Ultra-widefield OCTA assessment of retinal and choroidal microcirculation in cerebral small vessel disease

This cross-sectional study investigated widefield retinal and choroidal structure, as well as three-dimensional vascular density-including the choroidal vascularity index (CVI), choroidal stromal volume (CSV), and choroidal vascular volume (CVV)-in patients with cerebral small vessel disease (CSVD). A total of 40 CSVD patients (66 eyes) and 30 healthy controls (53 eyes) underwent magnetic resonance imaging (MRI) and comprehensive ophthalmic examinations, which included ultra-widefield (UWF) swept-source optical coherence tomography angiography (SS-OCTA) for quantitative retinal and choroidal assessment. After adjusting for confounders, generalized estimating equation models revealed that choroidal thickness and CVI in the nasal-superior quadrant, nasal quadrant, inferior quadrant and nasal-inferior quadrant were independently and inversely associated with CSVD risk. Superficial and deep vascular complexes in the inferior and nasal-inferior quadrants showed similar inverse associations, indicating that nasal and inferior quadrants of both the retina and choroid are most strongly linked to CSVD risk. With increasing CSVD burden, choroidal stromal and vascular volume reduction progressed from localized to global involvement. These findings collectively indicate that the choroid may serve as an accessible window for evaluating cerebral microvascular health, with UWF SS-OCTA offering potential for detecting and monitoring CSVD-related alterations.