Retinal Vascular Signs and Cerebrovascular Diseases

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Title Retinal Vascular Signs and Cerebrovascular Diseases
Creator Tyler Hyungtaek Rim; Alvin Wei Jun Teo; Henrik Hee Seung Yang; Carol Y. Cheung; Tien Yin Wong
Affiliation Singapore Eye Research Institute (THR, AWJT, HHSY, TYW), Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP) (THR, TYW), Duke-NUS Medical School, Singapore; and Department of Ophthalmology and Visual Sciences (CYC), The Chinese University of Hong Kong, Hong Kong
Abstract Background: Cerebrovascular disease (CeVD), including stroke, is a leading cause of death globally. The retina is an extension of the cerebrum, sharing embryological and vascular pathways. The association between different retinal signs and CeVD has been extensively evaluated. In this review, we summarize recent studies which have examined this association. Evidence acquisition: We searched 6 databases through July 2019 for studies evaluating the link between retinal vascular signs and diseases with CeVD. CeVD was classified into 2 groups: clinical CeVD (including clinical stroke, silent cerebral infarction, cerebral hemorrhage, and stroke mortality), and sub-clinical CeVD (including MRI-defined lacunar infarct and white matter lesions [WMLs]). Retinal vascular signs were classified into 3 groups: classic hypertensive retinopathy (including retinal microaneurysms, retinal microhemorrhage, focal/generalized arteriolar narrowing, cotton-wool spots, and arteriovenous nicking), clinical retinal diseases (including diabetic retinopathy [DR], age-related macular degeneration [AMD], retinal vein occlusion, retinal artery occlusion [RAO], and retinal emboli), and retinal vascular imaging measures (including retinal vessel diameter and geometry). We also examined emerging retinal vascular imaging measures and the use of artificial intelligence (AI) deep learning (DL) techniques. Results: Hypertensive retinopathy signs were consistently associated with clinical CeVD and subclinical CeVD subtypes including subclinical cerebral large artery infarction, lacunar infarction, and WMLs. Some clinical retinal diseases such as DR, retinal arterial and venous occlusion, and transient monocular vision loss are consistently associated with clinical CeVD. There is an increased risk of recurrent stroke immediately after RAO. Less consistent associations are seen with AMD. Retinal vascular imaging using computer assisted, semi-automated software to measure retinal vascular caliber and other parameters (tortuosity, fractal dimension, and branching angle) has shown strong associations to clinical and subclinical CeVD. Other new retinal vascular imaging techniques (dynamic retinal vessel analysis, adaptive optics, and optical coherence tomography angiography) are emerging technologies in this field. Application of AI-DL is expected to detect subclinical retinal changes and discrete retinal features in predicting systemic conditions including CeVD. Conclusions: There is extensive and increasing evidence that a range of retinal vascular signs and disease are closely linked to CeVD, including subclinical and clinical CeVD. New technology including AI-DL will allow further translation to clinical utilization.
Subject Cerebrovascular Disorders / diagnostic imaging; Cerebrovascular Disorders / pathology; Humans; Magnetic Resonance Imaging; Retina / diagnostic imaging; Retina / pathology; Retinal Vessels / diagnostic imaging; Retinal Vessels / pathology; Tomography, Optical Coherence
OCR Text Show
Date 2020-03
Language eng
Format application/pdf
Type Text
Publication Type Journal Article
Source Journal of Neuro-Ophthalmology, March 2020, Volume 40, Issue 1
Collection Neuro-Ophthalmology Virtual Education Library: Journal of Neuro-Ophthalmology Archives: https://novel.utah.edu/jno/
Publisher Lippincott, Williams & Wilkins
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management © North American Neuro-Ophthalmology Society
ARK ark:/87278/s6j44gzq
Setname ehsl_novel_jno
ID 1592860
Reference URL https://collections.lib.utah.edu/ark:/87278/s6j44gzq
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