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November 2008

The Retina as a Window to the Brain

Arch Neurol. 2008;65(11):1547-1548. doi:10.1001/archneur.65.11.1547

We read with interest the article titled “Seven-Tesla Magnetic Resonance Imaging: New Vision of Microvascular Abnormalities in Multiple Sclerosis” by Ge et al.1 We commend the authors for reporting these novel findings, which may have relevance to microvascular signs observed in the retina.

It would be useful for Ge and colleagues to describe the retinal neurovascular appearances for the 2 patients. If retinal venular abnormalities were noted, we would suggest that they are an accessible and cost-effective marker of neurovascular dysfunction. Peripheral retinal vascular sheathing is a well-recognized feature of multiple sclerosis (MS) and may be overlooked during the neurological examination in MS. Similarities to the findings by Ge and colleagues might suggest a shared vascular pathogenesis between the eye and the brain in MS. Insights into MS pathogenesis may be revealed from closer retinal inspection and image analysis of retinal vasculature.2 These may complement cranial magnetic resonance imaging (MRI) studies in elucidating the natural history and the neurovascular and retinal clinical correlates of vascular changes in MS. Optical coherence tomography, a noninvasive imaging tool, and brain imaging by MRI using SIENA-X (http://www.fmrib.ox.ac.uk/fsl) have demonstrated an association between retinal nerve fiber layer thickness and brain parenchymal fraction.3 Extending the link between brain and retinal vasculature might be achieved by using wide-field retinal imaging with fluorescein angiography in tracking subclinical retinal vascular endothelial dysfunction.4