Using Artificial Intelligence to Analyse the Retinal Vascular Network: The Future of Cardiovascular Risk Assessment Based on Oculomics? A Narrative Review

The healthcare burden of cardiovascular diseases remains a major issue worldwide. Understanding the underlying mechanisms and improving identification of people with a higher risk profile of systemic vascular disease through noninvasive examinations is crucial. In ophthalmology, retinal vascular network imaging is simple and noninvasive and can provide in vivo information of the microstructure and vascular health. For more than 10 years, different research teams have been working on developing software to enable automatic analysis of the retinal vascular network from different imaging techniques (retinal fundus photographs, OCT angiography, adaptive optics, etc.) and to provide a description of the geometric characteristics of its arterial and venous components. Thus, the structure of retinal vessels could be considered a witness of the systemic vascular status. A new approach called "oculomics" using retinal image datasets and artificial intelligence algorithms recently increased the interest in retinal microvascular biomarkers. Despite the large volume of associated research, the role of retinal biomarkers in the screening, monitoring, or prediction of systemic vascular disease remains uncertain. A PubMed search was conducted until August 2022 and yielded relevant peer-reviewed articles based on a set of inclusion criteria. This literature review is intended to summarize the state of the art in oculomics and cardiovascular disease research.