Our diagnostic approach to suspected cerebrovascular disease is quite simple. Concerning neurologic findings or history? Magnetic resonance imaging.
However, this approach is grossly inefficient – and, thus, the rise of various clinical scores such as the ABCD2 variants. And, now, ocular fundus photography. It generally makes sense – the retinal vessels travel through the optic nerve sheath. They are, then, a unique window into the cerebrovascular circulation – and, accordingly, the degenerative diseases within.
It sort of works.
Looking at patients presenting to the ED with a report of focal neurologic deficits, the multivariate regression OR for cerebrovascular disease in patients with arterial narrowing in 2 segments is reported as 8.1 for stroke and 5.1 for TIA. However, this finding was only present in 4 of 22 (18%) stroke patients and 6 of 59 (10%) TIA patients – compared with 5 of 176 (3%) patients who did not receive a diagnosis of cerebrovascular disease.
So, yes – it is probably true, as the authors claim, that finding arterial focal narrowing in the retinal vessels increases the likelihood of cerebrovascular disease (stroke and TIA). But, clearly, the positive predictive value is still quite low, and the number of patients for whom this ocular photography adds substantially to the diagnosis is quite small. At ~$25,000 a pop for the camera system, and the need for a specialist to screen the images for abnormalities, I do not share these authors’ enthusiasm for its eventual adoption into clinical practice.
“Ocular fundus photography of patients with focal neurologic deficits in an emergency department”
http://www.ncbi.nlm.nih.gov/pubmed/26109710