In principle, funduscopy is a fascinating method to investigate in vivo the intracranial vasculature for hypertension related changes. The authors rightly point out, however, that vascular changes in themselves (stages I and II of hypertensive retinopathy) are not very meaningful. The overlap with “normal” (for example, age related) vascular changes is too big for the ophthalmologist to be able to contribute to risk assessment in individual patients. In patients with parenchymatous changes of stages III and IV, due to highly elevated blood pressure any treating general practitioner or specialist in internal medicine knows that urgent treatment is required. Ophthalmologists can therefore not contribute any further information that would be of additional benefit in this scenario either. However, Professor Schmieder’s article (2) suggests that using new, computer supported methods for vascular analysis of the ocular fundus improves prediction of patients’ individual risk of developing hypertensive complications. Some individual health services (that patients have to pay for) create the same impression. A recent literature review does not support this assumption (1). Rather, it summarizes that computer aided methods to detect less pronounced vascular changes currently contribute little additional information to risk prediction made by the internal medical specialist.

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