Retinal vascular and structural changes in men with erectile dysfunction: a systematic review

To characterize evidence on whether men with erectile dysfunction (ED), particularly vasculogenic ED, demonstrate retinal or choroidal microvascular differences compared with controls.

Comprehensive searches of MEDLINE, Embase, CENTRAL, and Web of Science identified studies assessing ocular microvascular outcomes in adult men with clinically diagnosed ED. Eligible imaging modalities included optical coherence tomography (OCT), OCT angiography (OCT-A), fundoscopic exam, and dynamic vessel analysis (DVA). Two reviewers performed screening, data extraction, and risk-of-bias assessment. Owing to heterogeneity in study design and reported outcomes, findings were synthesized qualitatively and through quantitative exploratory analysis.

Nine studies comprising 1,924 participants (1,381 with ED) met inclusion criteria. Fundoscopic studies suggested a variably higher prevalence of retinal vascular abnormalities in men with ED, with weaker associations in diabetic populations. In contrast, non-diabetic vasculogenic ED cohorts showed more specific associations with early retinal vascular changes. OCT-A studies reported reduced vessel density in both superficial and deep capillary plexuses. Structural OCT identified thinning of the small choroidal vessel layer (inner choroid excluding Haller's layer) in non-diabetic ED patients. DVA demonstrated impaired arterial dilation, and vessel caliber studies reported alterations in retinal arteriolar and venular diameters across men with ED.

Current evidence suggests a possible association between vasculogenic ED and retinal microvascular alterations, but the underlying data are limited, heterogeneous, and confounded by shared vascular risk factors. These findings should be considered hypothesis-generating and are not yet sufficient to support clinical application. Standardized, longitudinal studies are needed to clarify temporal and causal relationships.