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Editors Selection IGR 25-4

Risk Factors: Blood pressure and IOP both shape retinal vessel calibre over time

Comment by Luís Abegão Pinto on:

126531 Longitudinal associations of retinal vessel morphology with intraocular pressure and blood pressure at follow-up visit-Findings from a Danish eye and vision cohort, Project FOREVER, Freiberg J; Welikala R; Rovelt J et al., Acta Ophthalmologica, 2025; 103: 33-42

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Freiberg and colleagues report on 2089 participants (mean age 61 years, 62% female) from the FOREVER cohort, followed for a mean of 4.1 years with repeated ocular and systemic measurements. Using automated QUARTZ analysis of retinal images, the study demonstrates that blood pressure (BP) and intraocular pressure (IOP) are independently associated with subtle yet measurable vascular changes.

At follow-up, a 10 mmHg increase in systolic BP was associated with a −0.13 pixel reduction in arteriolar width (95% CI −0.17 to −0.09; p < 0.001). Similarly, higher IOP at follow-up related to increased arteriolar tortuosity above baseline (0.59%, 95% CI 0.08–1.10; p = 0.024). These findings are modest in magnitude but biologically plausible, reflecting microvascular remodeling under systemic and ocular pressure load. The longitudinal design strengthens inference compared to prior cross-sectional studies and highlights vascular morphology as a dynamic, rather than static, biomarker.

The study population—middle-aged to older adults undergoing routine optician-based examinations—enhances translational relevance. Retinal vasculometry, if standardized across platforms and populations, could emerge as a scalable biomarker for both ocular and systemic vascular disease surveillance. The reported correlations between baseline and follow-up vessel diameters (r = 0.44–0.55) indicate stability but also leave room for identifying clinically meaningful progression thresholds.

Limitations include the use of non-contact tonometry and restricted ethnic diversity, which may limit generalizability. Nevertheless, this study provides strong evidence that changes in retinal vessel morphology track with vascular load, aligning with previous large-scale epidemiological reports linking retinal vasculature to systemic cardiovascular risk.

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