Retinopathy in Older Persons Without Diabetes and Its Relationship to Hypertension

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Abstract
SEVERE SYSTEMIC hypertension has long been recognized as a cause of various changes in the retinal vasculature of the eye, including flame and blot hemorrhages, microaneurysms, cotton-wool spots, hard exudates, arteriolar narrowing, light reflex changes, and arteriovenous nicking (nipping).1-6 The importance of these signs as a prognostic indicator of damage to other organs, such as the kidney, heart, or brain, was initially provided by the grading system introduced by Keith et al7 in 1939. However, other reports have shown that these retinal signs may also be observed in older people without hypertension and may be related to arteriosclerosis,8-10 carotid disease,11,12 and other less frequent causes such as anemia, vasculitis, irradiation,13 or human immunodeficiency virus infection.14 Extravascular retinopathy lesions of hemorrhages and microaneurysms are best known as the typical signs of diabetes, with the severity of retinopathy related to diabetes duration and the level of glycemic control.15 In the Rotterdam Study, retinopathy was not only associated with blood glucose level in people with diabetes, but a significant association was also found in people without diabetes over the normal range of blood glucose levels.16