Microvascular Diseases of the Eye: Retinal Vasculature as a Cardiometabolic Biomarker

Microvascular disease of the eye encompasses both structural and functional changes to the retinal vessels. Cardiometabolic disorders, such as hypertension and diabetes, are associated with early, measurable abnormalities in the retinal microvascular network that often emerge before cardiovascular disease becomes detectable. These features can be directly, noninvasively assessed with a multitude of evolving imaging techniques. Furthermore, these vascular changes can be used to predict future cardiac events, making them promising biomarkers for systemic disease. Early detection is essential, as retinal microvascular pathology not only reflects systemic health but, in certain conditions, can be detrimental to vision. Therefore, clinical evaluation requires a combination of ocular-specific strategies and a focus on underlying metabolic risk factors. As screening techniques advance, integrating assessment of the ocular microcirculation into broader cardiovascular care may become increasingly valuable.