From the Journals

Retinal vessel diameter in children may offer window into future CVD risk

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Retinal vessel measurement not ready for prime time

Currently, retinal vessel diameters are not a strong contender for clinical risk prediction, Alan E. Simon, MD, and Matthew W. Gillman, MD, wrote in an editorial commenting on the study by Köchli et al.

However, the concept has “intuitive appeal because the eye provides the opportunity to view systemic arteries and veins directly,” wrote Dr. Simon and Dr. Gillman.

The association between childhood retinal vessel diameters and cardiovascular endpoints in adults has not been evaluated, understandably, because of the very long follow-up that would be required. And even though studies have suggested that there might be some small added benefit for women in adding adult retinal vessel diameters to other cardiovascular risk prediction scores, the same does not appear to be true for men.

Even if childhood retinal vessel diameters had strong predictive value, it’s still not clear whether the retinal vessel evaluation would be useful for pediatricians grouping patients into risk categories for strokes or heart attacks at some point in the future.

Likewise, using retinal vessel diameters as an outcome measure in clinical trials is not justified at present, although that could change in the future.

“As technological advances make this novel assessment more available to clinicians, we hope that such availability is accompanied by additional evidence for or against its usefulness among clinicians and researchers,” the authors said in the editorial.



Retinal vessel diameters are a sensitive biomarker for cardiovascular risk stratification in children, results of a recent meta-analysis suggest.

Body mass index, blood pressure, and physical activity all affect retinal vessel diameters, authors of the meta-analysis found.

The findings raise the possibility that, one day, clinicians could help “substantially counteract” the increasing burden of adult cardiovascular disease by diagnosing retinal microvascular impairments early in life, according to investigator Sabrina Köchli, MSc, and her colleagues with the department of sport, exercise, and health at the University of Basel (Switzerland).

“Regular retinal vessel screening may have the potential to be implemented in future medical examination programs to optimize therapy guidance in children and adolescents,” Ms. Köchli and her colleagues wrote in the journal Pediatrics.

The meta-analysis by Ms. Köchli and her coauthors included 11 studies looking at the association between BMI, blood pressure, or physical activity in children.

They found that higher BMI was associated with narrower retinal arteriolar diameters and wider venular diameters in 8 studies including a total of 5,003 participants. The pooled estimate effect size was –0.37 for the association between BMI and retinal arteriolar diameters and 0.35 for the association between BMI and retinal venular diameters, data showed.

Higher blood pressure likewise was associated with narrower retinal arteriolar diameters in 6 studies including 7,687 participants, with a pooled estimate of –0.63 for systolic blood pressure and –0.60 for diastolic blood pressure.


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