Response to Letter by Aly et al
We thank Aly et al for raising several interesting points. We had recorded the size of the lacunar infarct and were able to reanalyze the data as suggested. We found that of 105 patients with lacunar stroke, 72 had MRI scans showing the recent lesion of whom only 7 had a lesion equal to or greater than 15 mm. Of these 7, one patient had retinopathy (14%). In the 65 patients with a lacunar lesion less than 15 mm, 17 had retinopathy (26%). This difference is not significant (Fishers exact test P=0.6) possibly because of a small number of outcomes, but we should emphasize that this study was not powered to investigate subsets of lacunar stroke. If subsets of lacunar stroke do not show associations with retinopathy it is possible that retinopathy may just represent exposure to systemic vascular risk factors rather than predict who will develop small or large artery disease.