseline, and were followed for 13 years. Using retinal photographs and a simplified classification of hypertensive retinopathy, they found that even among patients who were well-controlled on antihypertensive medication, moderate/severe retinopathy carried a nearly 3-fold increase in the risk of stroke. Retinal signs of vascular pathology include an increased light reflex of the retinal arterioles (copper wiring or silver wiring, thought to occur as a result of atherosclerotic vessel wall thickening) and other arteriolar changes, including focal arteriolar narrowing, arteriovenous nicking, and microaneurysms. Retinal cotton-wool spots and exudates are the visible manifestations of small retinal infarctions and retinal hemorrhages, respectively, and represent the retinal consequences of the underlying arteriolar disease. All these findings predict an increased risk of vascular disease, and in particular, the risk of stroke,2 but the kind of stroke predicted differs with the retinal …