title: Differing associations of white matter lesions and lacunar infarction with retinal microvascular signs.
abstract: BACKGROUND
  White matter lesions (WML) and lacunar infarcts (LI) are believed to have microvascular etiologies but the exact microvascular changes occurring in each is unclear.
  
  
  OBJECTIVE
  Using the retina as a proxy, we assessed retinal microvascular changes in WML and LI.
  
  
  METHODS
  We prospectively recruited 1211 acute stroke patients. Four subgroups were identified from neuroimaging: WML alone, LI alone, both WML and LI, neither WML nor LI. Masked retinal photographs identified retinopathy and retinal arteriolar wall signs and measured retinal vascular caliber.
  
  
  RESULTS
  Compared with 448 controls with neither WML nor LI, 384 patients with only WML were more likely to have retinopathy [odds ratio (OR) 1·5, 95% confidence interval (CI) 1·1 to 2·1] and enhanced arteriolar light reflex (OR 1·6, 95% CI 1·1 to 2·3); 200 patients with only LI were more likely to have arteriolar narrowing (OR 1·6, 95% CI 1·1 to 2·3) and enhanced arteriolar light reflex (OR 1·6, 95% CI 1·0 to 2·4); and 179 patients with both WML and LI were more likely to have arteriovenous nicking (OR 1·7, 95% CI 1·1 to 2·6), enhanced arteriolar light reflex (OR 2·0, 95% CI 1·3 to 3·2) and wider venules (OR 2·3, 95% CI 1·4 to 3·6). All analyses were adjusted for age, gender, study site and cardiovascular risk factors.
  
  
  CONCLUSIONS
  Both WML and LI were associated with retinal microvascular signs, supporting a microvascular etiology. Differing patterns of association suggest different mechanisms may predominate, e.g. greater endothelial permeability in WML, and ischemia associated with arteriolar wall disease in LI.
authors.affiliation: Centre for Vision Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia.
authors.forename: Gerald
authors.initials: G
authors.lastname: Liew
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Baker
authors.forename: Tien Y
authors.initials: TY
authors.lastname: Wong
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hand
authors.forename: Jie Jin
authors.initials: JJ
authors.lastname: Wang
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.forename: Deidre A
authors.initials: DA
authors.lastname: De Silva
authors.forename: Meng-Cheong
authors.initials: MC
authors.lastname: Wong
authors.forename: Elena
authors.initials: E
authors.lastname: Rochtchina
authors.forename: Richard I
authors.initials: RI
authors.lastname: Lindley
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Wardlaw
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Hankey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D055806:Microvessels / Q000473:pathology*; D008875:Middle Aged; D011446:Prospective Studies; D012171:Retinal Vessels / Q000473:pathology*; D059409:Stroke, Lacunar / Q000473:pathology*; D066127:White Matter / Q000473:pathology*; D055815:Young Adult