The clinical assessment of retinal microvascular structure and therapeutic implications

Abstract

Examination of the retinal microvasculature is widely used to assess diabetic eye disease and as an indicator of target organ damage in hypertension. The diagnostic value of grading of hypertensive retinopathy is dubious; however, many recent studies have demonstrated that hypertensive retinopathy is associated with a range of risk factors for cardiovascular disease and may predict cardiovascular events independently of blood pressure. Developments in digital imaging and computer-assisted analysis have facilitated the quantitative assessment of microvascular changes in cardiovascular disease. These approaches may be useful for assessing cardiovascular risk and targeting therapeutic intervention.

Altered Blood Vessel Responses in the Eye and Finger in Coronary Artery Disease

“…6 -8 While these abnormalities are reflective of large artery disease, there is also evidence of disturbance in small arteries and arterioles, down to the level of the peripheral vascular beds (i.e., the microcirculation), 9,10 an example of which is retinal disease, as is often present in diabetic and hypertensive retinopathy. 11,12 However, it is as yet unclear whether microcirculatory changes are contributors to, or sequelae of, the disease process.…”

Effect of antihypertensive treatment on retinal microvascular changes in hypertension

“…In hypertension, both arteriolar narrowing [7][8][9][10] and rarefaction [9,10] are evident in the retina using quantitative assessment of retinal photographs acquired by noninvasive techniques. Retinal microvascular abnormalities have been reported to predict cardiovascular disease [11][12][13], coronary heart disease [12,14,15], stroke [16], incident hypertension [17] and new onset type 2 diabetes [18]; in consequence, there is increased interest in quantitative retinal assessment as a clinical tool [19].…”

“…Regression of retinal microvascular abnormalities may be of particular relevance to stroke, as microvascular disease is an important cause of stroke and the retinal circulation is part of the cerebral circulation [19].…”

Determinants of Retinal Microvascular Architecture in Normal Subjects

“…The retinal circulation is closely related to the cerebral circulation and offers a rare opportunity to visualize the arteriolar and venular circulations in man in vivo using noninvasive techniques. Examination of the retinal fundus is commonly used to assess retinal microvascular damage in diabetes and as an indicator of target organ damage in hypertension 9 . Recent studies have shown that the existence of retinopathy and, especially, more quantitative measures of retinal microvascular abnormalities, even in those without diabetes and hypertension, predict incident cardiovascular disease (CVD), including stroke 29 26 18 and ischemic heart disease, 24 , heart failure 32 , hypertension 33 , as well as type 2 diabetes, 34 , often independently of other traditionally used risk factors.…”