Unveiling potential retinal and choroidal markers with SS-OCTA in detecting cerebral small vessel disease.

To investigate the potential retinal and choroidal markers in identifying cerebral small vessel disease (CSVD) through Swept Source Optical Coherence Tomography Angiography (SS-OCTA). Participants were enrolled from the FRESH-CSVD study, and underwent multimodal magnetic resonance imaging (MRI) and SS-OCTA. CSVD patients were identified on multimodal MRI based on STRIVE-2 criteria. SS-OCTA parameters were captured using the VG200I device. The association between SS-OCTA parameters and CSVD imaging features was analyzed based on a least absolute shrinkage and selection operator (LASSO)-derived Logistic regression model. Subgroup analyses were conducted to explore the potentially applicable populations for identifying CSVD through SS-OCTA markers. 170 eyes (101 CSVD patients) were included. Periventricular white matter hyperintensities (PWMHs), enlarged perivascular spaces (EPVS), lacunes and CSVD burden score were all associated with OCTA parameters (all P < 0.05). In the hypertension subgroup, OCTA markers still showed associations with CSVD imaging features (all P < 0.05). SS-OCTA revealed widespread alterations of fundus blood flow in CSVD patients, especially in deep microvasculature. Relationships between SS-OCTA markers and CSVD imaging features were consistent to be detected across hypertensive populations, suggesting the potential for early CSVD screening using SS-OCTA in this population.