[Hypertensive retinopathy--assessment]

Abstract

The authors intend to make a synthesis of several recent studies available on the Internet regarding hypertensive retinopathy. From the physiopathologic point of view, it is considered that the blood circulation at the level of the retina, choroid and optical nerve has distinct anatomo-physiological properties. It has a different response to the changes in the blood pressure, the result consisting of distinct individual types of the hypertensive disease which can be rendered evident during the optical fundus examination. The retina is considered to be one of the target organs in the hypertensive disease. Ascertaining the retinal changes has advanced from ophthalmoscopy to digital photography studied with appropriate software. The assessment of the hypertensive microangiopathy is subjected to a wide intra- and interobserver variability an accurate assessment requiring specialized software and standardized protocols. There is also a lack of consensus regarding the classification of hypertensive retinopathy and the usefulness of retinal examination in the assessment of cardiovascular risk. The Keith and Scheie staging scales are still in use, but they do not allow the clinician to differentiate slight or even moderate changes at the level of the retina of hypertensive patients. Furthermore, they do not correlate enough with the severity of the high blood pressure and they are not supported by the angiofluorography studies. There are not enough motives for the recommendation of a routine ophthalmoscopic examination for all hypertensive patients. It is required for patients with stage-3 hypertension. It is also recommended when the initial clinical signs are equivocal, as in borderline or fluctuating high blood pressure without any other obvious signs from the target organs, for diabetic patients, or in the presence of visual symptoms. The clinical implications of hypertensive retinopathy being unclear, many of the authors do not recommend ophthalmoscopic examination as a rule, or they don't consider the retinal signs as being useful for therapeutic decisions.