Screening for Retinal Ischemic Perivascular Lesions in Patients Undergoing Cardiovascular Assessment: A Cross-Sectional Study

Abstract

Purpose: Retinal ischemic perivascular lesions (RIPLs) are OCT findings associated with chronic retinal ischemia. Previous studies have proposed that RIPLs may serve as anatomical biomarkers for cardiovascular disease; however, their clinical significance remains uncertain. This study aims to evaluate the prevalence of RIPLs in a cardiovascular clinic and assess their association with major adverse cardiovascular events (MACE).

Design: Observational cross-sectional study of prospectively enrolled patients.

Participants: A total of 559 patients undergoing cardiovascular ultrasound at a vascular imaging laboratory.

Methods: Nonmydriatic 6 × 6 mm OCT angiography scans were obtained on the same day of ultrasound, and RIPLs were manually identified based on inner retinal layer thinning with compensatory outer nuclear layer expansion.

Main outcome measures: The prevalence of RIPLs was compared between patients with and without a history of MACE, defined as prior myocardial infarction (MI), stroke, transient ischemic attack (TIA), or coronary/carotid revascularization.

Results: Among 559 included patients (mean age 61.9 ± 12.5 years; 54.4% female), 26.3% had at least 1 RIPL. A history of MACE was present in 35.1% of patients; however, the prevalence of RIPLs did not differ significantly between those with MACE (28.6%) and those without (25.1%) (P = 0.426), despite the MACE group having a higher prevalence of traditional cardiovascular risk factors, including hypertension, dyslipidemia, diabetes, and smoking history (P < 0.05). Similarly, no significant differences were found in subgroup analyses of patients with prior MI (P = 0.688), stroke/TIA (P = 0.394), or revascularization (P = 0.369). The prevalence of RIPLs did not differ across atherosclerotic cardiovascular disease risk categories in patients without prior MACE.

Conclusions: In this large, prospectively enrolled cardiovascular cohort, RIPLs were found in only a quarter of eyes, providing preliminary evidence for their prevalence in this population. Additionally, RIPLs were not significantly associated with a history of MACE. Although RIPLs may reflect microvascular pathology, these findings challenge prior reports linking them to broader systemic cardiovascular disease and call for prospective longitudinal studies to clarify their clinical utility in cardiovascular risk assessment.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: Biomarkers; Cardiovascular diseases; OCT; Oculomics; Retinal ischemia.