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Cerebral white matter lesions, retinopathy, and incident clinical stroke

Tien Yin Wong1, Ronald Klein, A Richey Sharrett

  • 1Department of Ophthalmology, University of Wisconsin, Madison, USA. ophwty@nus.edu.sg

JAMA
|July 2, 2002
PubMed
Abstract

Insights

White matter lesions (WMLs) linked to retinal abnormalities increase stroke risk in middle-aged adults. Early detection of WMLs and retinopathy may help predict and prevent clinical stroke.

Area of Science:

  • Neurology
  • Ophthalmology
  • Vascular Medicine

Background:

  • White matter lesions (WMLs) on brain scans are suspected to stem from microvascular issues and precede stroke.
  • Limited clinical data exist to confirm the microvascular origin of WMLs and their predictive value for stroke.

Purpose of the Study:

  • To investigate the association between WMLs, retinal microvascular changes, and the incidence of clinical stroke.
  • To analyze these relationships in a cohort of healthy, middle-aged individuals.

Main Methods:

  • Utilized data from the Atherosclerosis Risk in Communities Study (ARIC), a prospective, population-based cohort.
  • Included 1684 participants aged 51-72 years who underwent cerebral MRI and retinal photography.
  • Assessed WMLs via MRI and retinal abnormalities, correlating them with incident stroke over a median 4.7-year follow-up.

Main Results:

  • Individuals with retinopathy showed a higher likelihood of WMLs (OR, 2.5).
  • The 5-year stroke incidence was elevated in those with WMLs (RR, 3.4) and retinopathy (RR, 4.9).
  • A significantly higher stroke risk was observed in individuals with both WMLs and retinopathy (RR, 18.1) compared to those with neither.

Conclusions:

  • Cerebral WMLs in middle-aged individuals are associated with retinal microvascular abnormalities.
  • The presence of WMLs independently increases the risk of clinical stroke.
  • Concomitant WMLs and retinopathy markedly elevate stroke risk, underscoring the link between cerebrovascular and retinal health.

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