Published Online
on February 28, 2008

A more recent version of this article appeared on April 1, 2008

This Article 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 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 Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Baker, M. L. Articles by Wong, T. Y. Search for Related Content PubMed PubMed Citation Articles by Baker, M. L. Articles by Wong, T. Y. Pubmed/NCBI databases Medline Plus Health Information Retinal Disorders Stroke Related Collections Cerebrovascular disease/stroke Imaging Type 2 diabetes Pathology of Stroke Risk Factors for Stroke Epidemiology

Submitted on June 11, 2007
Revised on August 4, 2007
Accepted on September 13, 2007

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; and 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.

^* To whom correspondence should be addressed. 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

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