Ophthalmic artery doppler in screening for preeclampsia - a systematic review of current evidence

Preeclampsia (PE) complicates 2-15% of all pregnancies and continues to be a leading cause of maternal morbidity and mortality. The incidence is about three times higher in multiple gestations compared to singleton pregnancies. Early identification of women at high risk for PE is crucial; first-trimester screening has become a standard component of prenatal care. This systematic review aims to summarize current evidence on the role of ophthalmic artery Doppler (OAD) in predicting PE among singleton and twins. Recent research has enabled the development of algorithms for PE prediction based on maternal factors, medical history, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), and placental growth factor (PLGF). Within OAD parameters, the elevated PSV2/1 ratio has been consistently observed in women who later developed PE compared with normotensive pregnancies. OAD PSV ratio is widely used as a prediction tool for PE. In contrast, the pulsatility index (PI), resistance index (RI), and end-diastolic velocity (EDV) demonstrated limited predictive ability and contributed minimally to overall model performance. Integration of OAD parameters into established multimodal screening models may improve predictive accuracy for PE. OAD is a potentially cost-effective, accessible, and technically feasible modality that may support risk stratification, particularly in settings with limited access to biochemical testing. However, further large-scale prospective studies are needed to validate its clinical utility, standardize assessment protocols, and determine its role in routine PE screening algorithms.