Retinal microvascularisation abnormalities and cardiovascular risk.

The progress of retinal imaging techniques has made retinal microvascular circulation easier to study. A number of observational studies were conducted to characterise the different abnormalities encountered and to determine the factors contributing to their onset. Three lesion groups were highlighted, including reduced arteriolar diameter, venular dilatation and retinopathy lesions. Retinal arteriolar narrowing signals the presence of hypertension (current or old) and the risk of hypertension onset. A genetic factor was implicated in this relationship. Venular dilatation and retinopathy correlate with the presence of diabetes, obesity and metabolic disorders. This association appears to be mediated partly by the presence of endothelial dysfunction and inflammation. The relationship between these abnormalities and cardiovascular risk was also studied in a number of longitudinal studies: the presence of retinal microvascular abnormalities is related with an increased risk of cardiovascular morbidity and mortality predominantly in individuals under the age of 75. More specifically, retinopathy is correlated with the presence of cerebral white matter lesions detected by MRI, an increased stroke risk and deterioration in cognitive function. On the cardiovascular level, a correlation was demonstrated between diminished coronary reserve, increased coronary calcifications observed by CT scan, coronary morbidity and mortality, and risk of heart failure. New techniques of retinal imaging, such as laser Doppler flowmetry, are still undergoing assessment and will help further to clarify these correlations.