Analysis of data on 540 hypertensive patients grouped according to the retinal criteria of Keith, Wagener, and Barker and followed for at least 20 years, or until death, showed that (1) the survival rate in each ophthalmoscopic group was less than that expected in a normal population of the same age and sex distribution, and was poorer for men than for women, (2) there was a definite relationship between severity of retinal changes (ophthalmoscopic grouping) and survival rate and incidence of cardiac and renal complications of hypertension, and (3) for any given level of diastolic blood pressure the prognosis worsened with increase in severity of retinal changes (from lower to higher ophthalmoscopic grouping). It is concluded that changes in the optic fundi remain the simplest, most practical, and most accurate guide to prognosis in hypertension, with or without complications.
Breslin DJ, Gifford RW, Fairbairn JF, Kearns TP. Prognostic Importance of Ophthalmoscopic Findings in Essential Hypertension. JAMA. 1966;195(5):335-338. doi:10.1001/jama.1966.03100050043015