Retinal Vessel Traits and the Risk of Stroke: The Canadian Longitudinal Study on Aging
In brief
Larger retinal venular area raises 6-year stroke risk by about 70%
In 30,097 older adults, a deep-learning analysis found that each standard-unit increase in retinal venular area was linked to a 71% higher odds of stroke over six years, while wider arterioles reduced risk by 16% and larger arteriolar area cut risk by 38%. Sex modified the effect of vessel tortuosity, suggesting retinal metrics could refine future stroke-prediction tools.
- Journal
- Ophthalmology science (Q1)
- Published
- 23 June 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Alexis O'Neil, Roshan A Welikala, Sarah Barman, Christopher G Owen, Alicja R Rudnicka, Mohan Rakesh, et al.
- PMID
- 42564809
- DOI
- 10.1016/j.xops.2026.101299
Why clinicians should know about it
- Picked for Ophthalmology (top studies of the week, 9 August 2026): High-quality evidence in a top journal
Abstract
PURPOSE: Retinal vascular changes could serve as an early, easily visible indicator of cerebrovascular health. Prior research on retinal vessel traits and stroke has predominantly focused on diameter, while vessel area and tortuosity remain underinvestigated and have yielded inconsistent results. Our goal was to examine longitudinal associations between retinal vessel traits and incident stroke. DESIGN: Prospective cohort study. PARTICIPANTS: Baseline and 6-year follow-up data from the Canadian Longitudinal Study on Aging Comprehensive Cohort (n = 30 097) were used. METHODS: A deep learning algorithm called Quantitative Analysis of Retinal Vessel Topology and Size extracted data from retinal images including arteriolar and venular diameter, area, and tortuosity. Participants were asked if a doctor had previously diagnosed them with stroke. Logistic regression was used to adjust for demographic, lifestyle, and clinical factors. Interactions with sex were also assessed. MAIN OUTCOME MEASURES: Stroke. RESULTS: Having wider arterioles at baseline was associated with lower odds of stroke development over 6 years (odds ratio [OR] = 0.84, 95% confidence interval [CI]: 0.74‑0.95). Having larger venular area was associated with a higher odds of developing stroke (OR = 1.71, 95% CI: 1.11‑2.63), whereas larger arteriolar area showed the inverse association (OR = 0.62, 95% CI: 0.44‑0.86). Statistically significant interactions were found between sex and both arteriolar and venular tortuosity (P < 0.05). CONCLUSIONS: This study confirms that retinal vessel area and stroke are associated. Vessel area and arteriolar width are associated with the development of stroke, which may help to develop stroke prediction models in the future. FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.