Information for this review was identified from MEDLINE with combinations of the search terms “stroke”, “retinal photographs”, “retinal microvascular”, “retinal arteriolar”, and “retinopathy”. The search was limited to publications from 1990 to 2003, although key studies from before 1990 were also included. From the articles identified, original investigations and review articles were included. The reference lists of articles were also searched for additional relevant articles.
Rapid ReviewIs retinal photography useful in the measurement of stroke risk?
Section snippets
Assessment of retinal microvascular signs from retinal photographs
Retinal photography is a potentially sensitive and precise method of assessing retinal microvascular signs. This concept is supported by current studies. In general, reproducibility from photographs has been found to be excellent for well-defined retinopathy signs (kappa values have ranged from 0·80 to 0·99 for microaneurysms and retinal haemorrhages) and fair to moderate for other more subtle retinal arteriolar lesions (0·80–0·79 for arteriolar narrowing and arteriovenous nicking).11, 12, 13
Association of retinal microvascular signs and stroke
The association of retinal microvascular changes with hypertension is well known. Newer data, including those from several population-based studies, indicate that retinal microvascular changes, when defined from photographs, are associated with stroke and various cerebrovascular diseases independent of hypertension (table).8, 9, 13, 14, 19, 20, 21, 22
The Atherosclerosis Risk In Communities (ARIC) study is a population based cohort investigation of cardiovascular disease and its risk factors
Research and clinical implications
These recent studies raised the intriguing possibility that retinal photography may be useful for further understanding the association of microvascular disease with stroke and other vascular disorders of the brain. Retinal microvascular lesions are pathologically related to hypertension and diabetes severity.3 Some retinal changes, such as generalised retinal arteriolar narrowing and arteriovenous nicking, seem to be related to chronically high blood pressure,26 and systemic markers of
Future opportunities
There are several opportunities for future research. First, researchers should develop a common and standardised photographic classification of these retinal microvascular changes that is not only based on pathophysiological data, but also relevant to contemporary clinical situations. This will facilitate comparative clinical and epidemiological studies. A classification system similar to diabetic retinopathy classification is ideal. Second, it is important to replicate some of these findings
Conclusions
Improved prevention of stroke and other cerebrovascular diseases requires a greater understanding of their pathogenetic mechanisms, identification of novel risk factors, and development of new approaches to identification of people at high risk. Recent studies suggest that retinal microvascular abnormalities are markers of concomitant cerebral microvascular diseases, and that a retinal photographic examination may provide a unique method for investigating subclinical microangiopathy in people
Search strategy and selection criteria
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