Retinal Arteriolar Emboli Research Articles

Meaningful correlation between asymptomatic retinal arteriole emboli and calcified carotid plaque found on panoramic dental imaging of males with diabetes

There is ongoing controversy with regard to the stability of calcified carotid artery plaques (CCAPs) seen in the bifurcation area on panoramic images (PIs). Therefore, we sought to evaluate the possibility of these plaques shedding emboli by observing their relationship with ipsilateral retinal emboli. The study group included 50 neurologically and visually asymptomatic males with diabetes, with PIs that incidentally demonstrated CCAPs (CCAP+) and contemporaneous digital retinal images that had been obtained for evaluation of diabetic retinopathy. The control group consisted of 50 males with diabetes who were matched for age and body mass index and had undergone both imaging studies and whose PIs were devoid of carotid plaques (CCAP-). The presence of retinal emboli was determined by two ophthalmologists blinded to the patients' medical histories, and the prevalence rates for the two groups were calculated. The presence of asymptomatic retinal arteriolar emboli was found in the eye ipsilateral to the radiographically observed carotid atheroma in 10 of 50 (20%) of the patients in the CCAP+ group, compared with 2 of 50 (4%) in the CCAP-group, and this difference was statistically significant (Fisher's exact P < .03). Some male patients with diabetes mellitus type II having calcified carotid artery atheromas in the bifurcation area, as visualized on PIs, may have significant sequelae as evidenced by retinal artery emboli.

Ocular Manifestations of Systemic Diseases: The Eyes are the Windows of the Body

An ocular manifestation of a systemic disease is an eye condition that directly or indirectly results from a disease process originating from another part of the body. There are many diseases known to cause ocular or visual changes as a result of systemic disease. Diabetes, for example, is the leading cause of new cases of blindness in those aged 20-74, with ocular manifestations such as diabetic retinopathy and macular edema affecting up to 80% of those who have had the disease for 15 years or more. Other diseases such as acquired immunodeficiency syndrome (AIDS) and hypertension are commonly found to have associated ocular symptoms. Physicians need to consider that systemic disease can involve the eyes and it is important for ophthalmologists to understand that they may be the first to suggest a diagnosis due to underlying systemic disease. According to the quote “The eyes are the windows of the soul”, ophthalmologists should view the eyes as not only windows of the soul but also a window to the physical state of the entire body. Systemic hypertension is a major risk factor for the development of retinal vascular diseases including hypertensive retinopathy, retinal vein or artery occlusion, and embolic events. High blood pressure also increases the risk for the development and progression of diabetic retinopathy. Signs of hypertensive retinopathy are predictive of target-organ damage including cardiovascular and cerebrovascular diseases [1]. High blood pressure affects the heart, kidney, brain, large arteries, and also the eyes. Retinal, choroidal, and optic nerve circulations undergo pathophysiological changes resulting in clinical signs referred to as hypertensive retinopathy, hypertensive choroidopathy, and hypertensive optic neuropathy. Systemic hypertension also increases the risk for the development of retinal vein and artery occlusion, retinal-arteriolar emboli, and diabetic retinopathy. Diabetic retinopathy is one of the common causes of blindness. It is an ocular manifestation of diabetes, which affects up to 80 percent of all patients who have had diabetes for 20 years or more. Diabetic macular edema is the most common cause of visual dimness in patients with diabetic retinopathy. Dr. Lee will discuss the challenges and current treatments to prevent the visual disturbance related to diabetic macular edema [2]. Systemic lupus erythematosus (SLE) is an autoimmune disease in which the body’s immune system mistakenly attacks healthy tissue in many parts of the body. SLE is a potentially life-threatening multisystem disease that is commonly associated with ocular manifestations. The purpose of this review is to outline the ocular manifestations of SLE and treatments [3]. Ocular complications have been reported in up to one-third of patients with SLE. Ocular manifestations can be associated with significant morbidity and eye issues may play a role as a marker for systemic disease activity. Keratoconjunctivitis sicca is the most common ocular problem in patients with SLE. When ophthalmologists see patients complaining of dry eye symptoms, determining the underlying reason as to why these patients are suffering from dry eye symptoms is important. The hypo-secretion of tears is one cause of dry eye symptoms.

Hypertension-related eye abnormalities

Hypertension affects a significant proportion of the population, however, it is often diagnosed with a delay. The aim of this article is to review the well known and less known eye abnormalities related to hypertension, and place them in the context of population based studies. Hypertension affects various parts of the eye. The originally classified hypertensive retinopathy (retinal microvascular changes) is still relevant, but new features are visible in cases of controlled hypertension. Signs of mild hypertensive retinopathy are more common than expected occurring in nearly 10–15% of the adult non-diabetic population. Hypertensive retinopathy can be an indicator of other hypertensive complications such as neurologic and cardiac complications. Microvascular changes are reversible in well controlled hypertension. Proper treatment of hypertension can reduce the development and progression of diabetic retinopathy and, thus, visual loss due to severe retinal diseases such as retinal vascular occlusion (artery and vein), retinal arteriolar emboli, macroaneurysm, ischemic optic neuropathy and age-related macular degeneration.Orv. Hetil., 154(45), 1773–1780.

Ocular manifestations of hypertension

Elevated blood pressure leads to a multitude of vascular changes in eye. The earliest ocular effect of hypertension comprises of retinal microvascular changes called hypertensive retinopathy which is associated with indicators of end-organ damage (e.g., left ventricular hypertrophy, renal impairment) and may herald future risk of clinical events such as stroke, congestive heart failure and cardiovascular mortality.Hypertension is also a major risk factor for the development and progression of diabetic retinopathy and has been associated with other ocular diseases such as retinal artery and vein occlusion, retinal arteriolar emboli, retinal macroaneurysm, glaucoma and age-related macular degeneration. In the management of patients with hypertension, physicians must be aware of the entire spectrum of the association between blood pressure and the eye.

How does hypertension affect your eyes?

Hypertension has profound effects on various parts of the eye. Classically, elevated blood pressure results in a series of retinal microvascular changes called hypertensive retinopathy, comprising of generalized and focal retinal arteriolar narrowing, arteriovenous nicking, retinal hemorrhages, microaneurysms and, in severe cases, optic disc and macular edema. Studies have shown that mild hypertensive retinopathy signs are common and seen in nearly 10% of the general adult non-diabetic population. Hypertensive retinopathy signs are associated with other indicators of end-organ damage (for example, left ventricular hypertrophy, renal impairment) and may be a risk marker of future clinical events, such as stroke, congestive heart failure and cardiovascular mortality. Furthermore, hypertension is one of the major risk factors for development and progression of diabetic retinopathy, and control of blood pressure has been shown in large clinical trials to prevent visual loss from diabetic retinopathy. In addition, several retinal diseases such as retinal vascular occlusion (artery and vein occlusion), retinal arteriolar emboli, macroaneurysm, ischemic optic neuropathy and age-related macular degeneration may also be related to hypertension; however, there is as yet no evidence that treatment of hypertension prevents vision loss from these conditions. In management of patients with hypertension, physicians should be aware of the full spectrum of the relationship of blood pressure and the eye.

OCCURRENCE OF SECTORAL CHOROIDAL OCCLUSIVE VASCULOPATHY AND RETINAL ARTERIOLAR EMBOLIZATION AFTER SUPERSELECTIVE OPHTHALMIC ARTERY CHEMOTHERAPY FOR ADVANCED INTRAOCULAR RETINOBLASTOMA

Superselective ophthalmic artery chemotherapy (SOAC) has recently been proposed as an alternative to intravenous chemoreduction for advanced intraocular retinoblastoma. Preliminary results appear promising in terms of tumor control and eye conservation, but little is known regarding ocular toxicity and visual prognosis. In this study, we report on the vascular adverse effects observed in our initial cohort of 13 patients. The charts of 13 consecutive patients with retinoblastoma who received a total of 30 injections (up to 3 injections of a single agent per patient at 3-week interval) of melphalan (0.35 mg/kg) in the ophthalmic artery between November 2008 and June 2010 were retrospectively reviewed. RetCam fundus photography and fluorescein angiography were performed at presentation and before each injection. Vision was assessed at the latest visit. Enucleation and external beam radiotherapy could be avoided in all cases but one, with a mean follow-up of 7 months. Sectoral choroidal occlusive vasculopathy leading to chorioretinal atrophy was observed temporally in 2 eyes (15%) 3 weeks to 6 weeks after the beginning of SOAC and retinal arteriolar emboli in 1 eye 2 weeks after injection. There was no stroke or other clinically significant systemic side effects except a perioperative transient spasm of the internal carotid artery in one patient. Vision ranged between 20/1600 and 20/32 depending on the status of the macula. Superselective ophthalmic artery chemotherapy was effective in all patients with no stroke or other systemic vascular complications. Unlike intravenous chemoreduction, SOAC is associated with potentially sight-threatening adverse effects, such as severe chorioretinal atrophy secondary to subacute choroidal occlusive vasculopathy or central retinal artery embolism, not to mention the risk of ophthalmic artery obstruction, which was not observed in this series. Further analysis of the risks and benefits of SOAC will define its role within the therapeutic arsenal. Meanwhile, we suggest that SOAC should be given in one eye only and restricted to advanced cases of retinoblastoma, as an alternative to enucleation and/or external beam radiotherapy.

Risk Factors for Retinal Arteriolar Emboli in Coronary Artery Disease

This study determined the prevalence of retinal arteriolar emboli risk factors in 148 patients (86 males) diagnosed with coronary artery disease who required coronary artery bypass graft surgery (mean +/- SD age 59.1 +/- 12.9 years). The prevalence of smoking was 50.7%, hypertension was 49.3%, diabetes mellitus was 27.0% and obesity was 31.1%. Retinal arteriolar emboli were detected using binocular indirect ophthalmoscopy of both eyes. They were found in 10 patients (6.8%) and identified as the cholesterol type. Patients were divided according to their baseline low-density lipoprotein cholesterol (LDL-C) serum level; retinal arteriolar emboli were significantly more frequent in patients with LDL-C levels > 100 mg/dl. These results demonstrate that the prevalence of hypercholesterolaemia and high LDL-C were increased in patients with retinal arteriolar emboli. Identification and treatment of modifiable risk factors, such as high LDL-C and hypercholesterolaemia, might be beneficial in these individuals.

Retrospective Review of Incidental Retinal Emboli Found on Diabetic Retinopathy Screening: Is There a Benefit to Referral for Work-Up and Possible Management?

With the rising utilization of diabetic retinopathy photography screening programs across the country, many clinical and socioeconomic questions remain. For the most part, diabetic retinopathy findings have standard follow-up and referral guidelines.1 However, management of other pathology, such as retinal arteriolar emboli, in this patient population is less clear. The association of these lesions with cerebrovascular and cardiovascular morbidity and mortality has been well described in the literature.2,3 Retinal emboli are associated with a higher risk of stroke4 and, as shown by a pooled analysis of two large, population-based studies, predict a modest increase in all-cause and stroke-related mortality independent of cardiovascular risk factors.5 Retinal emboli have been identified in 1.3-1.4%6,7 of individuals > 40 years of age. These are plaque-like lesions wedged within retinal arterioles. They are oval- or rhomboid-shaped and have either a reflective or nonreflective appearance.8,9 Reflective emboli are composed of cholesterol crystals, whereas nonreflective types consist of fibrin, platelets, and calcium.10 Cholesterol emboli, also known as Hollenhorst plaques, are the most common, accounting for about 80%.7,11 There are various sources for retinal arteriolar emboli. It is thought that cholesterol emboli ulcerate from atheromatous internal or common carotid plaques, platelet-fibrin emboli arise from mural thrombus in the carotid, and calcific emboli originate from cardiac valvular structures.12,13 The relationship between diabetes and retinal emboli is not well characterized. Of the two large studies that have examined retinal emboli—the Beaver Dam Eye Study (BDES)6 and the Blue Mountains Eye Study (BMES)7—only the BDES found that subjects with retinal emboli had a higher prevalence of diabetes than when compared to those patients without retinal emboli. Because retinal arteriolar emboli are associated with a higher risk of stroke and …

Acute Retinal Arteriolar Emboli After Cardiac Catheterization

There are concerns that cardiac catheterization may cause retinal embolization, a risk marker for cerebrovascular emboli and stroke. We describe the incidence of acute retinal embolism after cardiac catheterization. One hundred unselected patients attending a tertiary referral center for diagnostic cardiac catheterization were recruited. Digital retinal photography (optic disc and macular fields) was performed precatheterization and within 3 hours postcatheterization. New retinal emboli were identified by a senior researcher and confirmed by a retinal specialist. There was one case of retinal embolus precatheterization. Two patients (incidence 2.02%; 95% CI, 0.25 to 7.11) developed new retinal arteriolar emboli after catheterization. No patient developed clinically apparent visual or neurological changes. The risk of acute retinal embolism immediately after cardiac catheterization is 2%. This finding indicates that the retinal, and possibly the cerebral circulation, may be compromised more frequently than is clinically apparent as a complication of cardiac catheterization.

Prevalence and Risk Factors of Retinal Arteriolar Emboli: The Singapore Malay Eye Study

To examine the prevalence and risk factors of retinal arteriolar emboli, a risk predictor of stroke, in an Asian population. Population-based cross-sectional study. Retinal emboli were ascertained from retinal photographs obtained from both eyes of 3,265 Asian Malays, aged 40 to 80 years, according to a standardized protocol. Risk factors were assessed from detailed standardized interviews, clinical examinations, and laboratory investigations. The overall prevalence of retinal emboli was 0.6% (95% confidence interval [CI], 0.58 to 0.62). A finding of retinal emboli was strongly associated with increasing age (P = .005, for trend), but age-stratified prevalence rates were still lower than those reported from previous population-based studies of White persons. After adjusting for age and gender, the presence of retinal emboli was associated with cigarette smoking (odds ratio [OR], 5.96; 95% CI, 1.75 to 20.32), elevated total cholesterol (OR, 5.21; 95% CI, 1.93 to 12.82), low-density lipoprotein cholesterol (OR, 2.98; 95% CI, 1.20 to 7.39), and self-reported history of angina (OR, 5.67; 95% CI, 1.62 to 19.91). These associations remained significant in multivariate analysis with additional adjustment for other risk factors. Retinal emboli are less common in Asians than in similarly aged White persons, but are associated with similar cardiovascular risk factors.

Retinal Signs and Stroke

The retinal and cerebral vasculature share similar anatomic, physiological, and embryological characteristics. We reviewed the literature, focusing particularly on recent population-based studies, to examine the relationship between retinal signs and stroke. Summary of Review- Hypertensive retinopathy signs (eg, focal retinal arteriolar narrowing, arterio-venous nicking) were associated with prevalent stroke, incident stroke, and stroke mortality, independent of blood pressure and other cerebrovascular risk factors. Diabetic retinopathy signs (eg, microaneurysms, hard exudates) were similarly associated with incident stroke and stroke mortality. Retinal arteriolar emboli were associated with stroke mortality but not incident stroke. There were fewer studies on the association of other retinal signs such as retinal vein occlusion and age-related macular degeneration with stroke, and the results were less consistent. Many retinal conditions are associated with stroke, reflecting possible concomitant pathophysiological processes affecting both the eye and the brain. However, the incremental value of a retinal examination for prediction of future stroke risk remains to be determined.

Retinal Arteriolar Cholesterol Emboli

A 59-year-old man with a medical history of hypertension, hyperlipidemia, and coronary artery disease presented with transient, painless visual obscuration in the left eye, and he was referred for retinal evaluation. Two months earlier, he had undergone placement of a stent in the left carotid artery for severe stenosis. He was receiving antiplatelet therapy. Two years earlier, an eye examination had been unremarkable. Retinal examination of the left eye showed multiple, tiny refractile retinal arteriolar cholesterol emboli and a saddle embolus superior to the optic nerve (Panel A, arrow). Two months later, repeat examination showed an increase in the number . . .

Acute Retinal Arteriolar Emboli after Coronary Catheterisation in Cardiac Patients

Acute Retinal Arteriolar Emboli after Coronary Catheterisation in Cardiac Patients

Ocular manifestations of systemic arterial hypertension

Hypertension is a major cause of cardiovascular disease and is also a risk factor for various ocular diseases. Hypertension exerts its effects on the retinal, choroidal and optic nerve circulations. In this article, the various ocular manifestations of hypertension are reviewed. Retinal microangiopathy is strongly associated with blood pressure and risk of cardiovascular diseases, including stroke, cognitive decline and heart disease. Higher blood pressure is an important risk factor for the development and progression of diabetic retinopathy and has also been implicated in the pathogenesis of retinal vein occlusion, retinal artery occlusion, retinal arteriolar emboli and macroaneurysm. Hypertension has also been inconsistently linked with glaucoma and age-related macular degeneration. The management of patients with these ocular conditions should include appropriate assessment and management of hypertension.

Retinal Arteriolar Emboli and Long-Term Mortality

To assess the relationship between retinal arteriolar emboli and mortality in older people. Pooled data from 2 population-based cohort studies. At baseline, the Beaver Dam Eye Study (BDES) examined 4926 persons 43 to 86 years of age (1988 to 1990), and the Blue Mountains Eye Study (BMES) examined 3654 persons 49 to 97 years of age (1992 to 1994). Retinal arteriolar emboli were assessed by grading retinal photographs using standardized methods. Deaths and causes of death were determined from death certificates or Australian National Death Index. Cox regression models were used to estimate mortality hazard ratios (HRs) associated with emboli, adjusting for age, gender, body mass index, hypertension, diabetes, smoking, serum total cholesterol, high-density lipoprotein cholesterol, study site, and past histories of stroke, angina, and acute myocardial infarct. Of 8580 baseline participants, 8384 (98%) had retinal photographs available, and 111 showed retinal arteriolar emboli (BDES n=61; BMES n=50). Over 10 to 12 years, 2506 participants (30%) died, including 344 (4%) from stroke-related and 1315 (16%) from cardiovascular causes. The cumulative mortality rates were higher in participants with than without emboli (all-cause 56% versus 30%; stroke-related 12% versus 4.0%; cardiovascular 30% versus 16%). The increased mortality risk associated with emboli was independent of age, gender, other vascular risk factors, and past histories of stroke or heart disease for all-cause (multivariate-adjusted HR, 1.3; CI, 1.0 to 1.8) and stroke-related mortality (HR, 2.0; CI, 1.1 to 3.8) but not for cardiovascular mortality (HR, 1.2; CI, 0.8 to 1.7). Our pooled data from 2 older populations suggest that retinal emboli predict a modest increase in all-cause and stroke-related mortality independent of cardiovascular risk factors.

Ten-year incidence of retinal emboli in an older population

The prevalence of retinal artery emboli has previously been evaluated in a few studies. The same authors previously reported a 1.4% prevalence of retinal artery emboli in the Australian population. They now report the 10-year incidence of retinal emboli and its predictors in an older population. Survivors of 3654 Blue Mountains Eye Study participants at least 49 years of age were reexamined five and 10 years after inclusion in the study. Incident retinal emboli were assessed from retinal photographs. The authors found that cumulative 10-year incidence was 2.9% (95% CI, 2.1% to 3.6%) among 2361 at risk patients. Age was associated with incident emboli (P trend = .0001). After multivariate adjustment, hypertension (odds ratio [OR], 1.8; CI, 1.0 to 3.1), hypercholesterolemia (OR, 1.3; CI, 1.0 to 1.6), overweight (OR, 3.3; CI, 1.6 to 6.9), current smoking (OR, 2.5; CI, 1.1 to 5.9), increasing fibrinogen level (OR per mg/dL, 1.1; CI, 1.0 to 1.2), and retinal vascular signs (arteriovenous nicking OR, 2.0; CI, 1.2 to 3.6; arteriolar wall opacification OR, 2.3; CI, 1.1 to 5.0; retinal vein occlusion OR, 3.2; CI, 1.0 to 9.9) were significantly associated with incident emboli. The authors conclude that the 3% incidence of retinal arteriolar emboli found in this older population is likely to be an underestimate attributable to the transient nature of emboli and differential loss to follow-up. Most cardiovascular risk factors are associated with retinal embolism.—Valérie Biousse

Ten-Year Incidence of Retinal Emboli in an Older Population

To assess 10-year incidence of retinal emboli and its predictors in an older population. Survivors of 3654 Blue Mountains Eye Study participants > or =49 years of age were re-examined 5 and 10 years later. Incident emboli were assessed from retinal photographs. Cumulative 10-year incidence was 2.9% (95% CI, 2.1% to 3.6%) among 2361 at risk. Age was associated with incident emboli (Ptrend=0.0001). After multivariate adjustment, hypertension (odds ratio [OR], 1.8; CI, 1.0 to 3.1), hypercholesterolemia (OR, 1.3; CI, 1.0 to 1.6), overweight (OR, 3.3; CI, 1.6 to 6.9), current smoking (OR, 2.5; CI, 1.1 to 5.9), increasing fibrinogen level (OR per mg/dL, 1.1; CI, 1.0 to 1.2), and retinal vascular signs (arteriovenous nicking OR, 2.0; CI, 1.2 to 3.6; arteriolar wall opacification OR, 2.3; CI, 1.1 to 5.0; retinal vein occlusion OR, 3.2; CI, 1.0 to 9.9) were significantly associated with incident emboli. The 3% incidence of retinal arteriolar emboli found in this older population is likely to be an underestimate attributable to the transient nature of emboli and differential loss to follow-up. Most cardiovascular risk factors predict retinal embolism.

Cardiovascular Risk Factors for Retinal Vein Occlusion and Arteriolar Emboli: The Atherosclerosis Risk in Communities & Cardiovascular Health studies

To examine the associations of retinal vein occlusion and arteriolar emboli with cardiovascular disease. Population-based cross-sectional study. Pooled from the Atherosclerosis Risk in Communities Study (n = 12,642; mean age, 60 years) and the Cardiovascular Health Study (n = 2824; mean age, 79 years). Retinal vein occlusion and arteriolar emboli were identified from a single nonmydriatic retinal photograph using a standardized protocol. Photographs were also graded for arteriovenous nicking and focal arteriolar narrowing. All participants had a comprehensive systemic evaluation, including standardized carotid ultrasonography. Retinal vein occlusion and arteriolar emboli. Prevalences of retinal vein occlusion and arteriolar emboli were 0.3% (n = 39 cases) and 0.2% (n = 34 cases), respectively. After adjusting for age, retinal vein occlusion was associated with hypertension (odds ratio [OR], 2.96; 95% confidence interval [CI], 1.43-6.14), systolic blood pressure (BP) (OR, 4.12; 95% CI, 1.40-12.16; highest quartile vs. lowest), diastolic BP (OR, 2.64; 95% CI, 1.07-6.46; highest quartile vs. lowest), carotid artery plaque (OR, 5.62; 95% CI, 2.60-12.16), body mass index (OR, 3.88; 95% CI, 1.23-12.18; highest quartile vs. lowest), plasma fibrinogen (OR, 3.29; 95% CI, 1.08-10.02; highest quartile vs. lowest), arteriovenous nicking (OR, 4.09; 95% CI, 2.00-8.36), and focal arteriolar narrowing (OR, 5.17; 95% CI, 2.59-10.29). After adjusting for age, retinal arteriolar emboli were associated with hypertension (OR, 3.14; 95% CI, 1.44-6.84), systolic BP (OR, 3.46; 95% CI, 1.13-10.65; highest quartile vs. lowest), prevalent coronary heart disease (OR, 2.33; 95% CI, 1.01-5.42), carotid artery plaque (OR, 4.62; 95% CI, 1.85-11.57), plasma lipoprotein (a) (OR, 3.69; 95% CI, 1.20-11.41; highest quartile vs. lowest), plasma fibrinogen (OR, 3.09; 95% CI, 0.98-9.76; highest quartile vs. lowest), and current cigarette smoking (OR, 3.08; 95% CI, 1.47-6.47). Approximately a quarter of participants with retinal vein occlusion and arteriolar emboli had evidence of carotid artery plaque as defined from ultrasound. Retinal vein occlusion and retinal arteriolar emboli are associated with carotid artery disease, hypertension, and other cardiovascular risk factors.

Retinal arteriolar emboli: epidemiology and risk of stroke.

Retinal arteriolar emboli can be found in approximately 1% of adults more than 40 years of age. The frequency of retinal emboli increases with age and are more common in men than in women. Bilateral retinal emboli are rare, although multiple emboli in a single eye may be seen in up to one third of cases. Retinal emboli are associated with the presence of carotid artery plaque and stenosis, hypertension, cigarette smoking, and, possibly, diabetes. There are few prospective studies regarding the risk of stroke associated with retinal emboli. Available data suggest that retinal emboli in otherwise asymptomatic people are associated with a higher risk of stroke and stroke mortality, independent of conventional risk factors. Therefore, these patients are likely to benefit from a careful cardiovascular evaluation for risk stratification. Whether carotid ultrasound and other vascular imaging studies should be performed routinely for all patients with asymptomatic retinal emboli remains uncertain.

RETINAL EMBOLI AND STROKE

Objective To describe the prevalence at baseline and the 5-year incidence of retinal emboli, associated risk factors, and the relationship of retinal emboli at baseline to stroke and ischemic heart disease mortality. Methods The Beaver Dam Eye Study is a large (N=4926) population-based study of persons aged 43 to 86 years at the baseline examination. Retinal emboli were detected at baseline (1988-1990) and at a 5-year follow-up (1993-1995) by grading of stereoscopic 30° color fundus photographs using standardized protocols. Cause-specific mortality was determined from death certificates. Results The prevalence of retinal arteriolar emboli was 1.3%, and the 5-year incidence was 0.9%. After adjustments were made for age and sex, the prevalence of retinal emboli was associated with higher pulse pressure, hypertension, diabetes mellitus, past and current smoking, cardiovascular disease, and the presence of retinopathy. After adjustments were made for age and sex, the incidence of retinal emboli was associated with past and current smoking and a history of coronary artery bypass surgery. After age, sex, and systemic factors were controlled for, people with retinal emboli had a significantly higher hazard of dying with a mention of stroke on the death certificate (hazard ratio=2.61, 95% confidence interval=1.12-6.08) than those without retinal emboli. Conclusions Persons with retinal emboli are at an increased risk of stroke-related death. Data also show an association of smoking, hypertension, and cardiovascular disease with the prevalence of retinal emboli. Clinical Relevance Data from this population-based study suggest that after discovery of retinal emboli in the asymptomatic patient, referral for possible medical intervention to control hypertension, if present, may be beneficial.