Hypertension is a serious global health problem.
Hypertensive retinopathy is generally considered to be a predictor of
vascular disease elsewhere in the human body. In the past few decades, a variety of grading systems have been proposed for
hypertensive retinopathy. However, these grading systems have some limitations. This study utilized optical coherence tomography angiography (OCTA) to investigate the morphological changes and macular
retinal microvasculature in depth among 100 patients with
hypertensive retinopathy and 66 healthy participants. Five main pathological changes were discovered in
hypertensive retinopathy, as follows: focal capillary sparsity, scattered microangioma, focal macular arch ring defects, focal capillary disorder, and focal capillary nonperfusion at the levels of the superficial and deep vascular networks. In addition, we have found that the number of various pathological changes shows an increasing trend as
hypertensive retinopathy progresses and may be related to renal damage. Finally, deep vessel density tended to decrease with progressive stages of
hypertensive retinopathy and could be the best
indicator to predict the risk of
hypertensive retinopathy. Our study, therefore, proposes 3 stages of
hypertensive retinopathy without
macular edema according to the pathophysiology found by OCTA: stage 1 (only focal capillary sparsity), taking the place of KWB grade I; stage 2 (focal capillary sparsity and scattered microangioma), taking the place of KWB grade II; and stage 3 (focal capillary sparsity, scattered microangioma, focal capillary disorder, and nonperfusion), taking the place of KWB grade III. Hence, OCTA may be a potentially useful tool for evaluating the pathophysiology and staging of
hypertensive retinopathy. Further longitudinal prospective studies are needed to confirm our findings.