Changes in the Fundus Oculi in Relation to Hypertension

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AN understanding of the relationship of changes in the fundus oculi to grades of hypertension is important alike to the internist and the ophthalmologist. Various approaches to the study of the relationship have been suggested. These have been based on arbitrary classifications of ophthalmoscopic changes and hypertensive states, the early reports of which were those of Keith, Wagener and Barker1 in 1939, and of Wagener, Clay and Gipner2 in 1946. Wilson,3 in 1952, compared the two studies and suggested that a working combination of both classifications could be used. I have found the combination to be a practical basis for evaluating the over-all vascular status of the patient. Recently Minsky4 introduced a scheme of correlating ocular changes with diastolic blood pressure. To each type of retinal change he assigned a specific numerical value that he used in a mathematical formula to calculate the expected diastolic pressure. It is too soon as yet to assess the value of this procedure.


The ophthalmoscopic changes associated with hypertension may be classified into two groups: (1) Angiopathy, which includes generalized and focal vascular sclerosis and narrowing of arterioles; and (2) Retinopathy, which includes hemorrhages, exudates, neovascularization, papilledema, and macular stars.


Recognition and Grading of Sclerosis

There still is much confusion in regard to recognition and grading of sclerosis in the fundus oculi. The chief problem is to differentiate between atherosclerosis and arteriolar sclerosis. Only the central retinal artery and the larger branches near the disc are true arteries. At. . .



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