Predicting Stroke Subtype Risk With Retinal Microvascular Abnormalities

retinal abnormalities
retinal abnormalities
The results suggest a noninvasive method for predicting individualized risk for certain stroke subtypes.
The following article is part of conference coverage from the 2018 American Academy of Neurology Annual Meeting in Los Angeles, California. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AAN 2018.

LOS ANGELES – Abnormalities in retinal microvasculature in midlife may be associated with increased stroke risk, especially lacunar, cardioembolic, and hemorrhagic stroke, as reported in a study presented at the 2018 American Academy of Neurology Annual Meeting, April 21-27 in Los Angeles.

A team of investigators led by Michelle P. Lin, MD, of Johns Hopkins University School of Medicine in Baltimore, Maryland, conducted a subanalysis of the Atherosclerosis Risk in Communities (ARIC) study to determine whether retinal microvascular lesions have different risk profiles across stroke subtypes.

The population-based cohort includes 10,468 participants aged 45 to 65 years without stroke. The cohort underwent retinal imaging and were followed for incident stroke over a 20-year period. Abnormal retinal microvasculature was defined as any arteriovenous nicking, focal arteriolar narrowing, retinal microaneurysms, or retinal hemorrhage, with severity determined by the number of these abnormalities, with a maximum score of 4.

Overall, 6.4% (673) of participants developed incident stroke over a median follow-up of 18.8 years. Of those, 578 were ischemic (114 lacunar, 292 nonlacunar, 172 cardioembolic) and 95 were hemorrhagic in nature. Fifteen-year cumulative incidence of stroke was 4.3% vs 1.9% in patients with abnormal vs normal retinal microvasculature, respectively (P <.001). After adjustment, retinal microvasculopathy was found to have a positive association with ischemic stroke, specifically lacunar (hazard ratio 1.8; 95% CI, 1.2-2.7), but not with cardioembolic (HR 1.2; 95% CI, 0.8-1.6), hemorrhagic (HR 1.2; 95% CI, 0.8-1.9), or nonlacunar strokes (HR 1.3; 95% CI, 0.9-1.6). Notably, those with a greater number of abnormal retinal microvascular characteristics were at higher risk for ischemic and lacunar stroke (P <.05) but not other stroke subtypes.

Dr Lin pointed out that while all of the retinal images were reviewed at a single center, many of the photographs were unreadable and only captured a small area of the retina, which may have contributed to underestimation of the prevalence of retinal microvasculature abnormalities.

Still, the investigators concluded that “retinal imaging may offer a noninvasive tool to study the pathogenesis of cerebral small vessel disease.”

For more coverage of AAN 2018, click here.


Lin MP, Richey Sharrett A, Klein BE, Deal JA, Gottesman RF. Retinal microvasculature in predicting risk of stroke subtypes. Presented at: 2018 American Academy of Neurology Annual Meeting. April 21-27, 2018; Los Angeles, CA. Abstract CCI 001.