Use of retinal ischemic perivascular lesions (RIPLS) as a biomarker for cardiovascular disease – a systematic review and meta-analysis

This study aims to evaluate the association between retinal ischemic perivascular lesions (RIPLs) detected by optical coherence tomography (OCT) and the risk of all-cause cardiovascular morbidity. A systematic review and meta-analysis were performed. PubMed MEDLINE, Scopus, and Cochrane CENTRAL were searched for observational studies from January 2015 to March 2025 assessing RIPLs and cardiovascular disease (CVD). Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Of 61 studies screened, six met inclusion criteria and four were included in the meta-analysis (total n = 710). The pooled OR for CVD morbidity associated with RIPLs was 2.8 (95% CI: 1.98–3.95), indicating over a twofold increased risk. Heterogeneity was minimal (I² = 0%). RIPLs detected by OCT are significantly associated with increased cardiovascular risk. Due to OCT’s non-invasive and accessible nature, RIPLs may be a useful screening biomarker for early detection of CVD.