Retinal vessel diameters and function in cardiovascular risk and disease

In the last two decades evidence has gradually accumulated suggesting that the eye may be a unique window for cardiovascular risk stratification based on the assessment of subclinical damage of retinal microvascular struc-ture and function. This can be facilitated by non-invasive analysis of static retinal vessel diameters and dynamic recording of flicker light-induced and endothelial function-related dilation of both retinal arterioles and venules. Recent new findings have made retinal microvascular biomarkers strong candidates for clinical implementation as reliable risk predictors. Beyond a review of the current evidence and state of research, the article aims to discuss the methodological benefits and pitfalls and to identify research gaps and future directions. Above all, the potential use for screening and treatment monitoring of cardiovascular disease risk are highlighted. The article provides fundamental comprehension of retinal vessel imaging by explaining anatomical and physiological es-sentials of the retinal microcirculation leading to a detailed description of the methodological approach. This allows for better understanding of the underlying retinal microvascular pathology associated with the prevalence and development of cardiovascular disease. A body of new evidence is presented on the clinical validity and predictive value of retinal vessel diameters and function for incidence cardiovascular disease and outcome. Findings in children indicate the potential for utility in childhood cardiovascular disease prevention, and the efficacy of exercise interventions highlight the treatment sensitivity of retinal microvascular biomarkers. Finally, coming from the availability of normative data, solutions for diagnostic challenges are discussed and conceptual steps towards clinical implementation are put into perspective.

Automated summary

In the past two decades, evidence has accumulated suggesting that the eye can serve as a unique window for evaluating cardiovascular risk. By analyzing static retinal vessel diameters and recording the dilation of retinal arterioles and venules, researchers can assess subclinical damage to the retinal microvascular structure and function. These findings have the potential to be implemented clinically as reliable risk predictors. Methodological benefits, pitfalls, research gaps, and future directions are discussed in the article, along with the potential use of retinal vessel imaging for screening and monitoring cardiovascular disease. The article provides a comprehensive understanding of retinal vessel imaging, from the anatomical and physiological basics to the methodological approach, allowing for a better understanding of the association between retinal microvascular pathology and the development of cardiovascular disease.