Advancing Retinal Imaging for Cardiovascular Risk Assessment
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By
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Federico Bernardo Rossi
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Antonio Gallo
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Philippe Giral
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May 1, 2026
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Clinical Scorecard: Enhancing Retinal Imaging Techniques for Evaluating Cardiovascular Risk
At a Glance
| Category | Detail |
|---|
| Condition | Cardiovascular Risk Assessment |
| Key Mechanisms | Retinal capillary rarefaction and microvascular abnormalities as indicators of systemic cardiovascular disease. |
| Target Population | Asymptomatic individuals at high cardiovascular risk, particularly those with hypertension and diabetes. |
| Care Setting | Clinical settings utilizing optical coherence tomography angiography (OCTA). |
Key Highlights
- Coronary artery calcium (CAC) score provides prognostic value beyond traditional risk factors.
- Retinal imaging may enhance noninvasive cardiovascular risk assessment.
- Microvascular rarefaction and resistance-artery remodeling are early indicators of systemic cardiovascular disease.
- Retinal ischemic perivascular lesions may indicate occult microvascular ischemia.
- Integration of OCTA indices with structural markers could improve risk prediction.
Guideline-Based Recommendations
Diagnosis
- Utilize OCTA to assess retinal microvascular health in high-risk populations.
Management
- Monitor blood pressure and glycemic control to evaluate their impact on retinal perfusion metrics.
Monitoring & Follow-up
- Conduct sensitivity analyses in hypertensive individuals to understand the effects of blood pressure on microvascular perfusion.
Risks
- Consider the variability in retinal perfusion metrics due to changes in blood pressure control or antihypertensive therapy.
Patient & Prescribing Data
Individuals with hypertension and diabetes at risk for coronary atherosclerosis.
Retinal imaging may serve as an opportunistic assessment tool during routine ophthalmic evaluations.
Clinical Best Practices
- Combine perfusion-based OCTA indices with structural analyses for comprehensive cardiovascular risk assessment.
- Advocate for further research to establish retinal imaging as a clinically actionable strategy for early vascular disease detection.
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