What is Hypertensive Retinopathy & How is it Treated?| Causes, Symptoms, Stages, and Complications of Hypertensive Retinopathy

Hypertensive retinopathy is an eye condition occurring in people with high blood pressure. It is a progressive condition that can lead to vision loss.⁽¹⁾

High blood pressure causes damage to the blood vessels of the retina and can lead to vision loss. 1 in 4 people in the United States with high blood pressure is at risk of developing various health conditions amongst which hypertensive retinopathy is one.⁽²⁾

Hypertension is the main cause of hypertensive retinopathy. In a person with high blood pressure, the blood is pumped out of the heart into the arteries. The force with which the blood is pumped into the arteries is very high. As a result, the blood flows throughout the body with much pressure. The arteries and the blood vessels can get damaged over time.

The risk factors for hypertensive retinopathy include:

• Kidney disease
• High blood pressure
• High cholesterol
• Heart disease
• Smoking
• Diabetes
• Being overweight or obese
• Alcohol misuse
• Eating highly processed foods and salts
• Atherosclerosis

The symptoms of hypertensive retinopathy do not develop until the condition has reached later stages. The common symptoms of diabetic retinopathy include:

• Swollen eyes
• Headaches
• Vision problems
• Burst of blood vessels in the eye

If a person with high blood pressure experiences a sudden vision change, emergency help should be taken.

Grading of hypertensive retinopathy is done in various ways, some of which include the following.

Keith Wagener Barker is one of the classification systems of hypertensive retinopathy and correlates the condition with hypertension severity.

• Grade 1: This grade involves slight narrowing of the retinal arteries
• Grade 2: Here the narrowing grows further and is termed arteriovenous nicking
• Grade 3: This grade involves the symptoms of grade 2 plus the hemorrhage of the retina. There may be an appearance of fluffy white areas, cotton wool spots, and exudates. The exudates are the lipids and protein materials that leak out in the retina.
• Grade 4: This includes grade 3 plus optical disc swelling. There are severe vision problems. Such individuals are also at risk of heart disease and kidney diseases.

In Scheie classification, two main components are included, the staging of hypertensive retinopathy similar to KWB grades along with the staging of atherosclerosis.

Atherosclerosis is a condition in which the arteries harden or thicken.

• Stage 0: In this, there are no abnormalities.
• Stage 1: There is a widening of light reflex from the surface of the retina, which is the light reflected from the center of the retina.
• Stage 2: In this stage, there is stage 1 plus the arteriovenous crossing sign. It is a pattern where the arterioles cross the veins.
• Stage 3: In this stage, arterioles appear as copper wires.
• Stage 4: Here the arterioles appear as silver wires.

It involves a 3-grade classification system that may be easier for doctors to use.

• Mild: It includes arteriolar narrowing, arteriovenous nicking, and copper wiring of arterioles.
• Moderate: It includes retinal hemorrhage, cotton wool spots, or leaking from the retina.
• Malignant: It includes moderate signs of retinopathy along with optic disc swelling.

For diagnosing hypertensive retinopathy, an ophthalmologist performs routine check-ups, fundoscopic examinations, retinal imaging, and other exams.

An ophthalmoscope is used to shine light through the pupil and examine the back of the eye and retina. This is done to check the health of blood vessels and check the signs of narrowing and fluid leaking.

Fluoroscopic angiography is used to check the flow of blood to the retina. It involves taking images of the back of the eye, using medicated eye drops to widen the pupil, and using a dye called fluorescein that is injected into the arm.

The treatment of hypertensive retinopathy involves medications and lifestyle changes.

The medications are given to lower the blood pressure that may be causing damage to the retina. The medications include:

• ACE inhibitors
• Diuretics
• Beta-blocker

If there is severe hypertensive retinopathy, the reverse of the condition is not possible. A person may have permanent vision loss.

Lifestyle changes may be recommended to maintain moderate blood pressure. The changes may include:

• Reducing salt intake
• Quitting smoking
• Taking regular exercise
• Eating a well-balanced diet

Individuals with hypertensive retinopathy may develop complications, which include:

• Ischemic Optic Neuropathy: This condition occurs when due to high blood pressure the blood flow to the eyes is affected which damages the optic nerve.
• Retinal Artery Occlusion: It is a condition in which the blood vessel carrying blood to the retina gets blocked. This can damage the retina and may lead to vision loss.
• Nerve Fiber Layer Ischemia: This condition involves damage to the nerve fibers that result in the appearance of cotton wool spot images on the retina.
• Malignant Hypertension: It is a rare life-threatening condition of hypertensive retinopathy. It has a sudden occurrence and leads to vision loss.

People with hypertensive retinopathy are also at an increased risk of stroke. A study was done on people with age between 50-73. It was found that those with hypertensive retinopathy had a higher risk of stroke.⁽³⁾

The outlook for a person with hypertensive retinopathy depends on the extent or stage of the condition. People with higher grades have reduced outlook as they are associated with stroke, heart problems, and death. Early treatment can halt further retinal changes. But, if there is severe damage to the retina, it may be irreversible.