Ophthalmic features in stroke patients: a systematic review of imaging studies

PURPOSE: Stroke is a leading cause of morbidity and mortality. Ophthalmic imaging offers non-invasive, low-cost assessment of microvascular and neuronal structures which can provide insights into cerebrovascular health and disease. In this review, we sought to explore ophthalmic imaging features associated with a stroke, with a view to offering insights into the ocular features evident in stroke patients, what the significance of these may be, and to highlight research gaps requiring further attention.

METHODS: A literature search was conducted using the PubMed, Embase, and Web of Science databases to identify studies that assess retinal imaging features in stroke patients.

RESULTS: We found that individuals with stroke differ significantly from controls with respect to several neuroretinal and retinal vascular traits ascertained using color fundus photography, optical coherence tomography (OCT), and OCT angiography. Key differences include thinner retinal nerve fiber layer and ganglion cell layer, reduced vascular density, increased venular widths, decreased arteriolar widths, and morphological changes to the foveal avascular zone. Unlike in stroke prediction, where ophthalmic imaging features have been shown to have clear potential roles, we found there has been little consideration given to implications such findings may have in subjects with an established diagnosis of stroke.

CONCLUSIONS: Stroke is associated with several ophthalmic imaging features which are likely to reflect the direct effects of stroke itself, for instance via transneuronal retrograde degeneration of retinal neuronal structures, as well as shared pathophysiological processes in the retina and brain in those with stroke. The implications of these findings in stroke care and tertiary prevention have currently received little attention and warrant further study.