[Systemic cardiovascular risk assessment. Conventional or eye fundus-based?]

Abstract

Several systemic cardiovascular (CV) risk assessment algorithms exist, of which the ESC HeartScore, Framingham and PROCAM are the most frequently applied in Germany. The risk estimates generated differ and take a number of different risk factors into consideration. Due to existing homology of retinal vessels and brain vessels, eye fundus examination is a promising approach to improving risk prediction. Large cohort studies investigated retinal vascular changes, including arteriovenous ratio, as well as signs of retinopathy such as cotton-wool spots, microaneurysms, or retinal hemorrhages for their ability to predict systemic cardiovascular events. While signs of retinopathy proved to have high predictive power (but are rarely diagnosed,) the retinal vascular changes investigated could contribute little to enhancing systemic CV risk prediction. A number of new and promising approaches based on static and dynamic retinal analysis exist, but still need to be validated prospectively.