Retinal Microvascular Changes Do Not Predict Stroke Risk

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Researchers explored the link between short term ischemic events and presence of retinal microvascular change.

This article is part of Ophthalmology Advisor’s Focus on Retina coverage from the 2021 meeting of the American Academy of Ophthalmology, held in New Orleans from November 12 to 15, 2021. The team at Ophthalmology Advisor will be reporting on a variety of the research presented by the retinal experts at the AAO. Check back for more from the AAO 2021 Meeting.


Retinal microvascular changes do not appear to be linked to a 90-day risk of stroke or cardiovascular events, according to research presented at the American Academy of Ophthalmology 2021 meeting, held in New Orleans November 12-15. 

Researchers in this study sought to assess whether particular retinal microvascular findings in patients who have recently experienced a transient ischemic attack (TIA) are predictive for risk of either stroke or cardiovascular events within 90 days. The patients in the study had an NIH stroke scale of 3 or lower. The data was culled from 3 different emergency departments. 

Patients were examined using nonmydriatic fundus photographs to assess retinal microvascular findings. Retinal microvascular findings were defined as retinal hemorrhages, cotton wool spots, retinal emboli or occlusions, hard exudates, or microaneurysms. 

Of the 395 patients enrolled, 34 (9%) had at least 1 of these retinal microvascular findings. Following 90 days of their examination, 3 out of the 395 (0.8%) had a stroke, another 3 had a repeat TIA, and none had a cardiovascular event. 

All patients with stroke or recurrent TIA had an ABCD2 score of more than 3, vs 70% (273/295; P =.25) of other patients; none of them had microvascular findings, vs 9% (34/392; P =.59) of other patients. Overall, data from this study does not suggest that evidence of retinal microvascular findings are predictive of short-term ischemic events.


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Biousse V, Newman NJ, Bruce BB. Retinal microvascular changes do not appear to predict 90-day risk of stroke and CVEs among patients presenting to the emergency department with suspected TIA: the FOTO-TIA Study. Paper presented at: The American Academy of Ophthalmology 2021 Annual Meeting; November 12-15, 2021; New Orleans. Abstract PO272.