Retinal Vascular Changes are a Marker for Cerebral Vascular Diseases

Abstract

The retinal circulation is a potential marker of cerebral vascular disease because it shares origin and drainage with the intracranial circulation and because it can be directly visualized using ophthalmoscopy. Cross-sectional and cohort studies have demonstrated associations between chronic retinal and cerebral vascular disease, acute retinal and cerebral vascular disease, and chronic retinal vascular disease and acute cerebral vascular disease. In particular, certain qualitative features of retinopathy, retinal artery occlusion, and increased retinal vein caliber are associated with concurrent and future cerebrovascular events. These associations persist after accounting for confounding variables known to be disease-causing in both circulations, which supports the potential use of retinal vasculature findings to stratify individuals with regards to cerebral vascular disease risk.

Figure 1

Photographic image of the normal retinal circulation. Central retinal artery and vein (black arrow) pass through the optic nerve head (white dashed circle) and branch sequentially to supply (retinal arterioles) and drain (retinal venules) the inner retinal surface.

Figure 2

Photographic image of qualitative retinal circulation abnormalities characteristic of diabetic and hypertensive retinopathy. Bracket shows enhanced central arteriolar light reflex (copper wiring). Hollow arrow shows cotton wool spot, indicative of retinal infarct. Solid arrow shows focal narrowing of the venule at the site of arteriolar crossing (AV nicking). Oval shows hard exudates due to lipid deposition. Small arrows show retinal hemorrhages.