Fluorescein angiography is used to study patients with loss of central vision secondary to hypertensive retinal vascular disease. Narrowing of the retinal arteries, arterioles, and capillary bed is the earliest angiographic feature of systemic hypertension. Angiography may demonstrate multiple focal areas of severe retinal ischemia secondary to focal arteriolar narrowing or occlusion. Dilated retinal capillaries and microaneurysms develop at the margins of these areas, which are typically located around the optic disc or along the major retinal vessels. The macular area is relatively resistant to the ischemia produced by this chronic vessel narrowing. Loss of central vision in hypertensive patients is most frequently due to retinal vascular accidents, eg, hemorrhage, branch artery or vein occlusion.