In a recent scientific publication, several researchers from the RHU SHIVA programme, including Professor Stéphanie Debette, Omics VBHI referent, demonstrated similarities between retinal microvascular features and signs of cerebral small vessel disease visible on magnetic resonance imaging (MRI). This represents real hope for the early, cost-effective diagnosis of this disease on a large scale.
Background
Cerebral small vessel disease refers to damage affecting very small blood vessels in the brain. It can be detected using brain MRI. However, MRI scans are costly and difficult to deploy on a large scale.
We know that blood vessels in the eye located in the retina share many characteristics with those in the brain. For this reason, researchers investigated whether retinal images could serve as indicators of the condition of cerebral blood vessels.
Methods
The researchers first studied older adults from the French 3C-Dijon cohort.
- A brain MRI scan was performed at the start of the study.
- Ten years later, retinal photographs were taken to measure the shape and diameter of small retinal blood vessels.
They then:
- analysed all published scientific studies on the topic;
- used a genetic method known as Mendelian randomisation to assess whether there is a causal link between retinal vessel characteristics and cerebral small vessel disease.
Results
Among 670 participants (average age: 70 years):
- Certain features of retinal arterioles — in particular reduced complexity of the vascular network — were associated with more severe cerebral small vessel disease visible on MRI.
- Other signs, such as narrower arteriolar diameter or increased curvature of retinal venules, were also linked to MRI markers of the disease.
- Reduced complexity of the arteriolar network was associated with poorer performance in executive functions (organisation, concentration, planning).
Analyses of the scientific literature (nearly 8,000 individuals in total) showed similar findings. Genetic analyses also suggested that increased tortuosity of retinal venules may directly contribute to abnormalities observed in the brain.
Conclusion
Taken together, these results show that the shape and structure of small retinal blood vessels may reflect the condition of small blood vessels in the brain. This opens up promising prospects for earlier detection of cerebral small vessel disease using a simple, non-invasive eye examination that is more accessible than MRI.
Scientific publication: Arnould L, Soumaré A, D’Aoust T, Lima Rebouças SC, Bordes C, Crivello F, Korobelnik JF, Paques M, Sargurupremraj M, Mishra A, Zhu YC, Delcourt C, Helmer C, Khawaja A, Hysi P, Binquet C, Creuzot-Garcher C, Debette S. Retinal Microvascular Correlates of Cerebral Small Vessel Disease in Older Age. Neurology. 2025 Nov 11;105(9):e214251. doi: 10.1212/WNL.0000000000214251. Epub 2025 Oct 17. PMID: 41105908; PMCID: PMC12539934. https://www.neurology.org/doi/pdf/10.1212/WNL.0000000000214251
