Retinal vascular features are significantly associated with lacunar infarction in a meta-analysis of 7,277 participants.

This systematic review and meta-analysis investigated the relationship between retinal vascular features and the risk of lacunar infarction. The analysis included a total sample size of 7,277 participants who presented with lacunar infarction and various retinal vascular features. The study setting was not reported. The primary outcome of interest was the occurrence of lacunar infarction. The exposure of interest comprised specific retinal vascular features, including focal arteriolar narrowing, arteriovenous nicking, retinopathy, and venular dilation. No comparator group was explicitly reported in the provided data, as the analysis focused on the association between these features and the condition. The study design is a meta-analysis, which aggregates data from multiple studies to estimate overall effect sizes.

The meta-analysis yielded significant associations between all examined retinal features and lacunar infarction. Focal arteriolar narrowing demonstrated an odds ratio (OR) of 1.77, with a 95% confidence interval (CI) of 1.14 to 2.74 and a p-value of 0.01. The heterogeneity (I) for this outcome was 81%. Arteriovenous nicking showed an OR of 1.70 (95% CI 1.05-2.76, p = 0.03) with an I of 69%. Retinopathy was associated with an OR of 1.99 (95% CI 1.21-3.25, p = 0.006) and an I of 46%. Venular dilation presented an OR of 1.46 (95% CI 1.11-1.93, p = 0.007) with an I of 56%.

No secondary outcomes were reported in the provided data. Consequently, no specific data regarding adverse events, serious adverse events, discontinuations, or tolerability were available for inclusion. The safety profile of the retinal features themselves is not applicable in the traditional sense of drug or device safety, as these are anatomical or physiological markers. The study did not report data on discontinuations or tolerability related to the exposure.

The results suggest a potential link between retinal microvascular pathology and lacunar stroke risk. However, the evidence linking retinal vascular abnormalities to lacunar infarction has been inconsistent in prior literature, which this systematic evaluation sought to clarify. The findings indicate that retinal imaging could serve as a noninvasive biomarker for identifying individuals at risk of lacunar stroke. This approach may offer a practical method for risk stratification in clinical settings where advanced neuroimaging is not immediately available.

Several methodological limitations must be considered when interpreting these results. Heterogeneity ranged from moderate to high across the included studies. Funnel plot asymmetry suggested potential publication bias for focal arteriolar narrowing, arteriovenous nicking, and retinopathy. No significant bias was detected for venular dilation. These biases may influence the magnitude of the observed effect sizes. Furthermore, the observational nature of the data precludes definitive causal conclusions.

Causality has not been confirmed based on this evidence. Future large-scale, prospective studies are needed to confirm causality and improve clinical translation. The current evidence warrants a systematic evaluation but does not support immediate changes in clinical guidelines without further validation. Questions remain regarding the specific mechanisms linking retinal changes to brain infarction and the optimal timing for retinal screening in stroke prevention protocols.

In summary, this meta-analysis provides evidence of a significant association between retinal vascular features and lacunar infarction. While the data supports the utility of retinal imaging as a biomarker, the lack of confirmed causality and the presence of potential publication bias necessitate a conservative approach. Clinicians should recognize these associations as indicators of risk rather than definitive predictors of individual outcome. Further research is essential to translate these findings into actionable clinical strategies.