In the last two decades evidence has gradually accumulated suggesting that the eye may be a unique window for cardiovascular risk stratification based on the assessment of subclinical damage of retinal microvascular structure and function. This can be facilitated by non-invasive analysis of static retinal vessel diameters and dynamic recording of flicker light-induced and endothelial function-related dilation of both retinal arterioles and venules. Recent new findings have made retinal microvascular biomarkers strong candidates for clinical implementation as reliable risk predictors. Beyond a review of the current evidence and state of research, the article aims to discuss the methodological benefits and pitfalls and to identify research gaps and future directions. Above all, the potential use for screening and treatment monitoring of cardiovascular disease risk are highlighted. The article provides fundamental comprehension of retinal vessel imaging by explaining anatomical and physiological essentials of the retinal microcirculation leading to a detailed description of the methodological approach. This allows for better understanding of the underlying retinal microvascular pathology associated with the prevalence and development of cardiovascular disease. A body of new evidence is presented on the clinical validity and predictive value of retinal vessel diameters and function for incidence cardiovascular disease and outcome. Findings in children indicate the potential for utility in childhood cardiovascular disease prevention, and the efficacy of exercise interventions highlight the treatment sensitivity of retinal microvascular biomarkers. Finally, coming from the availability of normative data, solutions for diagnostic challenges are discussed and conceptual steps towards clinical implementation are put into perspective.

在过去的二十年中，逐渐积累的证据表明，基于对视网膜微血管结构和功能的亚临床损伤的评估，眼睛可能是心血管风险分层的独特窗口。这可以通过非侵入性分析静态视网膜血管直径和动态记录闪烁光诱导和内皮功能相关的视网膜小动脉和小静脉扩张来促进。最近的新发现使视网膜微血管生物标志物成为临床实施的可靠风险预测因子的有力候选者。除了对当前证据和研究状态的回顾之外，本文还旨在讨论方法论的好处和缺陷，并确定研究差距和未来方向。首先，强调了心血管疾病风险筛查和治疗监测的潜在用途。本文通过解释视网膜微循环的解剖学和生理学要点，从而对方法学方法进行详细描述，从而提供对视网膜血管成像的基本理解。这有助于更好地了解与心血管疾病的流行和发展相关的潜在视网膜微血管病理学。关于视网膜血管直径和功能对心血管疾病发病率和结果的临床有效性和预测价值，提出了大量新证据。在儿童中的发现表明在预防儿童心血管疾病方面的潜力，运动干预的功效突出了视网膜微血管生物标志物的治疗敏感性。最后，根据规范数据的可用性，讨论了诊断挑战的解决方案，并展望了临床实施的概念步骤。