"Your blood vessels look excellent;  no hardening of the arteries, no cholesterol plaques, and no leaky capillaries.  And if your retinal vessels look this good, we know the rest of your body is likely having great blood flow as well."  I said.

"You mean the blood vessels in my eye will tell you about the rest of my body?  I never realized that!"

My patient left happy and amazed that she was getting such a thorough check up, but it took me a second to recover from the surprise that this was the first year that we had made such a connection between her eye and her systemic health.  She had been getting retinal photos for years, and never before really seen the true value; your doctor is looking at the health of your eye, but they are more importantly checking the health of your entire body by using the eye as a window inside.

Not surprising to optometrists and other health care professionals, but a new study out this month published in Hypertension reports that there is a strong correlation between hypertensive retinal changes and the risk for stroke.  Retinal photographs were tracked over a course of 13 years, and the results were as follows:

• Mild Hypertensive Retinopathy (early changes like hardening of the arteries) had a 35% increased risk for stroke
• Moderate or Severe Hypertensive Retinopathy (like bleeding inside the eye) had a 137% increased risk for stroke

AGE RELATED MACULAR DEGENERATION

This is a photo of a caucasian female with early dry macular degeneration.  The macula (dark central vision area) shows evidence of 'soft' drusen, which appear as large yellow deposits in the macula in this photo. At this point, her vision is still correctable to 20/20, so we have found the disease in its earliest stages and can hopefully prevent progression.

BRANCH RETINAL VEIN OCCLUSION

All that blood and swelling in the superior retina is definitely not a good finding.  Note how close the bleeding is to the macula.  This patient did require ocular injections to treat the residual macular edema.

FLAME HEMORRHAGE

If you look closely at the inferior area of the photo, you can see a faint red area that is really an old, resolving hemorrhage.  This patient ended up having normal blood pressure and no other systemic issues, but there was obviously some incident in his past that had damaged the retinal arteriole.  Hemorrhages typically resolve in 3 months after their initial onset, and this one is definitely in the process of being absorbed by the surrounding tissue and vanishing.  Future photos will likely look entirely normal.  High blood pressure or an incident of high strain (like heavy lifting or even coughing) can cause a hemorrhage like this.

CHOROIDAL NEVUS and SCATTERED DOMINANT DRUSEN

Two things going on in this photo, but both are normal findings.
1) The darker area in the top of the photo is a freckle, or technically a "choroidal nevus".  These nevi are very common, and unless they show signs of growing or having elevation, are typically perfectly harmless.
2) The yellow deposits are also calcified drusen.  These "hard" drusen are benign, and are typically found in both eyes if a person has them.  I always discuss family history of macular degeneration with my drusen patients, but a retina like this is still considered normal.