This Article Full Text Full Text (PDF) CME: Take the course for this article: Stroke: April 2008, Volume 39, Number 4 All Versions of this Article: 39/4/1371    most recent STROKEAHA.107.496091v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Baker, M. L. Articles by Wong, T. Y. PubMed PubMed Citation Articles by Baker, M. L. Articles by Wong, T. Y. Related Collections Epidemiology Cerebrovascular disease/stroke Type 2 diabetes Imaging Pathology of Stroke Risk Factors for Stroke

(Stroke. 2008;39:1371.)
© 2008 American Heart Association, Inc.

Progress Review

Retinal Signs and Stroke

Revisiting the Link Between the Eye and Brain

Michelle L. Baker, MD; Peter J. Hand, MD, FRACP; Jie Jin Wang, MMed, PhD Tien Y. Wong, FRANZCO, PhD

From the Centre for Eye Research Australia (M.L.B., J.J.W., T.Y.W.), University of Melbourne, Victoria, Australia; the Department of Neurology (M.L.B., P.J.H.), Royal Melbourne Hospital, Victoria, Australia; the Centre for Vision Research (J.J.W.), University of Sydney, Sydney, Australia; and the Singapore Eye Research Institute (T.Y.W.), National University of Singapore, Singapore.

Correspondence to Tien Y. Wong, Centre for Eye Research Australia, University of Melbourne, 32 Gisborne Street, East Melbourne 3002, Australia. E-mail twong{at}unimelb.edu.au

Background and Purpose— The retinal and cerebral vasculature share similar anatomic, physiological, and embryological characteristics. We reviewed the literature, focusing particularly on recent population-based studies, to examine the relationship between retinal signs and stroke.

Summary of Review— Hypertensive retinopathy signs (eg, focal retinal arteriolar narrowing, arterio-venous nicking) were associated with prevalent stroke, incident stroke, and stroke mortality, independent of blood pressure and other cerebrovascular risk factors. Diabetic retinopathy signs (eg, microaneurysms, hard exudates) were similarly associated with incident stroke and stroke mortality. Retinal arteriolar emboli were associated with stroke mortality but not incident stroke. There were fewer studies on the association of other retinal signs such as retinal vein occlusion and age-related macular degeneration with stroke, and the results were less consistent.

Conclusion— Many retinal conditions are associated with stroke, reflecting possible concomitant pathophysiological processes affecting both the eye and the brain. However, the incremental value of a retinal examination for prediction of future stroke risk remains to be determined.

Key Words: stroke • mortality • hypertensive retinopathy • diabetic retinopathy • population-based cohort