Hypertension and the eye

Abstract

Purpose of review: This article reviews the findings of systemic hypertension in the eye and how these changes represent disease in the eye itself, as well as the predictive value of fundoscopic findings in relation to overall health. Systemic hypertension is associated with observable changes in the retinal microvasculature, including retinopathy, choroidopathy and optic neuropathy, as well as with an increased risk of ocular vascular abnormalities such as arterial and venous occlusive disease, retinal arteriolar macroaneurysm formation and embolic events. Hypertension also confers increased risk for development and progression of diabetic retinopathy, glaucoma and age-related macular degeneration. Grading systems have been proposed that attempt to correlate observed ocular hypertensive changes with systemic vascular disease severity, morbidity and mortality.

Recent findings: The widespread availability of digital imaging systems and computer analysis along with revised grading systems has enabled a more precise and reliable examination. This has renewed the interest in the use of routine fundoscopic screening for patients with hypertension in an effort to identify microvascular changes that may provide prognostic information for cardiovascular risk stratification and disease progression.

Summary: Identification of early microvascular changes on fundoscopic examination using reliable and reproducible imaging techniques may become an important and routine screening modality for the prevention and management of both the ocular and systemic complications of hypertension.